As the wave of COVID infections from the highly contagious BA.5 subvariant finally receded in late July, new subvariants were already competing for dominance—and the chance to lead the next wave of infections.
A little more than two months later, epidemiologists are close to picking a winner. In the UK, infections from a highly mutated subvariant called BQ.1.1 they double every week— growth rate far exceeding other main sub-variables. In the US, BQ.1.1 is spreading twice as fast as its subvariant cousin BA.2.75.2.
This means that BQ.1.1 is very contagious. But that’s not the most troubling quality of the minor variant. What’s more worrying is that it also avoids certain antibodies. In fact, BQ.1.1 appears to be the first form of COVID against which antibody therapies—for example, evusheld and bebtelovimab—don’t work at all.
Fortunately, the best vaccines still work against BQ.1.1 — especially the newer “bivalent” messenger RNA enhancers. However, uptake of the new booster has been shockingly slow, meaning that the new piercings still don’t offer much population-level protection.
We have the tools to defeat COVID. But “the reality is that no one is using the tools,” James Lawler, an infectious disease specialist at the University of Nebraska Medical Center, told The Daily Beast.
Highly contagious and immunogenic, BQ.1.1 is poised to take advantage of an increasingly vulnerable global population as antibodies from vaccinations and previous infections gradually wear off over the coming months. The question is not whether a new wave of infections is coming. It’s just when.
“We’re in a very fluid phase of the pandemic right now,” Edwin Michael, an epidemiologist at the Center for Global Health Infectious Disease Research at the University of South Florida, told The Daily Beast. Michael has built sophisticated computer models to simulate the COVID pandemic.
“BQ.1.1 or some other highly contagious new subvariant is just waiting for our defenses to slip.“
BQ.1.1 was not the inevitable winner of the viral competition that raged, mostly unseen, in the months following the peak of the BA.5 wave. There were other highly contagious and somewhat elusive subvariants, including BA.2.75.2 and BA.4.6.1.
But the BQ.1.1 had an edge, thanks in part to an eyebrow-raising trio significant mutations in its spike protein, the part of the SARS-CoV-2 virus that helps it grab onto and infect our cells. These mutations –N460K, K444T and R346T—to make BQ.1.1 more contagious than its cousins.
These and other mutations also confer the ability of BQ.1.1 to evade antibody treatments. These treatments aren’t the only way to treat COVID, of course—there are antiviral drugs and treatments that don’t involve doses of antibodies.
But antibody therapies have proven popular and effective against other variants and sub-variants of SARS-CoV-2. BQ.1.1 could begin to render them obsolete, limiting our options for preventing COVID infections from becoming deaths from COVID.
One of the most important trends as the COVID pandemic approaches its fourth year has been the “decoupling” of the infection rate from the death rate. The worst day for COVID cases was January 18, when 3.8 million people contracted the virus.
But by then tens of millions of people had been vaccinated – and hundreds of millions more had natural antibodies from previous infection. At the same time, our arsenal of treatments has expanded. This explains why it is the worst day for deaths from COVID it did not coincide with the worst day for infections. Instead, it happened almost exactly a year earlier: on January 20, 2021, when nearly 18,000 people died.
The disconnection trend has been maintained. The case rate fluctuates wildly, but the death rate—despite a few bumps here and there—for the most part continues to decline. But if BQ.1.1 is driving the next wave of COVID, as seems increasingly likely, the disconnect is likely to reverse somewhat as treatment options dwindle.
Fortunately, the latest mRNA enhancers from Moderna and Pfizer are still highly effective against BQ.1.1. There is a good reason for this. Moderna and Pfizer created the new bivalent enhancers specifically to provide immunity against BA.5. BQ.1.1 is a form of BA.5, albeit with additional mutations.
Of course, bivalent reinforcers only help if you take them. And a deepening sense of complacency in many countries has translated into lower and lower vaccine uptake. “Vaccine uptake has collapsed and will continue to decline,” Ali Mokdad, a professor of health measurement sciences at the University of Washington Health Institute, told the Daily Beast.
In the US, 80 percent of people have received at least one vaccine for COVID. 67 percent completed a full course of vaccines—either two doses of mRNA or one dose of certain other vaccines. Just 33 percent received the first round of boosters, which became available last fall. And only 10% received the bivalent boosters that regulators began rolling out in August.
The numbers aren’t much better in other developed countries – and much worse in developing countries. And that means the world depends mostly on antibodies from past infections to prevent a devastating wave of new cases and deaths.
But natural antibodies eventually weaken. “In terms of variables, the main one is the rate at which natural immunity will wane,” Michael said. It is possible for a useful degree of immunity from previous infection to last for a year or more. It is also likely to disappear after about six months.
Epidemiologists agree, however, that natural immunity does it eventually disappears—and vaccine uptake is too low to compensate for this loss of antibody in the entire population. BQ.1.1 or some other highly contagious new subvariant is just waiting for our defenses to slip. A new wave of infections could come as early as this winter. Or lingering antibodies could delay it. Michael said his computer models predict an increase in cases starting in April.
The sooner may actually be better for humanity. As bad as BQ.1.1 is, it is not the last word on the evolution of SARS-CoV-2. “It has a lot of potential mutations, still,” Mokdad said of the virus. “The flu virus continues to mutate and this one is no different.”
New and potentially worse subvariants will follow BQ.1.1. Even if these new subvariants continue to evade antibody therapies, a steady rollout of new enhancers would likely protect us. But we as a species can’t be bothered to dig.
So we rely on catching and surviving COVID and making natural antibodies in order to prevent possible worse COVID in the future. We collectively walk a tightrope of immunity.
It is easy to slip and fall. If you’re not up to date on your boosters and your antibodies from previous infections wear off before you get COVID again, you could be in big trouble. Especially if you catch BQ.1.1 or an even more elusive subvariant. The one that rejects some of our best drugs.
This is the person forecast. The outlook for humanity as a whole is equally alarming. Lawler said he thinks COVID will be with us, well, pretty much forever. Like the flu. But a lot worse than the flu.
The best-case scenario, as Lawler described it, is still pretty bleak. “I think over the next couple of years, gradual increases in vaccination and repeated infections with COVID — over and over and over again — may eventually give us enough population immunity that we’ll see less explosive cases and hospitalization and death rates that are a little lower. ” he said. “But I doubt they will reach seasonal flu levels.”