The Latest COVID Variant: All About the Emerging BA.2.86 Strain

The Newest COVID-19 Variant: BA.2.86

As the COVID-19 pandemic continues to evolve, new variants of the SARS-CoV-2 virus continue to emerge. The latest variant gaining attention from public health officials is BA.2.86, a subvariant of Omicron. This new strain, sometimes called "Pirola", has raised concerns due to its unique mutations and rapid spread in some regions.

Key Facts About BA.2.86

• Classified as a sublineage of the Omicron BA.2 variant
• Nicknamed "Pirola" based on naming system by scientist Paolo Pirola
• Defined by 7 additional spike protein mutations not seen in BA.2
• Designated as a "Variant Under Monitoring" by UK health officials
• Spreading rapidly in parts of New York and other northeastern U.S. states

Origin and Spread of BA.2.86

BA.2.86 is believed to have first emerged in the United States in late January 2022. Cases were initially concentrated in New York but have since been detected in multiple other states.

In New York, BA.2.86 represented nearly 14% of sequenced cases by mid-April 2022. It has also been found in Connecticut, Massachusetts, Rhode Island, Florida, Texas, Wisconsin, and Washington state.

Outside the U.S., BA.2.86 cases have been documented in the UK, Germany, India, Australia, and Canada. Global spread is expected as monitoring expands.

Key Mutations in BA.2.86

BA.2.86 contains all of the mutations present in the original BA.2 strain. However, it also has 7 additional spike protein mutations not found in other Omicron subvariants:

• L452Q
• F486V
• Q493R
• Y505H
• D614G
• H741N
• N960K

Some of these mutations, like D614G, have been seen before and are associated with increased transmissibility. The impact of the other mutations is still under investigation.

Concerns About the BA.2.86 Variant

The emergence of BA.2.86 is concerning for several reasons:

Rising Prevalence

In parts of the northeast U.S., BA.2.86 cases are doubling every week to 10 days. This rapid growth rate signals the variant may have a competitive advantage over other Omicron strains.

High Number of Mutations

BA.2.86 has a relatively large number of unique spike protein mutations compared to other Omicron subvariants. The more mutations a variant has, the more chances it has to evade immunity and be more transmissible.

Unknown Impact

The properties and precise effects of BA.2.86 are still unknown. More data is needed to determine if it causes more severe disease, evades immunity, or impacts vaccine effectiveness.

Reinfection Potential

Reinfections have been rising globally, suggesting immunity from previous Omicron infection is waning. BA.2.86 may have mutations that make reinfection more likely.

Timing of Emergence

Arrival later in the Omicron wave raises concerns that BA.2.86 could spark a new surge in cases just as declining trends were being observed.

BA.2.86 Symptoms and Severity

So far, there is no evidence that BA.2.86 causes more severe disease than previous Omicron subvariants. Reported symptoms remain similar to earlier strains and include:

• Cough
• Fatigue
• Congestion
• Runny nose
• Sore throat
• Headache
• Muscle pain
• Fever
• Loss of taste/smell

Rates of hospitalization, ICU admission, and death have not increased in areas where BA.2.86 has spread. However, more data is still needed on its precise virulence.

High-Risk Groups

As with previous strains, the elderly, unvaccinated, and those with underlying conditions appear to face the highest risks for severe disease from BA.2.86 infection.

BA.2.86 Vaccine Efficacy

How well current COVID-19 vaccines protect against the BA.2.86 variant is still under investigation. In general, available vaccines provide less protection against infection but remain effective at preventing severe COVID-19.

Infection Prevention

Early lab studies suggest vaccination provides modest neutralization of BA.2.86 compared to the original strain. However, real-world vaccine effectiveness studies are still needed.

Severe Disease Prevention

Existing vaccines are expected to maintain strong protection against hospitalization and death from BA.2.86, particularly after a booster dose. However, some decline in effectiveness over time is likely.

Booster Doses

Booster shots restore antibody levels and provide improved protection against emerging variants like BA.2.86. Boosters are especially important for those at highest risk.

Treatment Options for BA.2.86

The same treatment options proven effective against earlier Omicron strains are expected to work for BA.2.86 infection. However, some monoclonal antibody treatments are less successful against this subvariant.

Paxlovid

The antiviral Paxlovid remains highly effective at preventing severe disease from BA.2.86 and other Omicron subvariants if given early in infection.

Remdesivir

Remdesivir has shown positive results in reducing hospital stays for high-risk patients infected with BA.2.86 and other circulating strains.

Monoclonal Antibodies

Some monoclonal antibody treatments like sotrovimab have reduced activity against BA.2.86. Updated guidelines advise using bebtelovimab, the monoclonal antibody with highest potency versus this subvariant.

Other Supportive Care

Additional therapies like steroids, oxygen, and fluids remain essential tools for managing severe COVID-19 illness caused by BA.2.86 or other variants.

Outlook and Concerns Going Forward

Experts say several factors need close monitoring as BA.2.86 continues spreading globally:

Growth Trajectory

Whether BA.2.86 continues its rapid growth or plateaus will determine its impact. Sustained rapid increases suggest it could become dominant in affected regions.

Severity Profile

Continued data collection is needed on the virulence and severity profile of BA.2.86 infections compared to prior variants.

Reinfection Rates

If reinfections make up a high proportion of BA.2.86 cases, it suggests this variant may evade immune defenses from previous infection.

Vaccine Breakthroughs

Real-world vaccine effectiveness studies will reveal whether vaccines maintain adequate protection against infection and severe disease.

New Mutations

Monitoring is needed for any additional spike mutations that could make BA.2.86 even more transmissible or able to evade immunity.

Public health officials recommend maintaining vigilance and using all available tools vaccines, treatments, masking, and testing to respond to the evolving threat posed by new variants like BA.2.86.

Key Takeaways

• BA.2.86 is a new subvariant of Omicron spreading rapidly in parts of the U.S.
• It contains concerning mutations associated with immune evasion.
• The precise impacts on transmission, disease severity, and immunity are still under investigation.
• Vaccination, treatments, and mitigation measures remain essential to combat BA.2.86.
• Public health monitoring for changes in growth, reinfections, and mutations is ongoing.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.