What is Pirola, the new variant of the Coronavirus?

What to Know About the New BA 2.86 COVID Variant?

 The CDC and the World Health Organization have dubbed the BA 2.86 variant of COVID-19 as a variant to watch. 

  So far, only 26 cases of "Pirola," as the new variant is being called, have been identified: 10 in Denmark, four each in Sweden and the United States, three in South Africa, two in Portugal, and one each the United Kingdom, Israel, and Canada. BA 2.86 is a subvariant of Omicron, but according to reports from the CDC, the strain has many more mutations than the ones that came before it. 

  With so many facts still unknown about this new variant, we asked experts what people need to be aware of as it continues to spread.

 What is unique about the BA 2.86 variant? 

It is unique in that it has more than three mutations on the spike protein," said Purvi Parikh, MD, an infectious disease expert at New York University's Langone Health. The virus uses the spike proteins to enter our cells. 

This "may mean it will be more transmissible, cause more severe disease, and/or our vaccines and treatments may not work as well, as compared to other variants," she said.

Good news ― hospital admissions with Covid plateaued last week, and at levels lower than recent troughs. none of this has anything to do with new variant BA.2.86 ("Pirola") which is a tiny tiny proportion of sequenced cases. "Eris" (EG.5.1) still not dominant either.

What do we need to watch with BA 2.86 going forward? 

"We don't know if this variant will be associated with a change in the disease severity. We currently see increased numbers of cases in general, even though we don't yet see the BA.2.86 in our system," said Heba Mostafa, PhD, director of the molecular virology laboratory at Johns Hopkins Hospital in Baltimore. 

"It is important to monitor BA.2.86 (and other variants) and understand how its evolution impacts the number of cases and disease outcomes," she said. "We should all be aware of the current increase in cases, though, and try to get tested and be treated as soon as possible, as antivirals should be effective against the circulating variants." 

What should doctors know?

Parikh said doctors should generally expect more COVID cases in their clinics and make sure to screen patients even if their symptoms are mild.

"We have tools that can be used – antivirals like Paxlovid are still efficacious with current dominant strains such as EG.5," she said. "And encourage your patients to get their boosters, mask, wash hands, and social distance."

How well can our vaccines fight BA 2.86?

"Vaccine coverage for the BA.2.86 is an area of uncertainty right now," said Mostafa. 

In its report, the CDC says scientists are still figuring out how well the updated COVID vaccine works. It's expected to be available in the fall, and for now, they believe the new shot will still make infections less severe, new variants and all. 

If you weren't already aware, BA.2.86 (Pirola) is in the US Midwest%u2014probably the first time a major variant has been seen in the Midwest before the major US coastal cities. 

Prior vaccinations and infections have created antibodies in many people, and that will likely provide some protection, Mostafa said. "When we experienced the Omicron wave in December 2021, even though the variant was distant from what circulated before its emergence and was associated with a very large increase in the number of cases, vaccinations were still protective against severe disease." 

What is the most important thing to keep track of when it comes to this variant?

According to Parikh, "it's most important to monitor how transmissible [BA 2.86] is, how severe it is, and if our current treatments and vaccines work." 

Mostafa said how well the new variants escape existing antibody protection should also be studied and watched closely. 

What does this stage of the virus mutation tell us about where we are in the pandemic?

The history of the coronavirus over the past few years shows that variants with many changes evolve and can spread very quickly, Mostafa said. "Now that the virus is endemic, it is essential to monitor, update vaccinations if necessary, diagnose, treat, and implement infection control measures when necessary."

With the limited data we have so far, experts seem to agree that while the the variant's makeup raises some red flags, it is too soon to jump to any conclusions about how easy it is to catch it and the ways it may change how the virus impacts those who contract it.

How do viruses mutate, exactly?

 It is natural for all viruses to mutate over time and such changes are particularly common in viruses that have RNA as their genetic material, as in the case of coronaviruses and influenza viruses.

Once a virus enters the human body, its genetic material — RNA or DNA — enters the cells and starts making copies of itself which can infect the other cells. Whenever an error occurs during this copying process, it triggers a mutation.

Occasionally, a mutation comes along when the genetic mistakes that are introduced while copying prove to be advantageous for the virus — these help the virus copy itself or enter human cells more easily. Whenever a virus is widely circulating in a population, the more it spreads and replicates, its chances of mutating increases.

What differentiates Pirola?

Speaking to the Yale School of Medicine, Anne Hahn, a postdoctoral associate who leads the Yale SARS-CoV-2 Genomic Surveillance Initiative, said that this is a “much more interesting subvariant”, when compared to the Omicron subvariant known as XBB.1.9. That variant initially spread quickly but did not overwhelm populations at a significant scale.

The same report noted that it has been detected by surveillance labs in Israel and Denmark and later in labs in England, South Africa, and the United States.

According to Fortune, new data released on Twitter on Friday evening by Ben Murrell, a researcher at the Karolinska Institutet in Sweden, showed that blood samples taken last week performed better than expected when it came to neutralising BA.2.86.

Dr Eric Topol, a professor of molecular medicine at Scripps Research and founder and director of the Scripps Research Translational Institute, said in a tweet that the findings offer a more positive outlook for how new boosters might protect against the highly mutated variant.

What precautions need to be kept in mind against this new variant?

Roberts said that the US Centres for Disease Control and Prevention’s (CDC) preliminary report says there is not enough evidence right now to conclude whether Pirola could lead to more severe disease, death, or hospitalisation. “We don’t yet know how transmissible it is, and it’s very possible it doesn’t spread that well and we would see this peter out in a couple of weeks,” Dr Roberts said.
He added, “But it’s important to remember that it’s still the same virus at its core, so the same prevention methods — masking, vaccination, and hand-washing, among others — can help people avoid infection.”

Sources:

CDC: "Risk Assessment Summary for SARS CoV-2 Sublineage BA.2.86."

Purvi Parikh, MD, assistant professor, NYU Langone Health, New York City. 

Heba Mostafa, PhD, director, molecular virology laboratory, Johns Hopkins Hospital, Baltimore.

GISAID: "Tracking of hCoV-19 Variants."