Post by Nadica (She/Her) on Aug 16, 2024 0:33:12 GMT
FLiRTing with danger as SARS-CoV-2 variants evolve - Published Aug 14, 2024
As the Paris Olympics draws to a close, the event has been a triumph for sporting achievements but has been marred by dozens of athletes testing positive for SARS-CoV-2. This has prompted concerns among the Olympic community about containing further viral transmission ahead of the Paralympics. The numbers infected are likely an underestimate and COVID-19 cases have also been steadily rising in communities in several countries as a result of circulating new omicron-derived variants, the so-called FLiRT variants.
Recent FLiRT variants are named with a JN or KP prefix and have developed the same set of mutations in the spike protein through convergent evolution. They have demonstrated their viral fitness by becoming the dominant circulating variants. The relaxation of quarantine measures, lack of testing, and fewer vaccinations has provided the space for these variants to continue to circulate and evolve. The lack of community and home-based testing, waning immunity post-vaccination, and the generally milder disease experienced by the majority of those infected, means tracking case numbers is also challenging; viral levels are primarily being measured via wastewater and health-care case notifications. SARS-CoV-2 has previously shown seasonal variations in transmission and infection levels, and with autumn fast approaching in the Northern hemisphere, the FDA has called for the development of new monoclonal vaccines to target these FLiRT variants, and WHO also released similar recommendations earlier this year. Pfizer, Moderna, and Novavax are therefore developing vaccines targeting JN-1 or KP-2 variants, with the earliest vaccine expected within weeks in the USA.
However, the costs of these vaccines will not be covered by the government, except for the poorest and most vulnerable groups.
As these new variants emerge, and become dominant, developing vaccines in time to target them is difficult with companies often playing catch up, but even vaccines targeting previous variants are likely to have some benefit through broader immune effects and cross-reactivity. The importance of continuing to invest in vaccine development and encouraging uptake is highlighted by the predicted number of lives saved during the pandemic through vaccination programmes. A report in this issue by Margaux Meslé and colleagues estimated that 1·6 million lives (range 1·5–1·7) were saved in 34 countries in the WHO European region from December, 2020 to March, 2023 in those aged 25 years and older. The benefits were especially noted in those aged older than 60 years and included the omicron period. Vaccination has also been reported to reduce the number of people developing long COVID symptoms. Martí Català and colleagues reported data from more than 25 million people in Estonia, Norway, Spain, and the UK showing positive effects of vaccination on the development of one of 25 WHO-listed long COVID symptoms between 90 and 365 days after a positive PCR test or clinical COVID-19 diagnosis.
Long COVID affects multiple organs, and there are differing definitions, although symptoms persisting for more than 3 months after acute COVID-19 has gained the most traction in the community. A Review by Trisha Greenhalgh and colleagues in The Lancet noted the proportion of people with long COVID after acute infection is controversially reported as between 45% and 57%, with millions now affected globally. The quality of available data, lack of baseline information, differing definitions, and variable recognition of the condition has hampered such estimates. The Lancet authors call for increased research into the pathophysiological mechanisms of long COVID to enable the development of targeted treatments; better health-care services and infrastructure to support this growing group of people; continuity of care and appropriate specialist referral to multidisciplinary care; and engagement of societies, partnering with patients and advocates, and formal education programmes for health-care providers.
These efforts must go hand-in-hand with the continued development and delivery of vaccination programmes as, worryingly, long COVID cases are seen in patients with mild disease, and not just in those with the more severe clinical trajectories. Substantial inequity continues in access to vaccines, both between and within countries, and with governments no longer funding vaccinations outside of the most vulnerable groups, global cost of living challenges for many mean priorities will likely be directed elsewhere. Consequently, divisions in access to vaccines will widen allowing the SARS-CoV-2 virus, and its new variants, to circulate and evolve unchecked.
As the Paris Olympics draws to a close, the event has been a triumph for sporting achievements but has been marred by dozens of athletes testing positive for SARS-CoV-2. This has prompted concerns among the Olympic community about containing further viral transmission ahead of the Paralympics. The numbers infected are likely an underestimate and COVID-19 cases have also been steadily rising in communities in several countries as a result of circulating new omicron-derived variants, the so-called FLiRT variants.
Recent FLiRT variants are named with a JN or KP prefix and have developed the same set of mutations in the spike protein through convergent evolution. They have demonstrated their viral fitness by becoming the dominant circulating variants. The relaxation of quarantine measures, lack of testing, and fewer vaccinations has provided the space for these variants to continue to circulate and evolve. The lack of community and home-based testing, waning immunity post-vaccination, and the generally milder disease experienced by the majority of those infected, means tracking case numbers is also challenging; viral levels are primarily being measured via wastewater and health-care case notifications. SARS-CoV-2 has previously shown seasonal variations in transmission and infection levels, and with autumn fast approaching in the Northern hemisphere, the FDA has called for the development of new monoclonal vaccines to target these FLiRT variants, and WHO also released similar recommendations earlier this year. Pfizer, Moderna, and Novavax are therefore developing vaccines targeting JN-1 or KP-2 variants, with the earliest vaccine expected within weeks in the USA.
However, the costs of these vaccines will not be covered by the government, except for the poorest and most vulnerable groups.
As these new variants emerge, and become dominant, developing vaccines in time to target them is difficult with companies often playing catch up, but even vaccines targeting previous variants are likely to have some benefit through broader immune effects and cross-reactivity. The importance of continuing to invest in vaccine development and encouraging uptake is highlighted by the predicted number of lives saved during the pandemic through vaccination programmes. A report in this issue by Margaux Meslé and colleagues estimated that 1·6 million lives (range 1·5–1·7) were saved in 34 countries in the WHO European region from December, 2020 to March, 2023 in those aged 25 years and older. The benefits were especially noted in those aged older than 60 years and included the omicron period. Vaccination has also been reported to reduce the number of people developing long COVID symptoms. Martí Català and colleagues reported data from more than 25 million people in Estonia, Norway, Spain, and the UK showing positive effects of vaccination on the development of one of 25 WHO-listed long COVID symptoms between 90 and 365 days after a positive PCR test or clinical COVID-19 diagnosis.
Long COVID affects multiple organs, and there are differing definitions, although symptoms persisting for more than 3 months after acute COVID-19 has gained the most traction in the community. A Review by Trisha Greenhalgh and colleagues in The Lancet noted the proportion of people with long COVID after acute infection is controversially reported as between 45% and 57%, with millions now affected globally. The quality of available data, lack of baseline information, differing definitions, and variable recognition of the condition has hampered such estimates. The Lancet authors call for increased research into the pathophysiological mechanisms of long COVID to enable the development of targeted treatments; better health-care services and infrastructure to support this growing group of people; continuity of care and appropriate specialist referral to multidisciplinary care; and engagement of societies, partnering with patients and advocates, and formal education programmes for health-care providers.
These efforts must go hand-in-hand with the continued development and delivery of vaccination programmes as, worryingly, long COVID cases are seen in patients with mild disease, and not just in those with the more severe clinical trajectories. Substantial inequity continues in access to vaccines, both between and within countries, and with governments no longer funding vaccinations outside of the most vulnerable groups, global cost of living challenges for many mean priorities will likely be directed elsewhere. Consequently, divisions in access to vaccines will widen allowing the SARS-CoV-2 virus, and its new variants, to circulate and evolve unchecked.