Just one year ago, on November 22, a new variant of SARS-CoV-2 was detected in South Africa. The speed with which the World Health Organization was quick to raise the alarm about omicron suggested that it was going to change the rules of the game. That’s how it was: in Spain, the sixth wave of Covid infected more people than the previous five.
The WHO classified the new variant (known as B.1.1.529 in the most widely used virus classification, Pango) as ‘of concern’ just four days after its detection due to the high number of mutations it accumulated compared to the previous ones. previous. Immediately, The European Union suspended flights from seven African countries, but it was already late: the first case in Spain was detected less than a week after the African notice, on November 30. The alarm was such that the masks were reintroduced in open spaces.
The threat posed by omicron dashed hopes that vaccination would subdue the virus, although this – together with the lesser ferocity of the new variant – proved effective so that all this flow of infections did not turn into hospitalizations and deaths at same rate as in previous waves.
[El fin de la pandemia, cada vez más cerca: qué tiene que ocurrir para que la OMS lo declare]
Although the impact of omicron has deflated throughout 2022, experts have been warning that the arrival of cold and the change in habits associated with bad weather (more coexistence indoors, closed windows, etc.), together with the rise of most of the anti-Covid measures taken in the previous two years, could reverse the situation.
The strong irruption of two viruses that had been set aside by SARS-CoV-2, the flu and the respiratory syncytial virus or RSV), since the beginning of autumn heralded a ‘tripledemic’, putting the entire health system on guard in as a whole in the face of the threat of the collapse of the primary school and hospital.
However, the virus always surprises. A handful of new variants, arising from omicron but also from virus recombinations, has shown even higher transmission than the original omicronin addition to an ability to escape antibodies generated by previous infections or vaccines, currently outdated: BA.2.75, BA.4.6, BF.7, BQ.1.1, XBB…
Of these, the most fearsome appeared BQ.1.1 because it escaped the immunity generated by all available monoclonal antibodies. It is also expected to be the predominant variant in the northern hemisphere winter. However, in France, where it already accounts for 25% of new infections, compared to 7% of its ‘sister’ BQ.1, income has begun to grow but only slightly, while ICUs remain stable.
[BQ.1.1, BF.7 y BA.2.75.2: así son las variantes que protagonizarán el temido cuarto invierno de la Covid]
In the United States, much of the same has happened. If the statements of your president seemed fearful to some, Joe BidenAnnouncing that “the pandemic is over” last September, his top Covid adviser, Anthony Fauci, has confidently asserted that the country is prepared and that what was seen with omicron will not be repeated.
Some have claimed that BQ.1.1 may be the first variant with marked immune evasion that does not induce a new wave. In Spain, together with BQ.1 they already account for 46.4% of the new cases And, although it is early to judge its effect on hospitalizations, the incidence of the virus seems to have moderated in the last month after rising for most of October.
My review of the BQ.1.1 variant, on its path to dominance in the United States and many countries in Europe.
The first #SARSCoV2 variant with a marked increase in immune evasion not to have induced a wave.https://t.co/DqMJ7LAALu
—Eric Topol (@EricTopol) November 19, 2022
“Right now we have a variant that is highly transmissible but also significant immunity achieved by vaccines and previous infections,” he recalls. Angela Dominguezspokesman for the Spanish Society of Epidemiology.
This protection “is decreasing but we are already vaccinating the most vulnerable groups, which means a brake on the transmission of SARS-CoV-2.” That is why, he points out, the infection is especially affecting young children, who do not yet have a vaccine available. “Fortunately, that’s not translating to hospitalizations.”
The professor of Preventive Medicine and Public Health at the University of Barcelona acknowledges that it was expected that, with the cold, transmission would increase again. “And, in fact, that is the case. But since there is a large population immunized, there is a brake.” Therefore, she believes that “We have enough numbers so that what happened last year is not repeated“.
Of the feared ‘tripledemic’, this season it is SARS-CoV-2 that is lagging behind. RSV and flu cases have risen notably in recent weeks according to the latest report from the Carlos III Health Institute, while Covid is experiencing slight and sustained growth, without shocks. In hospitals, the classic viruses are skyrocketing and SARS-CoV-2 maintains the same low profile.
[Los hospitales, ante la peor ola de bronquiolitis que se recuerda: “Hay más niños que nunca y más graves”]
Does this mean that we are close to finally reaching herd immunity? “The concept has to do with transmission, not with the severity of the disease,” he clarifies Salvador PeiroPublic Health researcher at Fisabio, the Foundation for the Promotion of Health and Biomedical Research of the Valencian Community.
“The situation we have is different. There is Covid: a lot, I would say, and of course much more than what the case figures say, which only those over 60 look at. And there is a lot of reinfection. But vaccines – which somewhat reduce transmission, especially if they are close in time – and previous infections make severe disease rare.”
Despite the fact that the new variants show escape –in vitro– to the antibodies generated by previous infections and vaccines, “our dearest B lymphocytes, cellular immunity, recognize them just the same and make it difficult to pass on to severe disease.”
The slowness of vaccination
The seroprevalence survey of the Valencian Community gave 50% of people who passed the Covid in April. “I would not talk about group immunity. Another thing is that, for so many millions of people affected, if we extrapolate the figures to all of Spain, we have not done so badly at the level of hospitalizations.” But if there are millions of infected, “as much as the rate of severe cases goes down, you end up having a significant drip“.
Hence, the administration of the second anti-Covid booster in the vulnerable population (chronic patients and those over 60 years of age) is essential. And our country is slow: two out of three over 80 years of age already have their fourth dose of the vaccine, but only 47.19% of those between 70 and 79, and 27.35% of those between 60 and 69 years.
This slowness, for Ángela Domínguez, is “a facility that we give the virus so that it can act on people whose immunity has decreased. We have a long way to go and it is important that all the people included in the risk groups are vaccinated”.
Although she is confident that the virus will not give unpleasant surprises, the epidemiologist recalls that the virus continues to circulate and that the appropriate measures, that is, vaccination, yes, but also masks, personal distance or hand hygiene, “contribute to stopping the transmission”.
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