By Siddharth Mala
New Delhi: In a concerning turn of events, the emergence of a highly mutated COVID-19 variant, referred to as BA.2.86 or Pirola, has raised an alarm among scientists worldwide. This variant, marked by its significant spike protein mutations compared to its predecessors, has been detected in various countries, including the United States and Canada, following its initial identification in Denmark in July 2023.
As medical experts diligently observe the situation, questions linger about whether this new variant possesses greater transmissibility compared to current strains and whether it will assert dominance in the ongoing fight against COVID-19. ETHealthworld recently spoke to medical experts to gain further insights into this updated version of the COVID-19 virus.
According to the UK Health Security Agency (UKHSA), the Pirola variant has now been identified within the United Kingdom, with cases spreading across different regions and displaying no apparent travel links. Community transmission of the variant is suspected, although it is yet to be confirmed whether the new variant has a growth advantage over other circulating variants within the UK.
Citing a document of Centers for Disease Control and Prevention (CDC), Dr Neha Rastogi Panda, Consultant, Infectious Disease, Fortis Memorial Research Institute, Gurugram, said, “The difference between this Pirola virus is that it is a more mutated and more highly potent version of the previous omicron variants, including the recent Eris variant.” Another point of concern is the Coronavirus stands out as distinct and more mutation-prone. It possesses an additional 30 mutations, resulting in 30 structural alterations that enhance its fitness and make it more adept at spreading within the human body, added Dr Panda.
“The BA.2.86 variant of COVID-19 is characterised by a high number of spike protein mutations, which distinguish it from earlier versions of the virus,” said Dr Rakesh Gupta, Senior Consultant, Internal Medicine, Indraprastha Apollo Hospitals, while highlighting several notable features that distinguish Pirola from earlier versions.
Dr Gupta further emphasised a notably increased number of mutations, particularly within the spike protein of the virus. The spike protein is essential for the virus’s ability to enter human cells, and mutations within this region can potentially affect its transmissibility and the effectiveness of vaccines.
While there is uncertainty surrounding whether the Pirola variant is more transmissible than existing strains, preliminary evidence suggests that it might possess enhanced transmissibility. With 28 cases, an outbreak in Norfolk Care home, UK, demonstrated a high attack rate associated with this variant, implying that it may spread more easily in close-contact settings.
Concerns have arisen regarding the impact of the numerous spike protein mutations in the Pirola variant on vaccine efficacy. These mutations have the potential to influence the virus’s ability to evade the immune system, which could potentially reduce the effectiveness of current vaccines.
It is still too early to ascertain whether this variant will become dominant or represent a significant threat in the ongoing battle against COVID-19, added Dr Gupta.
While commenting on the effectiveness of current COVID-19 vaccines work against the Pirola variant, Dr Suneetha Nareddy, Senior Consultant, Infectious Diseases, Apollo Hospitals, Jubilee Hills, said,” Due to the genetic differences, there is a concern, that it may evade immunity from previous infections and available vaccines. However, as of today, there is no evidence of an increase in severe infections with this strain”, adding to that Dr Nareddy also informed that Moderna has announced that its vaccine produces a strong response to BA.2.86.
Commenting on the same, Dr Gupta emphasised “In many cases, current vaccines have shown some level of effectiveness against emerging variants, although the degree of protection may vary. Booster shots and updated vaccine formulations may be developed to address variants that are less susceptible to the immunity conferred by existing vaccines, these booster shots might contain modified versions of the spike protein from the new variant or target multiple variants simultaneously”
Dr Gupta further added that the need for variant-specific vaccines depends on several factors, including the prevalence and characteristics of the variant, its ability to evade immunity generated by previous infections or vaccinations, and the overall public health impact. Health authorities and vaccine manufacturers continually monitor the situation and adapt their strategies accordingly. It’s essential to stay informed through credible sources, such as the World Health Organisation (WHO) and CDC, for the most up-to-date information on COVID-19 variants and vaccine efficacy. Vaccine strategies may evolve as new variants emerge, and research provides more insights into their behavior and impact on vaccine effectiveness.
Dr Aklesh Tandekar, Head consultant, critical care, Wockhardt Hospitals, Mira road, suggested the reason why Pilora could be worse, the unusually high number of mutations on the mutated virus’s spike proteins, more than 30 compared to other common variants, more even than were discovered in 2021 on what remains the globally dominant Omicron variant. These spike proteins are what enable the virus to penetrate cells, a key step in their replication and the onset of disease. So if any of those mutations conveys a strong new advantage to the mutated virus that could result in more cases or worse disease or both. COVID remains in circulation with epidemiological data, such as hospitalisations and outbreak reports, suggesting a recent slight uptick in cases from a very low baseline.
Commenting on the nicknames of the COVID virus Dr Tandekar said “The new Pirola variant is known to scientists as BA.2.86. Under the Pango nomenclature system, devised in the early days of the pandemic based on previous tracking of influenza evolution that means it is the 86th generation of the second subvariant of BA. So a nickname is in order, to help people keep track in their minds. That practice started on a chat group of epidemiologists tracking the genetic evolution of COVID. First was Centaurus then Sphinx, Minotaur, Cerberus, and others. The common factor was that the names were taken from astrology or mythology, and often both. Kraken, the XBB1.5 Pirola shares its name with a minor planet, an asteroid about 40 kilometers across called 1082 Pirola, which was also named for Pyrola, the mint-flavored subarctic plant commonly known as wintergreen. The Greek letter convention is used for what the WHO calls variants of concern, a broader and more serious designation. Currently, the dominant variant of concern worldwide is Omicron, of which Pirola and the others are subtypes. Any future variant of concern sufficiently different from Omicron would be called Pi.”
“It has been seen that in the US and Denmark as far as it is slowly spreading, especially in the institutional centers, such as the nursing home, the daycare centers, so that makes it that they are attacking the more vulnerable population who are living in the groups and so the immunocompromised individuals such as the cancer patients, the patients on dialysis, uncontrolled diabetes, elderlies and too younger children are at the risk of this population,” stated Dr Panda.
Adding to it Dr Tandekar informed that the worry revolves around the possibility that this variant might possess a heightened ability to elude the immune reactions in individuals with COVID antibodies, whether acquired from prior infection, vaccination, or both. This does not imply that such individuals face an elevated risk of falling ill. Naturally, it can also infect those who haven’t been vaccinated or previously infected, thus lacking any COVID-specific immune defenses.
Collectively, experts have put forth a series of recommendations aimed at safeguarding individuals from the Pirola variant. To ensure their safety, people are advised to:
Firstly, staying well-informed is crucial. This entails keeping abreast of the most recent updates provided by local health authorities concerning the Pirola variant. This information encompasses its transmission patterns, associated symptoms, and any additional precautions that might be deemed necessary.
Secondly, vaccination should be seriously considered, if eligible. Getting a COVID-19 vaccine remains a pivotal measure for reducing the severity of illness and curbing the virus’s spread. Furthermore, adhering to basic hygiene practices is vital. Individuals should continue washing their hands regularly with soap and water for at least 20 seconds or using hand sanitizer containing at least 60 per cent alcohol.
Wearing masks is another key step, especially when indoors or in crowded environments, as per local health authority recommendations. Ensuring masks fit snugly and cover both the nose and mouth is essential and maintaining a safe physical distance from individuals outside one’s household, particularly in crowded or enclosed spaces, is also advised.
Considering the prevalence of the Pirola variant, non-essential travel should be postponed, particularly to areas with high transmission rates. Additionally, individuals must adhere to quarantine and testing guidelines outlined by local authorities if they have been in contact with a Pirola variant-infected person or have recently visited an affected area.
It remains imperative to adapt precautions and behaviors in accordance with the most up-to-date guidance and the specific conditions prevailing in one’s locale. Staying well-informed and heeding the counsel of health authorities is of paramount importance in safeguarding both oneself and the community against emerging variants of the virus.
