New Coronavirus News from 25 Apr 2022

Here's what we know about the BA.2 Omicron subvariant now driving a new wave [National Geographic, 25 Apr 2022]

BY SANJAY MISHRA

BA.2 infections aren’t as mild as once thought and even newer versions of Omicron are circulating and spreading fast

After a brief two-month plateau, COVID-19 cases are rising again in the United States, propelled by the Omicron BA.2 subvariant and its more transmissible descendants. The uptick has experts worried, as more people are shedding their masks and returning to pre-pandemic activities.

Between April 1 and April 24, new COVID-19 cases have jumped by 75 percent, mostly due to BA.2; this subvariant now accounts for almost 75 percent of COVID-19 cases in the U.S. While hospitalizations are still at their lowest levels since the start of the pandemic, they are also trending upward nationally. And COVID-19 cases among nursing home residents and staff are rising again after falling for roughly three months.

“Ongoing transmission of BA.2 is probably related both to the increased transmissibility of the virus together with the reduction of pandemic restrictions,” says Dan Barouch, an immunologist at Harvard Medical School who directs the Center for Virology and Vaccine Research at Beth Israel Deaconess Medical Center. “Clearly both are contributing to the current surge.”

At the same time, national vaccination rates have stalled out. Only 45.6 percent of the U.S. population has received a booster dose, and in at least 10 states, mostly in the South, more than a third of the population remains unvaccinated. This is especially troublesome because early data suggest BA.2 may cause more severe disease than the original form of Omicron.

The first Omicron wave arrived when many people in the U.S. were already vaccinated, so it seemed to cause less severe illness and got the reputation of being mild, says Ben Cowling, an epidemiologist at the University of Hong Kong. But “mild” was only relative to the very severe disease that previously dominant Delta variant had caused.

Melinda Maldonado, a communications strategist in Toronto, was triple vaccinated when she got a breakthrough infection in December 2021, during the peak of the Omicron wave in Canada. It left her bedridden for weeks, and three months later she still suffers with debilitating fatigue, brain fog, and cognitive disorientation.

“When people say ‘mild,’ they mean you're not dying, like you don't end up in the ICU,” Maldonado says. “For me, this was not mild.”

Now, evidence is building that the BA.2 subvariant is even more infectious than the first form of Omicron, produces more virus particles upon infection, and causes longer-lasting cases of COVID-19.

Why would BA.2 cause more severe disease?
The earlier form of Omicron, called BA.1, was more contagious than previous variants, but it caused less lung damage than Delta because it stayed mostly in the upper airways, says Guowei Wei, a mathematician and molecular biologist at Michigan State University, whose artificial intelligence model had predicted Omicron would be highly infectious. Still, the current crop of vaccines guarded against BA.1, which in most cases caused less severe disease than previous variants among the vaccinated and those who had some immunity from a previous infection.

Studies have shown that the overall risk of severe outcomes from an Omicron infection was lower than it was for Delta. But the risk of hospitalization among children younger than 10 did not significantly differ between Omicron and Delta, and Omicron infections led to a rise in hospital admissions of very young children.

Another study showed that in children, Omicron caused three times as many hospitalizations for respiratory infections compared with prior variants.

Now it seems BA.2 may be even more worrisome. In the U.K. the number of cases being recorded during the current BA.2 surge is much lower than what they saw during the Omicron wave in late December 2021—but the number of hospitalizations is almost equal.

One study that is yet to be peer reviewed suggests why BA.2 might be more severe. A team led by Kei Sato, a virologist at the University of Tokyo, created a synthetic version of BA.2 in the lab, and found that it grows faster in cells lining the nasal passage and has greater propensity to attack the lungs. This BA.2 look-alike virus also caused more severe disease in hamsters than its BA.1 counterpart.

The research suggests that mutations in BA.2’s spike protein—the part of the virus that binds to cells—enable it to dodge antibodies from a previous BA.1 infection.

Another study by Cowling and his team that has not yet been peer reviewed shows that in Hong Kong, the severity of a BA.2 infection is as bad as it was for the original SARS-CoV-2 variant for unvaccinated people of any age.

“In Hong Kong, and right now in Shanghai, I don't think [BA.2] is as mild as maybe people thought,” says Cowling.

Do vaccines still work for BA.2?
Available data show that the currently approved vaccines will prevent severe infection and hospitalization from COVID-19, more so in cases of BA.2 than BA.1.

Both Denmark and South Africa currently have high levels of immunity in their populations stemming from vaccination and infection, respectively. But data from both countries has shown there’s not much difference in severity between BA.2 and BA.1 infections. Reinfection with different subtypes of Omicron is possible, although in highly vaccinated Denmark, it was rare and mainly affected younger unvaccinated individuals.

Booster doses are also showing a lot of promise at protecting people from all forms of Omicron.

Various studies have shown that a third dose of a vaccine, or a breakthrough infection, can rekindle the immunity system’s memory to produce antibodies that work well against all variants, including Omicron. Harvard’s Barouch led a study showing that a third dose of the vaccine is a must for producing sufficient antibody levels against BA.2, just as is required for full protection against BA.1.

The Centers for Disease Control and Prevention (CDC) now recommends a fourth dose of vaccine for people age 50 and older, four months after the third dose; and additional dose for those with compromised immune systems, such as cancer patients. In a study not yet peer reviewed, a fourth dose substantially reduced breakthrough infection among healthcare workers with high exposure risk, even at the peak of the first Omicron wave. In addition, booster doses substantially reduce a person’s chances of transmitting the virus.

By contrast, the Hong Kong study revealed that the outcomes can be severe among unvaccinated people infected with any of the Omicron variants, including BA.2.

More variants on the horizon
As SARS-CoV-2 continues to spread and mutate globally, facilitated by pandemic fatigue, recombinants of variants keep forming; the recently discovered XE subvariant is a hybrid of BA.1 and BA.2 that is starting to spread; XE cases are relatively rare but have grown high enough that the U.K. Health Security Agency estimates it’s about 10 percent more contagious than BA.2.

Meanwhile, a new BA.2 descendent called BA.2.12.1 is spreading even more rapidly, causing 20 percent of all cases in the U.S. within a month of its discovery in early March. Earlier estimates show that BA.2.12.1 spreads faster than earlier strains and could be better at dodging the immune system’s antibodies.

“There are actually many new versions of Omicron, not just two. And in some cases, they do appear to be outcompeting even BA.2,” says Harvard’s Barouch.

This all means the U.S. “needs to recharge its vaccination program” to avoid a likely surge in the fall and winter, says Saad Omer, an epidemiologist who directs the Yale Institute for Global Health in Connecticut.

In addition to vaccines, masks have been shown to be effective in limiting the risk of COVID-19, both by reducing the spread of viral materials from an infected person and by reducing the chances of getting an infection. And avoiding an infection really should be the goal, experts stress: The aftereffects of COVID-19, including the array of symptoms collectively known as long COVID, can be debilitating.

“I thought if I got COVID, it would be the sniffles because that's the predominant narrative,” says Maldonado. “I want people to consider the risk when they think about things opening and not using a mask, because you don't know if it could be you.”

An uptick in COVID cases left Beijing scrambling to avoid a Shanghai-style lockdown [Fortune, 25 Apr 2022]

BY NICHOLAS GORDON

Panicked shoppers stripped supermarket shelves bare in Beijing after local health authorities ordered 3.5 million people in the city's largest district to undergo three rounds of mandatory COVID tests this week.

“The situation is grim”, a member of Beijing’s municipal party committee said on Sunday, saying the whole city needed to “act immediately” to prevent a surge in cases. Local officials have placed several buildings on lockdown and have suspended some in-person social activities to prevent the virus spreading. But Beijing health authorities believe the virus may have been “spreading invisibly” for a week.

Beijing authorities reported 19 new COVID cases on Monday morning, with almost 60 cases recorded since Friday. Reported cases have been traced mostly to Beijing's Chaoyang district, home to the capital's central business district as well as several of the city's foreign embassies.
Although Beijing's daily case number is low compared to infection levels in other major world cities, the capital is desperate to prevent its minor COVID spike from spiralling into an uncontrollable crisis, like the COVID outbreak currently gripping Shanghai.

Some Beijing residents, perhaps mindful of how a compulsory testing order in Shanghai evolved into an indefinite period of citywide lockdown that has left Shanghaiers desperate for food, are preparing for a prolonged lockdown in the capital. Shoppers are stockpiling food and other household supplies even as local officials pledge to ensure adequate supplies in order to avoid the food shortages seen during Shanghai’s lockdown.

Shanghai's lockdown tightens

A COVID outbreak in Beijing would further strain China’s COVID zero policy, which uses mass testing and lockdowns to completely suppress outbreaks when they emerge. While the policy has successfully controlled earlier outbreaks, it has not been able to control Shanghai's current outbreak of the Omicron variant.

Shanghai, a city of 26 million, is now in its fourth week of lockdown—though some parts of the city have been isolated for far longer. On Monday the financial hub reported almost 19,500 new COVID cases as well as 51 COVID deaths, marking a record high COVID fatality rate for the city.

Facing mounting COVID cases, Shanghai officials vowed to strengthen their COVID quarantine measures on Thursday evening. Soon after, social media posts showed authorities in several districts had erected wire fences around entrances to buildings with confirmed COVID cases, caging locked-down residents inside.

Public frustration is building over Shanghai's lockdown. A video clip compiling audio snippets from Shanghai's lockdown, including recordings of people pleading with local authorities to provide food and medical treatment, went viral on Chinese social media over the weekend, leading to a cat-and-mouse game between social media users sharing the video and China's internet censors attempting to block it.

Shanghai's COVID outbreak has roiled global supply chains too. The city is home to the world's largest port but COVID control measures have forced factories to close and prevented truckers from travelling across the city, leading to a severe backlog of container ships waiting to dock and unload their cargo.

Authorities have permitted some factories to reopen under a "closed-loop system", where workers live on-site and where entry is tightly controlled, but operations remain unstable. On Monday, the South China Morning Post reported that two factories owned by iPhone supplier Foxconn in Kunshan, a city that borders Shanghai, have been closed since Wednesday due to reported COVID cases among its staff.

COVID zero continues
Despite growing evidence of the economic and social costs of maintaining a COVID-zero policy, President Xi Jinping has called for the country to continue its zero-tolerance approach to managing COVID, leaving little room for his political underlings to waver.

Vice Premier Sun Chunlan, who is overseeing Shanghai's COVID response, said Sunday that the city would need to take “the strongest measures” to fight the outbreak, arguing that a prolonged coronavirus outbreak—ignoring that the current outbreak has lasted over a month—will only "cost more social resources.”

Beijing races to contain 'urgent and grim' Covid outbreak as Shanghai lockdown continues [CNN, 25 Apr 2022]

By Simone McCarthy

Hong Kong (CNN)Beijing is racing to track a Covid-19 outbreak that may have been spreading in the capital for a week, city authorities said over the weekend, raising the prospect more stringent restrictions could soon be implemented in line with other Chinese cities.

Chaoyang, one of the city's largest districts, announced Sunday that it would launch three rounds of mass testing of those who work and live in the district, some 3.5 million residents, according to the latest census.

The announcement came after 11 cases were detected in a 24-hour period, sparking panic buying in the district, which includes the business center and a number of foreign embassies, as residents rushed to stock up on basic goods in case of a lockdown, despite authorities' assurances there were ample supplies.

Beijing officials said over the weekend they were tracking cases across multiple districts and involving students, tour groups, and interior decoration workers. The capital recorded 19 new local cases on Sunday, bringing the total in the city since April 22 to 60, according to national health data released Monday morning.

"The city has recently seen several outbreaks involving multiple transmission chains, and the risk of continued and undetected transmission is high. The situation is urgent and grim," municipal official Tian Wei told reporters Saturday. "The whole city must act immediately."

The pressure to contain the outbreak in the capital comes as cases continue to grow in Shanghai, despite a failed weeks-long lockdown that has brought the financial hub to a halt. The city reported more than 19,000 new cases and 51 deaths on Sunday, according to official figures released Monday morning.

The daily death count marks a record high since city officials first reported fatalities in the city's ongoing outbreak last Monday, though questions have been raised about whether the numbers account for all fatalities.

In Beijing, authorities mobilized to curb transmission, placing several residential communities in Chaoyang under "control management," according to state media, using a term that typically means residents are barred from leaving the area while they undergo testing. A district official on Sunday warned that disruptions to business and work were inevitable in the course of fighting the outbreak.

Screening would be upped in tour groups in the city, after cases were detected among a group of mainly elderly tourists who were now under quarantine, officials said on Saturday. At least one village in a suburban district of Beijing linked to a positive case was also closed down as mass testing was carried out.

The rush to contain the outbreak comes as fears grow across China that more stringent measures could be in store as the country sticks with a stringent "zero-Covid" policy to eliminate the spread of the virus in each outbreak.

That policy has faced its most stark challenge since March 1 as the highly transmissible Omicron variant sparked several simultaneous outbreaks. Case counts have ballooned to unprecedented levels in China, driven by large outbreaks in northeastern Jilin province and Shanghai.

Lockdowns and enforced quarantines in Shanghai have sparked anger and desperation among citizens, who have struggled to access to food and medical care. The city had earlier said it was not going to implement a full, citywide lockdown, leaving many unprepared when officials rapidly changed course late last month.

Restrictions have also spilled over into other areas with several dozen cities rolling out some form of lockdown restrictions, according to a count earlier this month.