A conversation with EricTopol about the BA.5 subvariant, why he’s so troubled by it, and America’s maddening capitulation to the virus
A transmission-electron micrograph of SARS-CoV-2 Omicron virus particles replicating within the cytoplasm of an infected CCL-81 cell . Photo: NIAID Integrated Research Facility/NIAD We’re still in the midst of one of the largest COVID waves of the pandemic, and it’s fueled by the Omicron BA.5 subvariant, the most contagious and most immune-evasive coronavirus strain yet. Scripps’s Dr. Eric Topol, who has been one of the loudest voices sounding the alarm over BA.
I recently had a long conversation with Topol about BA.5, why he’s troubled by it, and what the variant and its arrival portend for the future. Kaiser Southern California has also had two reports on vaccine effectiveness in their big network of patients, and they show the same attrition against hospitalizations as was seen in this much larger new comparison from the CDC.
Right, if a variant emerges that Paxlovid isn’t as effective against, that could suddenly leave us much more vulnerable to severe COVID again. There seems to be at least anecdotal evidence that a small number of people are now getting reinfected within a matter of weeks. What do you make of that? If some people think, Oh, it can’t get worse, it’s going to get better. We don’t know that. You have to plan for the worst-case scenario. And the worst-case scenario is that the virus further increases its immune evasion. It’s already picking up things that worked in prior versions of the virus: For instance, BA.2.12.1 and BA.5 have the same key L452R mutation that the Delta variant had. Anyone who thinks the virus doesn’t have room to evolve further is just not paying attention.
I agree that the animal reservoirs are also a concern because we’ve already seen spillover to many different species, including hamsters, mink, cats, and deer. So that’s another way that the virus can evolve, in an animal reservoir, and come back to spillover in humans. It’s a good question because we don’t really know how BA.5 evolved. We just know it did. And could BA.5 have come in from an immunosuppressed person de novo without BA.1? Possibly. We just don’t know. Basically new mutations showed up. Four key mutations showed up beyond BA.2 that have caused a lot of trouble, but we don’t really know precisely how that occurred.Yeah. The virus is under pressure from vaccines and prior infections and now Paxlovid.
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