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‘The tools are getting picked off’: An ever-mutating

mix of COVID variants means fewer and less effective
treatments this fall
BY Erin Prater
September 24, 2022, 5:00 AM EDT

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COVID is ramping up for a fall wave—one likely to be fueled by multiple and compares U.S.
variants, experts say, as the virus mutates and spreads exponentially. inflation to the fall...

The Institute for Health Metrics and Evaluation at the University of September 22, 2022
Washington and other experts, including Dr. Anthony Fauci, the nation’s BY Will Daniel
top infectious disease expert, foresee a wave beginning to swell in late
October, and peaking in late December or January. Success
Mark Zuckerberg has long
put employees on a ’30-
It could kill another 20,500 Americans, according to the IHME. ay list’ to find a new role
or leave—now the list is
While the coming wave may be caused by multiple variants, they may growing
start to look increasingly similar as they mutate to become more efficient
take the same path to achieve it. September 22, 2022
BY Chloe Taylor
The wave may be carried by one variant, Dr. Raj Rajnarayanan, assistant
dean of research and associate professor at the New York Institute of
Technology campus in Jonesboro, Ark., told Fortune this week .

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

And they may all end up with the same disastrous effect: rendering
current COVID countermeasures like drugs and vaccines powerless.

The spawn of Centaurus

Omicron spawn BA.2.75, dubbed “Centaurus,” seemed like the COVID
variant to watch this summer—one with the potential to wreak havoc
later in the year. Related Articles
But Centaurus is no longer a worry, according to Rajnarayanan. Instead, Health
one of its children, BA.2.75.2, has outcompeted it, eliminating it as a New COVID variants may
threat—but replacing it with a more formidable one. evade current treatments
or render them entirely
ineffective, experts say
Fauci this week called the BA.2.75.2 variant “suspicious,” in that it has
September 22, 2022
the potential to develop into a variant of concern for the fall. By Erin Prater

In Rajnarayanan’s book, it’s the most formidable of up-and-coming

Well
strains because of its spike protein—a feature that allows it to enter cells
binds more tightly to human cells than that of any other variant. By Just in time for fall,
there’s a brand-new
doing so, it makes it more difficult for antibodies to successfully attack. COVID variant making
headway in the U.S.
The variant is picking up mutations that make it more similar to globally September 20, 2022
dominant BA.5 and the deadly Delta variant of late 2021. And it’s just “a By Erin Prater
couple of mutations away from picking up increased transmission speed,”
Rajnarayanan said. Well

Scientists were worried

To make matters worse, the new variant shows “extensive escape” ability, about a particular COVID
according to a new preprint paper released this week by researchers at variant this fall. They
didn’t expect its
the Imperial College in London and the Karolinska Institute in Sweden. offspring
September 21, 2022
The paper, which is not yet peer reviewed but has been widely cited by By Erin Prater
experts, called the variant “the most neutralization-resistant variant
evaluated to date,” and said it may effectively evade antibody immunity, Health
built by vaccination and prior infection.
Monkeys could hold the
key to a future vaccine
A spin-off of a heavyweight champ for all COVID variants and
the original SARS virus
Another major contender: Omicron spawn BF.7. It’s a spin-off of globally August 24, 2022
dominant strain BA.5, three generations removed. By Erin Prater

The new subvariant has a change in the spike protein seen in other Health
Omicron strains making headway. It also has a change in the nucleotide What is BA.4.6? The CDC
sequence— sometimes referred to as the blueprint of an organism—that is tracking a new COVID
could cause it to behave differently than other subvariants, Dr. Stuart ‘variant of concern’
that’s overtaking earlier
Ray, vice chair of medicine for data integrity and analytics at Johns Omicron strains ...
Hopkins Department of Medicine, told Fortune this week. August 4, 2022
By Nicholas Gordon
Scientists are taking note of BF.7 because it’s making headway in an
increasingly crowded field of Omicron subvariants.

“The same growth advantage in multiple countries makes it reasonable to

think that BF.7 is gaining a foothold,” and that it’s potentially more
transmissible than parent BA.5, Ray said.

Convergent evolution & ‘frankenviruses’

There are more contenders, including BQ.1.1. The variant is jockeying
with BA.2.75.2 to lead the wave this fall, Rajnarayanan said.

Major players are beginning to pick up identical advantageous mutations

as they try to gain supremacy over their rivals, according to
Rajnarayanan. Some mutations offer advantages like increased
transmissibility, while others make it more difficult for the human
immune system—as well as treatments and vaccines—to fight them off.

It’s common for variants to garner multiple mutations—and increasingly,

variants of potential concern are acquiring many of the same ones.

“Eventually all variants may look the same at the spike level,”
Rajnarayana said.

Variant hunters are also keeping their eye on recombinants—

of multiple variants that form “frankenviruses” of sorts.

One Rajnarayanan and others are watching: XBB, a combination of two

different Omicron spawns. It’s not currently a concern in terms of
spread, but “it’s probably the most immune evasive yet”—even more so
than the rising BA.2.75.2, which is more immune evasive than globally
dominant BA.5, the most immune evasive until recently.

It’s a concerning pattern that has the ability to reduce the effectiveness of
COVID treatments, as acknowledged by World Health Organization
officials this week—and perhaps even vaccines. In a worst-case scenario,
increasingly immune-evasive variants could render them ineffective
entirely.

BA.2.75.2 is being watched for its potential to escape the immunity

provided by the last antibody drug that is effective on all variants,
Bebtelovimab, according to Rajnarayanan and other experts. It’s
administered to those at high risk of serious outcomes from COVID.

According to a preprint updated Friday by Yulong Richard Cao, an

assistant Professor at Peking University’s Biomedical Pioneering
Innovation Center in China, and others, BQ.1.1 beat it to the punch. The
variant escapes immunity from Bebtelovimab, as well as another
antibody drug that only works against some variants.

“Such rapid and simultaneous emergence of variants with enormous

advantages is unprecedented,” Cao and others wrote in the paper.

It’s unknown how well new Omicron boosters will hold up against
coming variants. But Cao’s paper notes that herd immunity and boosters
may not protect against new strains. It urges the rapid development of
broader COVID vaccines and new antibody drugs, and encourages
researchers to test them against recombinants they construct in the lab,
in an effort to gauge their effectiveness ahead of time.

Rajnarayanan worries for the future of COVID countermeasures and, like

WHO officials, calls on countries to keep up testing and the genetic
sequencing of samples. It’s the only way to know what’s coming, they
contend. Ideally, such knowledge will allow researchers to scramble to
create new countermeasures, or update old ones, as necessary.

“We used to say we have the tools,” he said. “The tools are getting picked
off.”

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