Fauci Warns About BQ.1 and BQ.1.1 COVID-19 Variants – What to Know and How to Stay Safe

It appears that we are recognizing new COVID-19 variants faster than ever before. This is, at least in part, likely due to a greater ability to monitor and sequence virus samples around the world.

Recall how 3 years ago, there were barely enough tests that could even detect the original Wuhan variant and no one was sequencing every sample hoping to find new variants. Identification of new variants is always cause for concern, considering that Delta was a new variant once, but are not a cause for panic.

Despite predictions by a variety of people that any day now the world will be devastated by a new variant, this has yet to happen. Yet, those sensationalists do serve to remind us that COVID-19 can still have nasty surprises for us in the future.

Right now, the main variant in the United States is BA.5, but other strains are on the rise. BA.4.6 is still behind but gaining ground for percentage of cases seen. Similarly, BQ.1 and BQ.1.1 are seeing rapid increases in percentage of cases on a regional basis.

Separating hype from actual science has been difficult during the past 3 years, but in general variants of concern are ones with high infectivity and multiple mutations in the spike protein and other key regions. These mutations can impact the virus’ ability to dodge the human immune system and effect which areas of the body are most involved along with severity of the infection.

Despite media generated names, such as “nightmare” variant and other concerns, there is no actual evidence that any of the variants being watched right now cause more severe disease. The downside is that mutations in variants such as BQ.1, BQ.1.1 and BF.7 may cause them to be resistant to some treatments, including bebtelovimab, tixagevimab, and cilgavimab.

Anything that limits our options for treatment makes patient care more complicated due to potential contraindications seen with different available treatments. The XBB variant is causing challenges in Singapore where reinfection rates have increased from 5% to 17%, allegedly due to this variant, suggesting some degree of immune escape by XBB.

What may be even more challenging for the world’s effort to both combat and recover from COVID-19 is variant splintering. Although at its basis, this is nothing different from what we observed throughout the pandemic, it has taken on a different scale.

Splintering refers to the dominance of different variants in different parts of the world. In the past, we may have seen a variant first detected in South Africa or India spread throughout Europe and then the United States.

A small number of variants—or even just a single variant—was thought to be responsible for most COVID-19 infections worldwide at any one time. However, we are now seeing entire countries or regions with dominant strains not yet impacting other portions of the world.

For example, Singapore is wrestling with XBB while most infections in the United States are still caused by BA.5. This can mean vaccine and treatment efficacy may differ from country to country, or at least region to region, at any one time.

Additionally, population immunity can differ from one region to another, making areas more susceptible to new variants brought in from abroad. Responding to these variants may now be even more complicated for drug-makers as they face an ever-changing game board of different variants with divergent mutations in the virus.

About the Author

Michael Blaivas, MD, MBA, FACEP, FAIUM, is chief medical officer at Anavasi Diagnostics.