covid landscape changing

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The landscape of COVID-19 is changing. The UK government seems to have decided that it is time for COVID-19 to be an endemic virus and have dropped all restrictions and it is now a free for all.

Cases of COVID-19 are on the up but luckily deaths are not matching, this due to vaccination and the nature of the COVID-19 variant in play at the moment (Omicron). So at some time it is likely that COVID-19 is coming your way. Remember the nature of symptoms are changing although we seem to be fixated on fever loss of smell and cough, omicron is associated with a runny nose, headache, fatigue, sneezing (if you have been vaccinated) sore throat (according to the ZOE app).

However, if you do get one of these

You may get an option of an anti-viral. What is on offer is changing all the time and depends on the prevailing variant of SARS-CoV-2. Alpha gave way to delta, which has given way to omicron and BA.1 varinat is giving way to omincron BA.2. As omicron became more prevalent bamlanivimab/etesivimab casiririvimab/imdevimab and regdavimab has become less useful. Sotrovimab is seen as the option against omicron (BA.1) but it is not good if you are infected with BA.2. Tixagevimab is no good against omicron

Seroneutralization of Omicron BA.1 and BA.2 in patients receiving anti-SARS-CoV-2 monoclonal antibodies. Bruel, T., Hadjadj, J., Maes, P., Planas, D., Seve, A., Staropoli, I., Guivel-Benhassine, F., Porrot, F., Bolland, W.-H., Nguyen, Y., Casadevall, M., Charre, C., Pere, H., Veyer, D., Prot, M., Baidaliuk, A., Cuypers, L., Planchais, C., Mouquet, H., Baele, G., Mouthon, L., Hocqueloux, L., Simon-Loriere, E., Andre, E., Terrier, B., Prazuck, T., Schwartz, O.10.1101/2022.03.09.22272066 

The SARS-CoV-2 Omicron BA.1 variant has been supplanted in many countries by the BA.2 sub-lineage. BA.2 differs from BA.1 by about 21 mutations in its spike. Human anti-spike monoclonalantibodies(mAbs)areusedforpreventionortreatmentofCOVID-19. However, the capacity of therapeutic mAbs to neutralize BA.1 and BA.2 remains poorly characterized. Here, we first compared the sensitivity of BA.1 and BA.2 to neutralization by 9 therapeutic mAbs. In contrast to BA.1, BA.2 was sensitive to Cilgavimab, partly inhibited by Imdevimab and resistant to Adintrevimab and Sotrovimab. Two combinations of mAbs, Ronapreve (Casirivimab + Imdevimab) and Evusheld (Cilgavimab + Tixagevimab), are indicated as a pre-exposure prophylaxis in immunocompromised persons at risk of severe disease. We analyzed sera from 29 such individuals, up to one month after administration of Ronapreve and/or Evusheld. After treatment, all individuals displayed elevated antibody levels in their sera and neutralized Delta with high titers. Ronapreve recipients did not neutralize BA.1 and weakly impaired BA.2. With Evusheld, neutralization of BA.1 and BA.2 was detected in 19 and 29 out of 29 patients, respectively. As compared to Delta, titers were more severely decreased against BA.1 (344-fold) than BA.2 (9-fold). We further report 4 breakthrough Omicron infections among the 29 participants. Therefore, BA.1 and BA.2 exhibit noticeable differences in their sensitivity to therapeutic mAbs. Anti-Omicron activity of Ronapreve, and to a lesser extent that of Evusheld, is reduced in patients sera, a phenomenon associated with decreased clinical efficacy.

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MouseDoctor

14 comments

  • Professor G recently wrote an article about where we are with covid and he seems surprisingly relaxed about out how covid has weakened and is becoming endemic!
    He seems to be of the view that we need to get on with our lives and not stress so much about masks etc particularly as we now have antivirals which this article does not really support does it?

    • We are where we are and we have to accept that certainly for the politicians and a large number of the population, COVID is done. This may be overly premature but unless a nastier variant emerges that is the case. Not much comfort to those more vulnerable I know but it’s a fact of life. I hope the anti-virals will be freely available and importantly in a timely manner to those who are more at risk

    • How COVID has weakened…yes and no, omicron is killing people is droves in the far east but agree it is mild/past infected in the vaccinated and it is becoming endemic as we embrace it….the lateral flow picture is mine….as for anti-virals good if you can get them

      • Regarding antivirals is it it only those within the community who received PCR tests as priority patients who are using them and is that why they are running out or?

        Apparently in America if you go into a pharmacy and test positive will automatically get antivirals

        Can they be prescribed and purchased privately in the UK?

          • It’s not the PCR test running out it’s the antivirals apparently so there must be a lot of clinically vulnerable people who have tested positive and have had them prescribed

        • Fyi- I’m terrified here in States because antivirals are still in short supply and require dogged persistence and a bit of luck to access.

  • From what I understand antivirals aren’t an option for many who might be on other medications, such as those to manage nerve pain or spasticity, given the huge number of drug interactions that occur with them. Please correct me if I’m wrong?! I don’t really believe the Govt’s endemic story either, I think it’s an attitude that places vulnerable people even more at risk. There may be less people dying and that’s fantastic but so many are being left with long Covid and I can’t imagine what that would be like on top of already having MS.

    • Yes Paxlovid has alot of drug-drug interactions that limits its use if you are using symptomatic agents.
      In Scotland 1 in 11 people have COVID in England and Wales it was 1 in 16. I know of someone who was infected 8 weeks ago who has been re-infected so is this virus going anywhere as there is nothing to stop it infecting…

      • Half life of the symptomatic agents varies quite a bit so with some simply stopping the symptomatic agent upon symptoms might work.

        May not be the nicest option but probably better than the alternative.

    • Completely agree about the endemic story! The worrying thing is some doctors including certain neurologists are saying that as well!

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