Raising the alarm early on the COVID -19 variant BA.2.86 – Kudos to the BMJ

Dear Editor

The BMJ needs to be commended on raising the alarm over BA.2.86 (1), also known as Pirola. It has more than three mutations on the spike protein and has the potential to be more transmissible, cause severe disease and the current vaccines and treatments being less effective (2) although no definitive conclusions can be drawn as yet due to limited data. The 30 mutations it has on its spike protein is similar to the number of mutations that differed between the Delta strain and Omicron, and there are concerns it may possess the potential to bypass both vaccines induced and naturally induced immunity (3).

As this issue is of great interest to the public, Channel 4 the Public Service Broadcaster released its FactCheck titled “Is the new BA.2.86 Covid variant spreading in the UK?” (4). Reports have emerged that BA.2.86 was the cause of a care home outbreak in Norfolk (5). Cases were reported from a Care home in Norfolk to the UK Health Security Agency (UKHSA) as the cases were higher in number and severity compared to previous outbreaks. As of 5 September 2023, 33 out of 38 residents have tested positive, an attack rate of 86.6%. Of the 43 samples sent for sequencing, 22 residents and 6 staff were identified as BA.2.86 and the rest could not be sequenced (6-8).

On the 9th of September UKHSA updated its technical briefing 53 (8) and acknowledged that the rate of detection of new sequenced cases cannot be used as an indicator of growth due to limited and lagging genomic surveillance globally. UKHSA made an important admission commenting on the high attack rate seen in the Norfolk care home outbreak – “in contrast to recent laboratory data suggesting lower infectivity in vitro, this is an early indicator that the variant may be sufficiently transmissible to have impact in close contact settings”. UKHSA has partly answered one of the questions posed in the BMJ news item (1), which is “At the time of writing, little is yet known about the transmissibility of BA.2.86”. Now we know that it is transmissible in closed settings due to the high attack rate seen. UKHSA briefing also highlighted some of the constraints facing the scientists including the limitation of the current surveillance system. It is worth noting the recent reporting of BA.2.86’s high infectivity in CaLu-3 cells – the highest among all Omicron variants tested (9). Calu-3 epithelial cells are isolated from lung tissue and this cell line is valuable for SARS-CoV-2 propagation in vitro.

The UK government brought forward the vaccination drive this year and according to NHS England (10), “ … the new covid variant presents a greater risk now, which is why we will be ensuring as many people as possible are vaccinated against covid sooner”. There are already calls to expand the eligibility criteria for COVID vaccination (11), and the All-Party Parliamentary Group on coronavirus has called for extending the booster programme to people aged 50 to 64.

We are entering a potentially anxious time with no dedicated COVID-19 surveillance systems and the emergence of BA.2.86. Hence unless we are alert, we might miss some of the early warning signs of an impending wave. However, the British Public is fortunate that we have a Public Health blue light service in the form of UKHSA (12), a world leading organisation with a team of dedicated Public Health experts, scientists and epidemiologists who have time and again shown that they can rise up to the challenge as demonstrated recently by their swift and successful management of BA.2.86 Norfolk care home outbreak.

Dr Padmanabhan Badrinath, Freelance Consultant in Public Health Medicine, Colchester, UK
[email protected]

Disclaimer: The views expressed here are the professional views of the author and in no way represent the views of any organisation the author has been associated with at present or in the past.

References
1. Looi MK. Covid-19: Scientists sound alarm over new BA.2.86 “Pirola” variant. BMJ 2023; 382: p1964.
2. Grant K. Q&A: What to Know About the New BA 2.86 COVID Variant. August 31, 2023. Internet. Available from https://www.medscape.com/s/viewarticle/996031 . Accessed 9 September 2023.
3. Macmillan C. Will BA.2.86 (‘Pirola’), the New Coronavirus Variant, Increase COVID-19 Cases? August 31, 2023. Internet. Available from https://www.yalemedicine.org/news/new-covid-variant-ba286-pirola Accessed 9 September 2023.
4. 4 News. FactCheck. Is the new BA.2.86 Covid variant spreading in the UK? 8 September 2023. Internet. Available from https://www.channel4.com/news/factcheck/factcheck-is-the-new-ba-2-86-cov… Accessed 9 September 2023.
5. Roxby P. BBC News. New Covid variant BA.2.86 behind Norfolk care home outbreak. 8 September 2023. Internet. Available from https://www.bbc.co.uk/news/health-66750359 Accessed 9 September 2023.
6. Topol E. Ground Truths. The BA.2.86 variant and the new booster. 8 September 2023. Internet. Available from https://erictopol.substack.com/p/the-ba286-variant-and-the-new-booster . Accessed 9 September 2023
7. Schnirring L. CIDRAP. University of Minnesota. 8 September 2023. Internet. Available from https://www.cidrap.umn.edu/covid-19/uk-reports-nursing-home-covid-outbre… Accessed 9 September 2023.
8. UKHSA. Research and analysis. SARS-CoV-2 variant surveillance and assessment: technical briefing 53 Updated 9 September 2023. Internet. Available from https://www.gov.uk/government/publications/investigation-of-sars-cov-2-v… Accessed 9 September 2023.
9. Shan-Lu Liu. Twitter.com. 10 September 2023. Internet. Available from https://twitter.com/ShanLuLiu1/status/1701029792571592936 Accessed on 11 September 2023.
10. Lacobucci G. Covid-19 and flu boosters to start earlier than planned, with extra funding for GPs. BMJ 2023;382:p2004.
11. Mason R, Gregory A, Campbell D. UK MPs press for wider Covid vaccine access amid concern over new variant. The Guardian. 8 September 2023. Internet. Available from https://www.theguardian.com/world/2023/sep/08/uk-mps-press-for-wider-cov… Accessed 9 September 2023.
12. Badrinath P. Hats off to the UK Health Security Agency – Our own blue light service for Public Health. 12 December 2022. Internet. Available from https://www.bmj.com/content/379/bmj.o2941/rr-1 Accessed 9 September 2023.