XB what? BQ huh? Do you need to keep up with Omicron’s ever-expanding offspring?

It’s like clockwork now. Every few months, we’re warned that the Omicron variant of the SARS-CoV-2 virus has spawned yet another subvariant, this one even more transmissible than the ones it is fast overtaking.

The new entity is given a name, an unwieldy string of letters and numbers separated by periods. There’s discussion — some of it breathless — on Twitter and in the media about the threat the new subvariant poses. People who are still following Covid-19 news worry. People who are determined to ignore Covid pay no attention.

Rinse and repeat.


The cycle has some experts wondering about how useful these discussions are. We aren’t, after all, obsessing about which strain of H3N2 flu has been causing most of the illness that has cycled through the United States in this abnormally early flu season. That’s because new strains of existing flu viruses may make us more vulnerable to infection, but they don’t render us defenseless against influenza. The same is true with SARS-2 subvariants — but that sometimes gets lost in the back and forth.

“This keeps happening every couple of months. I sort of feel like it’s Groundhog Day, except with ‘scariants,’” said Angela Rasmussen, a coronavirus virologist at the University of Saskatchewan’s Vaccine and Infectious Disease Organization, using a term coined by Eric Topol.


(For the record, Topol, founder and director of the Scripps Research Translational Institute, disagrees vehemently with the notion that people don’t need to pay much attention to which variant or subvariant is currently circulating, arguing among other things that the public discussion could encourage more people to get the latest booster shots.)

Rasmussen has spent a lot of time recently dealing with interview requests from journalists keen to explore the significance of XBB.1.5. She’s not clear that the public is getting information that they can do much with.

If a new variant of concern were to materialize, a version of the virus that fundamentally eroded our immune systems’ ability to fend off SARS-2 requiring a rapid updating of Covid vaccines, the public would need to take note, Rasmussen said. But in the absence of that, “then it’s really hard for me to see how it is actionable, or it’s useful, really, to anybody to know that oh, well, XBB.1.5 is taking over when we thought it might be BQ.1.1.”

Rasmussen is quick to stress she is not suggesting that Covid is no longer a problem, or that the world should stop tracking the evolution of SARS-2. “We should,” she insisted. “But does the public really need to be on the edge of their seat about that? I don’t think they are, actually. And I think that … this just kind of confuses people.”

The actions people should take to fend off XBB.1.5 are the same as the actions they should be taking to fend off its predecessors, Rasmussen said. Stay up to date on vaccinations; get boosters when they are advised. Consider wearing a high quality mask in public settings. Take steps to try to avoid being infected.

“I just don’t see how knowing which variants we’re talking about changes the advice that we would give to the public for the people who are going to listen,” she said.

Andrew Pollard, director of the Oxford Vaccine Group, and a professor of infection and immunity at the University of Oxford, actually likes that people — some people anyway  — are paying attention to SARS-2’s viral evolution. He thinks it is increasing public understanding of how complex respiratory pathogens are and how difficult it is to control them through vaccination.

But he does not approve of the tenor of the coverage of the subvariants, saying some of it casts these developments in far too ominous a light.

“[T]he hyped framing of the news stories misinforms about the significance of each new variant to public health,” he wrote in an email. “In highly vaccinated and Covid-19-experienced populations, such as the U.K. and the U.S.A., pandemic levels of death from Covid-19 will not return as a result of viral evolution because of the wall of immunity across the population, but the crisis narrative in the media suggests the worse.”

Pollard has a point. But it’s not the media that starts ringing the alarm bells every time a new subvariant hits the radar. Some scientists head for the public square — a.k.a. Twitter — to swap information on what’s known about the new strain. Some of the discussion is measured. Some of it is less so. Reporters pick up on the concerns aired.

Jonathan Ball, a professor of virology at Britain’s University of Nottingham, is frustrated with scientists whose conjecture about how immune-evasive new variants and subvariants will be is based on studies that measure how well a single component of our immune response, called neutralizing antibodies, recognizes the new strain. Those are the easiest studies to do, and the quickest to emerge when a new strain is spotted. But neutralizing antibodies are only one type of immune system weapon we have against the virus; focusing on them alone ignores the fact that our arsenals contain other important firepower we bring to the fight.

“I think what it doesn’t really encompass is the subtlety and the eloquence, as it were, of your immune system and its ability to also evolve and respond to virus evolution,” Ball said.

He didn’t let the media off the hook, though. “I suspect that journalists have cottoned on to the fact that if you mention a variant, people’s ears do prick up,” he said. “Because there’s very little else new about SARS-CoV-2.”

The upshot of this kind of coverage? People are either turned off or scared, Rasmussen said. “And neither of those two outcomes encourages the thing that we need to happen, which is people going to get their bivalent boosters, and maybe in places of high transmission considering taking other precautions as well.”

Some of these discussions ignore the basics of biology. When people start to develop immunity to a virus, it must evolve to be able to continue to infect people. Three years into our coexistence with SARS-2, most people on the planet have either been infected (in some cases several times) or vaccinated (in some cases multiple times) or some combination of the two. The virus must employ new tricks to get around our mounting defenses.

“It is important to explain that variants will continue to emerge as the very survival of the virus depends on it,” Pollard explained. “We can expect new variants for the rest of our collective lifetimes, but we might anticipate less frequent waves in the future as immunity across the population continues to build.”

Maria Van Kerkhove, the World Health Organization’s point person for Covid-19, confessed she’s surprised that she is still quoted saying this subvariant or that subvariant is more transmissible than the ones that came before. “I say that every time,” she said. Each new variant or subvariant must be more transmissible than its predecessor, or it would die out. “That’s what viruses do,” Van Kerkhove said.

She is uncomfortable with the idea of telling people they don’t need to pay attention to the details of each successful version of the virus, preferring to stress that people should understand that the WHO and national public health agencies, scientists, and governments around the globe are monitoring the viral evolution of SARS-2 and constantly assessing whether vaccines still work or need to be updated, whether public health advice should change.

“I don’t want people to be like, ‘Hey, there’s nothing to worry about.’ But I also don’t want to be like ‘The sky is falling,’” Van Kerkhove said. “And frankly, the people who want to listen to us, do. The people who don’t, really, really don’t.”

Topol, as mentioned earlier, is not a fan of the suggestion that average individuals don’t need to pay close attention to each new subvariant. He took umbrage at the notion that this is not information people can act on, suggesting public discussion of XBB.1.5 might prompt more people in this country to get a bivalent booster.

According to the latest data from the Centers for Disease Control and Prevention, only 15.4% of people over the age of 5 in the U.S. have received the updated booster. Even among people aged 65 and older — those at the highest risk of dying from Covid — less than 40% have gotten the new booster, which targets both the original strain of SARS-2 and an Omicron strain. Topol called that uptake rate “pitiful.”

“And we’re seeing the effects of that in people 65 and older, where the hospitalization rates are alarmingly high. And most of them are preventable,” he said.

Topol is worried about XBB.1.5; he thinks it is a serious enough threat that the WHO ought to give it a Greek name, in the way the global health agency used letters from the Greek alphabet to highlight that Alpha, Delta, Omicron, and a number of other strains were sufficiently different that they had earned the label “variants of concern.”

XBB.1.5 is an offshoot of Omicron, but Van Kerkhove told STAT in September that the WHO would give a subvariant a Greek name if it felt the strain behaved sufficiently differently to warrant it. On Wednesday, an expert committee advising the WHO on viral evolution reserved judgment on the import of the XBB.1.5, saying there is not yet enough evidence to know whether it will erode vaccine protection or trigger more severe disease.

Topol equated the notion of easing up on the variant discussions as surrendering to the virus. “I don’t agree that we’re impotent, powerless to defend,” he said, insisting the country needs better Covid vaccines — nasal vaccines that should block infections — and government financial support to develop them. Worried individuals of course can’t make a Republican-controlled House authorize funding for an Operation Warp Speed 2.0, but that doesn’t mean people shouldn’t press their elected representatives to support the work, Topol said.

Michael Osterholm, director of the University of Minnesota’s Center for Infectious Disease Research and Policy, falls somewhere between Rasmussen and Topol on this issue.

The emergence of a new subvariant provides an opportunity to emphasize the importance of getting a booster shot and the value of wearing an N-95 mask in public settings, he said. Though he acknowledged that most people have chosen their camps on the issues of boosters and masks, there might still be some gains to be made, Osterholm said. “If I could pick up even 1%, I’d do it.”

But he admitted that we could be getting to the point where people can no longer process the information. “It doesn’t help to tell the public: Oh, by the way, this is XYZ247 dah, dah, dah, dah, dah. They get lost. It doesn’t mean anything.”

Osterholm said three years into the pandemic, public health hasn’t yet figured out how to effectively communicate about the evolution of the virus.

“None of us yet really understand how to interpret the scientific information that continues to come in on variants and subvariants and try to translate that into meaningful public health policy — or for that matter, how to even talk about it,” he said. “I think we’re in a place right now where we’re trying to understand: How do we talk about this [in a way] that’s meaningful to people and that has public health consequence?”

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Source: STAT