Sunday, Jan. 30, 2022

If you need a sign that we’re still deep into the weeds of this pandemic, just look at this pharmacy door! Free vaccines! We’re hiring! Wear your mask! The hallmark of this year so far is that everything is happening at once.

And now we’re hearing about a new variant, B.A.2, related to Omicron, reported to be circulating in half of the states. That sounds alarming until you read the article and find there were only 127 known cases in the United States at that point. So you can almost relax until you remember that they don’t test every case, and to show up in the cases that are tested means that there are many more cases out there. B.A.2 came to the world’s attention recently because it has outpaced the now-familiar old Omicron in Denmark, and appears to spread 1.5 times faster, contributing to a rapid surge of COVID cases in Denmark.

Effect of Omicron: First Case in Denmark was detected on Nov. 22, 2021.
(Total Daily Covid Cases in Denmark.

B.A.2 went from 20% of cases in Denmark to 45% in two weeks. It has been found in at least 40 other countries as well. Whether B.A.2 will replace Omicron in other countries remains to be seen. We also don’t know whether it spreads faster because its mutations enable it to infect more efficiently or because it can bypass immune protection gained from vaccination or previous infection. In fact the answer to almost any question you might have about B.A.2 right now is–they don’t know yet. We do know that Omicron alone has brought a huge surge of cases to the U.S. with or without B.A.2.

Effect of Omicron: First case in U.S. was identified on Dec. 1, 2021. (Total Daily COVID cases in the U.S.)

So far B.A.2 hasn’t earned the title of Variant of Interest, much less the more serious label of Variant of Concern. When I looked it up, I learned something new. I knew that both the WHO and the CDC designate new variants of COVID in a four-tiered structure:

  1. Variants being monitored
  2. Variant of interest
  3. Variant of concern
  4. Variant of high consequence

But I didn’t realize that the variants in each category are not the same for the CDC as for the WHO. The CDC is specifically interested in variants as they occur in the United States. The WHO classifies variants according to their global significance. Which makes sense if you think about it. These are dynamic working categories, not scientific classifications. Viruses can be put on the list, taken off the list, or moved up or down according to their relative potential threat.

What raises the potential threat level? The CDC looks for specific genetic markers or evidence of increased resistance to diagnostics, treatments, and vaccines, increased transmissibility or increased disease severity. These are relative, not absolute, indicators. To reach the 4th level (Variant of High Consequence) a variant would be able to overcome most of our tools for diagnosis, prevention, and treatment and cause more severe disease and more hospitalizations. Fortunately, so far no variant has reached the 4th level.

So here’s today’s score:

  1. The World Health Organization
    1. Variants Under Monitoring (VUMs): 3. At this level, they don’t get Greek letters.
    2. Variants of Interest (VOI): 2. Lambda (earliest documented in Peru) and Mu (earliest documented in Colombia.
    3. Variants of Concern (VOC): 5. Alpha, Beta, Gamma, Delta, and Omicron*. Omicron is marked with an asterisk, meaning that it includes all descendent lineages, such as BA.1, BA.1.1, BA.2, and BA.3. BA.2 is the one that gained attention recently when it overtook the parent Omicron in Denmark. If it replaces Omicron in more countries, will it get its own Greek letter?
  2. Center for Disease Control
    1. Variants Being Monitored (VBM): 10
    2. Variant of Interest (VOI): Currently none
    3. Variant of Concern (VOC): 2. Delta and Omicron.
    4. Variant of High Consequence (VOHC): Currently none. This would be a VOC which eludes detection, vaccines, or therapeutics, or causes more severe disease.

As any of the experts will be happy to tell you, variants happen all the time. Most of them don’t make any of these lists and they have to be at least a VOI to earn a Greek letter. The WHO also has a list of 17 Formerly Monitored Variants, has-beens who are no longer considered a potential threat either because they do not make much of an impact or there just aren’t enough of them around. None of them have Greek letters.

With the rise of Omicron and its spin-offs, it’s tempting to think that variants are getting less virulent. But there are no guarantees. COVID-19 is spreading all over the world, mutating all the time, and variants have a high degree of randomness. Even if Omicron is less virulent (which is still being debated), the next variant of interest may not be related to Omicron and inherit different characteristics. However (and I owe this insight to the Goats and Soda article below), we ourelves are changing both as individuals and as a population. Our immune systems present the virus with a moving target, as we adapt due to exposure and vaccines, and that is working in our favor.

And to help us keep ahead of the game, it was announced this week that Pfizer and Moderna are beginning clinical trials with an Omicron vaccine.

Maybe that B.A.2 Omicron offshoot will never have a chance at that Greek letter.

Today’s Notable Headlines

“The latest Covid variant is 1.5 times more contagious than omicron and already circulating in almost half of U.S. states,” CNBC, Fri. Jan. 28, 2022. https://www.cnbc.com/2022/01/28/the-new-bapoint2-omicron-subvariant-is-already-circulating-in-half-of-us-states.html

“What is ‘stealth Omicron’? The rise of the subvariant is alarming some scientists who say it needs its own Greek letter,” Fortune, Jan. 21, 2022. https://fortune.com/2022/01/21/what-is-stealth-omicron-new-covid-variant-substrain-denmark/

“The Coronavirus Will Surprise Us Again,” The Atlantic, Jan. 29, 2022. https://www.theatlantic.com/health/archive/2022/01/coronavirus-variant-after-omicro/621404/

“Fact check: The theory that SARS-CoV-2 is becoming milder,” Goats and Soda, NPR. Jan. 14, 2022. https://www.npr.org/sections/goatsandsoda/2022/01/14/1072504127/fact-check-the-theory-that-sars-cov-2-is-becoming-milder#:~:text=That%20is%3A%20The%20coronavirus%20SARS,less%20severe%2C%22%20says%20Dr.

“How to think about boosters in light of this week’s Pfizer and Moderna news,” CNN, Jan. 27, 2022. https://www.cnn.com/2022/01/27/health/omicron-booster-wait-wen-wellness/index.html

Other Useful Resources

“Denmark: Coronavirus Pandemic Country Profile,” Our World in Data, Jan. 28, 2022. https://ourworldindata.org/coronavirus/country/denmark

“SARS-CoV-2 Variant Classifications and Definitions,” CDC updated Dec. 1, 2022. https://www.cdc.gov/coronavirus/2019-ncov/variants/variant-classifications.html#anchor_1632237683347

“Tracking SARS-CoV-2 variants,” WHO. Updated 25 Jan, 2022. https://www.who.int/en/activities/tracking-SARS-CoV-2-variants/

Why am I doing this?

The coronavirus pandemic will be written on our memories just as the 1918 Flu Pandemic, the Great Depression, or the Cold War left their mark on past generations. Since March 11, 2020, this blog has examined the modern pandemic experience both in the media and in everyday life, drawing on my experience as a medical technologist, a historian, and an ordinary person living through an extraordinary world crisis.

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