‘Instruments of choice’: The ever-changing combination of COVID variants means treatments are getting less and less effective this fall

The pandemic may have ended in the minds of some. But like it or not, COVID is breaking out into a downward wave — one that could be fueled by multiple variations, experts say, as the virus mutates and spreads exponentially.

The Institute of Health Metrics and Evaluation at the University of Washington and other experts, including Dr. Anthony Fauci, the nation’s top infectious disease expert, predict a wave that begins in late October and peaks in late December. or January.

According to the IHME, it could kill another 20,500 Americans.

While the coming wave could be caused by multiple variations, they may start to look more and more alike as they morph to become more efficient — and follow the same path to it.

Dr Raj Rajnarayanan, associate dean for research and associate professor at the New York Institute of Technology campus in Jonesboro, Ark., said the wave could be made by a variant. Luck this week.

“But if you look closer, they probably have the same set of mutations.”

And they can all end up with the same disastrous result: rendering current COVID countermeasures like drugs and vaccines helpless.

Reproduction of Centaurus

Omicron spawned BA.2.75, dubbed “Centaurus,” which seems like the COVID variant to watch this summer—a potentially devastating variant later in the year.

But Centaurus is no longer a concern, according to Rajnarayanan. Instead, one of its children, BA.2.75.2, overcame it, dismissing it as a threat — but replacing it with another.

Fauci this week is called BA.2.75.2 “suspicious” variant, where it is likely to develop into a disturbing variation for the fall.

In Rajnarayanan’s book, it is the most formidable of the growing strains because its mutant protein — a feature that allows it to enter cells — binds more closely to human cells. than any other variant. Doing so makes it harder for the antibodies to successfully attack.

This variant is collecting mutations that make it similar to the globally dominant BA.5, and the Delta variant that died in late 2021. And it’s just “a few mutations that avoid increasing transmission speed,” Rajnarayanan speak.

To make matters worse, the new variant shows the ability to “escape wide”, according to new preprint paper released this week by researchers at Imperial College in London and the Karolinska Institute in Sweden.

The paper, which has not been peer-reviewed but has been widely cited by experts, calls the variant “the most neutralizing resistance variant evaluated to date” and says it can evade antibody-based immunity. effectively, built up by prior vaccination and infection.

The Wheel of a Heavyweight Champion

Another big competitor: Omicron spawns BF.7. It is a variant of the globally dominant strain BA.5, which has been culled for three generations.

The new sub-variant that features a mutation in the mutant protein seen in other Omicron strains is making progress. It also has a change in the nucleotide sequence—sometimes mentioned like an organism’s blueprint — can make it behave differently from other sub-organisms, said Dr. Stuart Ray, vice president of medicine for data integrity and analytics at the Johns Hopkins Department of Health, said Luck this week.

Scientists are paying attention to BF.7 because it is evolving in an increasingly crowded field of Omicron subvariables.

“The same growth advantage in many countries makes it logical to think that BF.7 is firmly established,” says Ray.

Convergent Evolution & ‘Frankenvirus’

There are many other candidates, including BQ.1.1. Rajnarayanan says this variant is working with BA.2.75.2 to lead the wave this fall.

The big players are starting to realize identical beneficial spikes as they try to gain the upper hand over their opponents, according to Rajnarayanan. Some mutations offer advantages such as increased transmissibility, while others make it more difficult for the human immune system – as well as treatments and vaccines – to fight them. .

Variants that collect multiple mutations are common — and more and more likely to be of interest to have multiple identical mutations.

“Ultimately all variants can look the same to a degree of spike,” says Rajnarayana.

Variant hunters are also keeping an eye on recombinants — the combination of many variants that form “Frankenviruses.”

A Rajnarayanan and others are watching: XBB, the union of two different Omicrons. It’s not currently a contagion concern, but “perhaps it’s the best kind of immune evasion” – even more so BA.2.75.2 is on the rise, potentially immune evasion. more than BA.5 dominating the globe, the most evasive immunity until recently.

It’s a disturbing pattern that has the potential to reduce the effectiveness of COVID treatments, acknowledged this week by World Health Organization officials — and even vaccines. In the worst case scenario, variants that increasingly evade immunity can render them completely ineffective.

BA.2.75.2 is being watched for potential exit Immunity is provided by the last antibody drug that is effective on all variants: Bebtelovimab. It is used for people who are at high risk of severe COVID-19 outcomes.

According to one preprinted Updated Friday by Yulong Richard Cao, an Assistant Professor at Peking University’s Biomedical Pioneer Center in China, and others, BQ.1.1 beat it. The variant escapes immunity from Bebtelovimab, as well as another antibody drug that works against only some variants.

“The rapid and simultaneous emergence of variants with enormous advantages is unprecedented,” Cao and others write in the paper.

It’s unclear how well the new Omicron boosters will counter upcoming variants. But Cao’s paper notes that herd immunity and boosters may not protect against new bacterial strains. It spurs the rapid development of broader COVID vaccines and new antibody drugs, and encourages researchers to test them against recombins they create in the lab, aiming to evaluate their effectiveness ahead of time.

Rajnarayanan worries about the future of COVID countermeasures and, like WHO officials, urges countries to continue testing and genetic sequencing of samples. They assumed that was the only way to know what was going to happen. Ideally, such knowledge would allow researchers to scramble to create new countermeasures or update old ones as needed.

“We used to say we had the tools,” he said. “Instruments are being selected.”

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