This is an ominous sign if, as experts predict, there is a new global wave of COVID in the coming months. It’s one thing to deal with an increase in infections that lead to mostly mild illness. Cases are increasing, but hospitals and deaths are not. But an increase in serious illnesses could also lead to an increase in hospitalizations and deaths. It could be like 2020 or 2021, all over again. The big difference is that we now have easy access to safe and effective vaccines. And vaccines still work, even against the new subvariants. A new study from Ohio State University is the first red flag. A team led by Shan-Lu Liu, co-director of HSU’s Viruses and Emerging Pathogens Program, modeled new subvariants of SARS-CoV-2, including BQ.1 and its close cousin, BQ.1.1. The team confirmed what we already knew: BQ.1 and other new subvariants, most of which are descendants of the BA.4 and BA.5 forms of the Omicron variant, are highly contagious. And the same mutations that make them so contagious also make them unrecognizable by the antibodies produced by monoclonal therapies, rendering those therapies useless. That should be reason enough to pay close attention as BQ.1 and its cousins compete with BA.4 and BA.5 and become dominant in more countries and states. But then Liu and his colleagues also checked for the “co-relativeness” of the subvariants. That is, how well they merge with our own cells. “Fusion between viral and cell membrane is an important step of viral entry,” Liu told The Daily Beast. In general, the greater the fusion, the more severe the disease. Liu and his colleagues “observed increased cell fusion in several new Omicron subvariants compared to their respective parental subvariants,” they wrote in their study, which appeared online Oct. 20 and is still under review in the New England Journal of Medicine. If these new subvariants are indeed more contagious and more severe, they could reverse an important trend as the COVID pandemic approaches its fourth year. The trend, so far, is for each successive major variant or subvariant to be more contagious but cause less severe disease. This trend, combined with widespread vaccination and new treatments, has led to what scientists call a “disconnection” of infections and deaths. Cases of COVID occasionally increase as some new, highly contagious new variant or sub-variant becomes dominant. But because these new forms of SARS-CoV-2 cause less severe disease, deaths don’t rise nearly as much. This disconnect, along with the availability of vaccines and treatments, has allowed most people around the world to return to some sort of normalcy in the past year or so. If BQ.1 or another high fusion subvariable reconnects infections and deaths, this new normal could become a new nightmare. “More hospitalizations and more deaths,” summarized Ali Mokdad, a professor of health measurement sciences at the University of Washington Institute of Health who was not involved in the OSU study. It’s possible we’ve already seen the first reunion. As new sub-variants began to seriously compete for dominance in recent months, epidemiologists have been closely monitoring the statistics of COVID to detect any real-world effects. Singapore was a false flag. The tiny Asian city-state has seen a rapid, uptick in cases this month that some experts initially worried could include a dangerous new sub-variable. But the country’s health ministry sequenced several virus samples, quickly, and determined that BA.5 was the culprit. Singapore’s high vaccination and booster rate—92 percent of residents have the best vaccines and 80 percent are boosted—slowed the BA.5 wave without a significant increase in deaths. But there is Germany, where cases have also increased this month. German authorities have yet to determine which variant or sub-variant is to blame, but it is worth noting that BQ.1 is spreading rapidly across Europe. And there are signs of reunification in Germany. In October, the country recorded up to 175,000 new cases a day—matching the peak of the previous wave in July. But 160 Germans died each day on average in the worst week of the current outbreak, compared to just 125 per day in the worst week of the summer. “We could see the same patterns in other European countries … and in the US,” Mokdad said. There’s still a lot we don’t know about the latest sub-variants of COVID. And their real-world impact won’t come into focus until we get good data from Germany. “Close monitoring of new variants and studying their properties is critical,” Liu said. But one thing is clear. For all their transmissibility and fusion, the new subvariants have not significantly escaped the immunological effects of the leading vaccines. And the latest “bivalent” boosters, designed specifically for BA.4 and BA.5, should maintain vaccine efficacy as long as the dominant subvariants are closely related to Omicron. Get vaccinated and stay on top of your boosters. It is impossible to overemphasize this. Yes, BQ.1 and its cousins exhibit some troubling properties that could bend the arc of the pandemic toward widespread death and disruption. But only if you are unvaccinated or way behind on your souvenirs.
