The failing effectiveness of COVID-19 monoclonal antibodies against BA.1, BA.4-5, BA.4.6, BA.2.75, BJ.1 and BQ.1.1

[AussieNeil]

This post is in response to a couple of recent posts highlighting concerning changes in the effectiveness of our monoclonal antibody armament against new COVID-19 variants:-

A COVID treatment wanes: New variants outsmart most monoclonal antibodies : NPR

healthunlocked.com/cllsuppo... by  patagozon

4 of 5 treatments for covid in immunocompromised being removed in NHS

healthunlocked.com/cllsuppo... by  Harvist

 sparkler and  cujoe have also noted the changes in the effectiveness of COVID-19 medications and  CLLerinOz summarised them in a reply to our pinned post in SARS-CoV-2/COVID-19 information in the last week here: healthunlocked.com/cllsuppo... healthunlocked.com/cllsuppo...

Dr Eric Topol illustrates the worrying situation in his Substack article The BQ.1.1 variant story erictopol.substack.com/p/th... with the accompanying graphic, where he says, "A new report by Arora and colleagues from Germany compared resistance to monoclonal antibodies for many of the most troublesome new variants (mutation map of spike protein below) and, unlike the others assayed, showed that BQ.1.1 demonstrates resistance to all available monoclonal antibodies."

Later in his article, Dr Topol notes "Under pressure from prior infections, vaccinations, boosters and combinations of these, the virus is having a harder time finding new hosts. To date, BQ.1.1 has not been able to induce a new wave in 2 countries, a very positive sign. Sure, there are Omicron lineages with 7 mutations on top of BA.2, like CH.1.1 and BQ.1.1.10, and 8 or 9 mutations (XBB.3 and 4) but are they going to look any different? You might think that BQ.1.1 would qualify as an acid test and so far its outcome looks far more favorable than initially projected. For further context, all of this is happening with minimal mitigation, such as the very low use of masks or avoidance of indoor gatherings. No less in colder weather, heading into winter." (Though as I have recently posted, it's high or low indoor relative humidity that increases the spread of the coronavirus that causes COVID-19, more so than the season. healthunlocked.com/cllsuppo....

Dr Topol does share some good news with regard to the bivalent booster.

There have been 2 reports that the BA.5 bivalent booster has some neutralizing antibody cross-protection against BQ.1.1. First was Emory’s report, that showed a >5-fold increased neutralizing antibody response with the bivalent vs BQ.1.1 as compared with a single original booster.and then the U Texas Galveston Shi lab report with about a 5-fold increased neutralizing antibody response for the bivalent to BQ.1.1 compared to the monovalent, original booster. Both of these studies showed a similar bivalent benefit vs. BA.2.75.2, a variant in the wings that could pick up steam in the months ahead.

He also specifically addresses the concern of our community.

Another concern is that BQ.1.1 is going to cause some trouble. It has blown through Evusheld protection, a vital help for immunocompromised people, and left us without a monoclonal antibody treatment that works for people at high-risk not responding to (or unable to take) Paxlovid. Sadly. we see no new monoclonal on the short term horizon to take their place, even though so many very broad neutralizing antibodies (with potential of being variant-proof) have been identified in many academic labs.

Remember, the size of the SARS-CoV-2 virus hasn't changed. Well fitted high filtration masks (N95, FFP2, etc) work equally well across all variants . As Dr Topol closes, And, of course, there are things you can do to maximize protection (like a bivalent booster and high quality masks).

Neil

[cujoe]

Another masterful summary, Neil. We all benefit daily from your tireless efforts. Many Thanks!

[Jetliz]

Just a BIG THANK YOU to this updated information so valuable in knowing the current situation!

Julia

[bennevisplace]

Neil, thanks for summarising this report.

In less than 2 years the entire field of SARS-COV2-targeting monoclonal antibody meds, starting with Bamlanivimab, has been picked off by the mutating virus. Perhaps it's telling us that MAbs are just not the way to go.

The pandemic has given birth to successive kingpin variants, each more evasive and transmissible than its predecessor. A new, highly resistant strain like BQ.1.1 preoccupies scientists in the same way his humanoid creation fascinated Dr Frankenstein. It's not necessarily going to conquer the world though, see cov.lanl.gov/content/index

Reported new infection rates in the US are holding steady at about 40,000 a day, in the UK ditto 3,300 a day. In Australia it's climbing, currently 47,000, not sure what to make of that. Neil?

[Fran57]

Thanks so much Neil.

Your information, research and knowledge are invaluable to us all.

Stay safe,

Fran 😷

[wmay13241]

As Neil said: "Well fitted high filtration masks (N95, FFP2, etc) work equally well across all variants ."👍👍👍

[janvog]

The people in Japan and others in East Asia have been wearing face masks since decades while in public settings. Obviously we can't wear masks forever and everywhere. But I at 88 with CLL under good control at present, I will be wearing a face mask while in public and when possible in medical environments. The point is to diminish the probability of all airborn infections. For myself the mask will be a stable just like diet and exercise.

[SofiaDeo in reply to janvog]

But we *can* mask appropriately forever. I don't see putting on a mask any different than putting on a coat when it's cold outside. I hope at some point, it will be normalized to wear a simple surgical mask if one is coughing/sneezing when out in public. As well as better hygiene, few remember to sneeze or cough into their shoulder or the elbow crook. Public places need to step up air sanitizer use. A number of places in the US are using these.

[janvog in reply to SofiaDeo]

There are societies in which masks forever will find popular approval.

[SofiaDeo]

Remember the eyedrops or wraparound goggles! Infection through the eye mucosa is very very low, but not zero. I personally think it's a major player behind the reports we have of "but I wore a mask and we opened the windows". IMO public transportation and public places are the most important places to use eye protection.

How Covid can affect eyes

[janvog in reply to SofiaDeo]

Good idea ! I try to wear both mask and sunglasses in the elevator.

[stevebran]

Thanks Neil, that’s a lot to be getting on with but education is our best defence. I never leave home without my trustee FFP2 and I’m careful to avoid indoor gatherings. I guess this will be the foreseeable future, at least for us in the UK. I feel so sorry for all the hardworking and sorely under appreciated NHS staff and their betrayal by the government. These people are real life heroes who have saved countless lives through their own sacrifices. I can’t imagine how it felt especially in the beginning when so little was known about COVID, risking not only their own lives but that of their families as well. And how does the government reward them? With a below inflation pay offer and the promise of harder times ahead expecting them to carry on working alongside agency workers earning twice as them. All money spent that could be used to train or retain nurses rather than going to corporations and shareholders.

Yes it can’t be easy watching the NHS being starved into submission until the demand is so great they will have their way and swing the doors wide open to full privatisation by USA healthcare and insurance schemes. Dr Bob Gill does a great job tracking this slide and We Own It are organising against it but it will be an uphill battle as there appears to be consensus on privatisation between both major political parties.

Long live the NHS (free at the point of delivery!)