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These two new COVID variants could drive the next surge. Here’s why they’re
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Bay Area // Health


THESE TWO NEW COVID VARIANTS COULD DRIVE THE NEXT SURGE. HERE’S WHY THEY’RE
CAUSING SURPRISE AND CONCERN

Kellie Hwang
Oct. 16, 2022Updated: Oct. 19, 2022 6:44 a.m.

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Two new COVID variants BQ.1 and BQ.1.1 could drive the next surge.

Yalonda M. James/The ChronicleShow MoreShow Less 2of2

Meena Bubakar, lead vaccine coordinator, restocks Covid-19 vaccines at the
community testing and vaccination clinic United in Health/Unidos en Salud Sept.
23 in the Mission District of San Francisco.

Amy Osborne, Freelance / Special to The ChronicleShow MoreShow Less
 * 
 * 

UPDATE: Is there really a COVID ‘nightmare variant’ spreading? Here’s what
experts say.

Concern is rapidly growing over emerging omicron coronavirus variant BQ.1 and
its sibling BQ.1.1, which experts say appear to be strong candidates for a
winter surge in the U.S. and could knock the BA.5 variant out of its dominant
spot.

The BQ.1 and BQ.1.1 variants, descendants of BA.5, were first identified in
mid-July, according to UC Berkeley infectious disease expert John Swartzberg.
They were first detected in the U.S. just a month ago and each rose quickly to
account for 5.7% of cases sequenced nationwide for the week ending Oct. 15,
according to updated estimates from the Centers for Disease Control and
Prevention’s variant tracker.



Meanwhile, BA.5, which has dominated the U.S. coronavirus picture since the
summer, has been on the decline, dropping from its Aug. 20 height of 86.5% of
sequenced cases to 67.9% on Oct. 15.

BQ.1 and BQ.1.1 are worrisome because they both appear to be more transmissible
and could possibly be more immune evasive than earlier variants.

More for you
 * How long does immunity from the new COVID bivalent boosters last 'in the real
   world'?
   
 * COVID in California: ‘Don’t wait to be boosted,’ say infectious disease
   doctors
   

Dr. Anthony Fauci, President Biden’s chief medical adviser, expressed concern
over the two new variants last week. “When you get variants like that, you look
at what their rate of increase is as a relative proportion of the variants, and
this has a pretty troublesome doubling time,” he said in an interview Friday
with CBS News.

Infections from BQ.1.1 have been doubling weekly since mid-September in the
United Kingdom, leading to a significant increase in hospitalizations.



BQ.1.1 has an estimated growth advantage of 15% compared with BA.5, according to
UCSF infectious disease expert Dr. Peter Chin-Hong. In a recent Chronicle story
about emerging variants that could cause a winter surge, Stacia Wyman, senior
genomics scientist at the Innovative Genomics Institute at UC Berkeley, noted
that BQ.1.1 has a growth advantage of 14% over BA.5.

The BQ.1.1 variant, which is increasing in New York and Germany as well as other
European countries, “is perhaps the most immune evasive subvariant circulating,”
Swartzberg said. “This makes it the leading contender to overtake BA.5 in the
next few weeks.”

Chin-Hong said some BQ.1 and BQ.1.1 mutations in the receptor binding domain
(where the spike protein attaches to the body) “may be associated with antibody
evasion,” and some lab studies support that finding. In addition, BQ.1 is the
first variant to prove resistant to the two available antibody therapies
Evusheld and bebtelovimab, he said.

“However, I must emphasize that (the therapies) will still be protective and
that we don’t know if it is truly immune evasive until we see what happens in
real life, not just the laboratory,” he added. “We also need more studies about
BQ.1 specifically.”

That BQ.1 is a “grandchild” of omicron and a “child” of BA.5 bodes well for the
effectiveness of vaccines, especially the new bivalent booster shots, both
Chin-Hong and Swartzberg said.

“It is highly likely that an omicron-updated booster which targets BA.5 will
provide excellent protection against infection, and continue to provide
spectacular protection against serious disease and death,” Chin-Hong said.

Against infection from these new variants, the boosters will possibly provide
protection for only two to three months, “but protection against serious disease
will continue for many, many months if not years,” Chin-Hong said.

He added that antivirals such as Paxlovid and remdesivir “work without regard to
the spike protein appearance, so they will continue to work very well.”

The BQ.1 sublineage was first reported in Nigeria in July, and has since been
found in a number of European countries and Japan, but is not yet dominant
anywhere, Chin-Hong said.

He explained that some variants stay off the global radar until multiple
countries report them, they get mentioned on social media, or they show up on
global COVID variant tracking site GISAID.

That’s why BQ.1 seemed to suddenly burst on the scene, to the surprise of many
virus watchers, he said.

“It likely came out of nowhere because they were all classified as BA.5
previously, because that is the parent sublineage,” he said. “With these
sub-subvariants (or grandchildren) you can’t often find them until you actually
sequence for, and look for them.”


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largest water districts.

Dr. Eric Feigl-Ding, head of the COVID Risk Task Force at the New England
Complex Systems Institute, tweeted Thursday about the BQ.1 and BQ.1.1 variants
and suggested the CDC might have been holding onto the BQ variant data, as they
only just showed up on the agency’s tracker.

Chin-Hong said that while the CDC gets data only once a week and says it doesn’t
include any variants with a proportion under 1%, “it appears that (BQ.1 and
BQ.1.1) were surprisingly retroactively added,” and he personally was “shocked”
when the CDC site was updated.

“I kept reading and re-reading the figures, adding up the percentages, and
pinching myself to make sure I wasn’t dreaming,” he said.

Omicron subvariants with similar mutations to the spike protein are
proliferating because of “convergent evolution,” Swartzberg said.

“It’s like all these different omicron viruses are settling on the same
strategy,” he said. “They have found something they like.”

The high transmissibility and growth advantage of the BQ.1 and BQ.1.1 variants
make it seem increasingly likely that they will eventually become dominant in
the U.S. and lead to a surge in cases and hospitalizations later this fall and
winter, Chin-Hong said.

Unvaccinated, elderly and immunocompromised individuals would likely have the
worst outcome of the surge, he added.

“I don’t think hospitalizations and deaths will approach what we have seen in
the last two winters, because the overall population is very immunologically
experienced at this time,” he said. However, “Many people may become infected,
or reinfected, and this could be disruptive to the community, even though many
of these will be mild clinically.”

Kellie Hwang is a San Francisco Chronicle staff writer. Email:
kellie.hwang@sfchronicle.com Twitter: @KellieHwang







Fifth & Mission
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DROUGHT MAP

Track water shortages and restrictions across Bay Area
Updated to include drought zones while tracking water shortage status of your
area, plus reservoir levels and a list of restrictions for the Bay Area’s
largest water districts.



Written By
Kellie Hwang

Kellie Hwang is the engagement reporter for The San Francisco Chronicle. Before
returning to the Bay Area, she held roles as transportation reporter and
trending news reporter at the IndyStar in Indianapolis. Previously, Kellie
covered dining news and trends, visual arts, events and nightlife for the
Arizona Republic, and freelanced for the former Contra Costa Times. Kellie also
serves as co-director of the Asian American Journalists Association Features
Forum. She is a University of Washington graduate.

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