Omicron XBB.1.5 is fast becoming new dominant subvariant Covid-19, here are the concerns

Now the US is dealing with a new X-factor. It is actually an XBB factor: the XBB.1.5 Omicron subvariant. XBB.1.5 made up about 40.5% of all Covid-19 cases last week, according to data from the Centers for Disease Control and Prevention (CDC). That’s up from 21.7% the previous week. This one-week jump brought XBB.1.5 ahead of BQ.1 and BQ.1.1 as the new dominant subvariable in the US

This caused a “Wow” on Twitter from Eric Topol, MD, founder and director of the Scripps Research Translational Institute, which I guess could be described as “Twow”:

As another tweet from Topol saidthis new XBB.1.5 was first spotted in, guess where, the US:

XBB.1.5 was specifically first found in New York City, prompting Lucky Tran, PhD, an organizer for the March for Science and communication scientist at Columbia University, to recall a New York moment:

As you can see, Tran tweeted, “Since XBB.1.5 was discovered in New York, we should call it the “You do you” variant..” This was about the WTF posters about face masks that were posted on the New York subways in September. These posters showed cartoons of a person with and without face masks with the words: “You do you.” Those posters were soon taken down after people realized it was, um, how shall we say, a really bad idea, as I covered Forbes then. Such messages could have further contributed to the lack of face mask use and other Covid-19 precautions in many parts of New York.

And what might happen when SARS-CoV-2 is allowed to spread unfettered? It spreads, multiplies, mutates and spreads. The more the virus spreads, the more likely it is that new subvariants will emerge. Asking XBB.1.5, “Who’s your daddy”, could get an answer like “The Omicron XBB sub-variant”. That is if the virus had a mouth. XBB.1.5 arose through mutations in the XBB variant. The XBB variant has already spread to more than 70 countries, including India and Singapore. XBB, in turn, likely arose from a connection between two other earlier Omicron subvariants, BA.2.10.1 and BA.2.75. And that children are what happens when you allow the virus to continue to spread.

The rapid rise of XBB.1.5 demonstrates that this version of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may have a “growth advantage” over other versions of the virus. While a “growth advantage” might sound great in bed, it doesn’t when we’re talking about a new version of a respiratory virus. It suggests that XBB.1.5 could be more contagious than previous versions of SARS-CoV-2. Or it could be better to overcome existing immune protection. Or both.

As a result, there could well be another outbreak of Covid-19 after the holidays, this time due to XBB.1.5. During these last two weeks, many people seem to have avoided Covid-19 precautions as if they were quilted vests or low-cut ankle boots, in other words, out of fashion. This is not great when many people are traveling and attending gatherings. Makes you wonder if the ball that drops on New Year’s Eve will have spikes and be the Covid-19 coronavirus.

Whenever a new variant and subvariant of SARS-CoV-2 becomes dominant, five natural questions arise. One is whether people infected with this new version will be more contagious than with previous versions? The second is will this new version make people sicker than previous versions? Three is, will this new version be able to overcome vaccine-induced and natural immune protection? Four is whether the treatments will be just as effective against this new version? And five is what the bleep?

The answer to the first question is maybe. Or alternatively, maybe.

The answer to the second question is “It doesn’t seem that way”, so far. There do not appear to be any differences in the rates of people who become very seriously ill with Covid-19 after being infected with XBB.1.5 compared to other previous Omicron subvariants. Certainly, hospitalizations related to Covid-19 have increased in most parts of the country. According to New York Times, the average daily number of hospitalizations related to Covid-19 rose by 4% to 42,324 over the past two weeks. However, hospitalization rates in parts of the country where XBB.1.5 has already become dominant were not necessarily higher than those where other subvariables are still more dominant.

The answer to the third question is “so it seems.” Given the F486P mutation that XBB.1.5 has, the big concern is how much more evasive XBB.1.5 can be. In this case, avoidance does not mean that the virus refuses to answer when you ask: “Where were you last night?” In contrast, XBB.1.5 may be better able to evade antibodies generated by the Covid-19 vaccination or previous Covid-19 infections. This could mean that XBB.1.5 may be better able to overcome your immune defenses.

This new evasion would also help answer the fourth question. That is if monoclonal antibody treatments were available that still work against circulating strains. This extended set of Omicron waves has effectively rendered ineffective all those monoclonal antibody treatments that were effective against much older versions of the virus. Antiviral drugs like Paxlovid and Remdesivir still seem to work if taken early enough. However, this does not leave clinicians with many specific treatments until more monoclonal antibody therapies are developed.

So what can you do to stay safe from XBB.1.5. Well, there are the same-as-a-lot layers of precautions, including high-quality face masks, ventilation, air filtration, testing and vaccinations. If you haven’t taken the Covid-19 bivalent booster yet, it’s a good idea to do so as soon as possible. A research letter published on December 21 at New England Journal of Medicine described a study that discovered how Moderna and Pfizer-BioNTech bivalent Covid-19 mRNA boosters generated a significantly better antibody response against the XBB variant than the original Moderna and Pfizer-BioNTech Covid-19 mRNA vaccines. The study did not specifically look at antibody activity against XBB.1.5, but these results suggest that the bivalent will give you better protection against XBB.1.5 than the original versions of the vaccines.

In what has unofficially become the complacent phase of the Covid-19 pandemic, it can be easy to forget that SARS-CoV-2 is still a serious threat. The virus continues to multiply, spread and mutate. And it can be hard to keep up with these new sub-variants that have names that sound like Wifi passwords. Eric Feigl-Ding, PhD, epidemiologist and head of the Task Force on COVID-19 at the New England Complex Systems Institute, questioned why the CDC didn’t notify the public about the spread of XBB.1.5 sooner in the tweet below:

Ultimately, the big X-factor in the coming months is how many people end up getting the Covid-19 bivalent booster and maintaining their Covid-19 precautions. If the answer is not too many, XBB.1.5 may mark the point with even more hospitalizations, deaths and other bad Covid-19 outcomes. Politicians and various TV, radio and podcasting personalities can claim that the Covid-19 pandemic is over. But that only gives opportunities for this new X-tra sub-variant to spread.

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