With experts around the globe now talking about a so-called "stealth omicron" variant, many are wondering what exactly is it and is it a new COVID variant?
Chicago's top doctor said "stealth omicron," also known as BA.2, is not technically a new COVID variant, and has not yet been classified as a variant of interest or concern by international authorities. It's actually a subvariant or sub-type of the omicron variant.
"It's still omicron," Chicago Department of Public Health Commissioner Dr. Allison Arwady said Tuesday. "It's just... sort of certain letters point one versus certain letters point two. It's a slight variation in terms of what is being picked up, but I want to be really clear it has not even been classified as a variant of interest yet... this isn't even a new variant."
She highlighted it again Thursday, calling it "a slightly different flavor of omicron."
The subvariant has been detected in more than 40 countries so far.
This version of the coronavirus is widely considered stealthier than the original version of omicron because particular genetic traits make it somewhat harder to detect. Some scientists worry it could also be more contagious.
But they say there’s a lot they still don’t know about it, including whether it evades vaccines better or causes more severe disease.
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"There's nothing that we've seen at this point that is raising a high level of concern but please rest assured we're watching it and we'll let you know if there's anything to be interested or concerned about," Arwady said.
For now, the original version, known as BA.1, and BA.2 are considered subsets of omicron. But global health leaders could give it its own Greek letter name if it is deemed a globally significant “variant of concern.”
"Every time there's a new variant, first of all, we will get a name," Arwady said. "So if this is something we have to worry about, nobody will call it the 'stealth something,' it would get a Greek letter name."
The World Health Organization classifies omicron overall as a variant of concern, but it doesn’t single out BA.2 with a designation of its own. Given its rise in some countries, however, the agency says investigations of BA.2 “should be prioritized."
The UK Health Security Agency, meanwhile, has designated BA.2 a “variant under investigation," citing the rising numbers found in the U.K. and internationally. Still, the original version of omicron remains dominant in the U.K.
BA.2 has lots of mutations. About 20 of them in the spike protein that studs the outside of the virus are shared with the original omicron. But it also has additional genetic changes not seen in the initial version.
It's unclear how significant those mutations are, especially in a population that has encountered the original omicron, said Dr. Jeremy Luban, a virologist at the University of Massachusetts Medical School.
So far, it has not yet been detected in Chicago, Arwady said.
Since mid-November, more than three dozen countries have uploaded nearly 15,000 genetic sequences of BA.2 to GISAID, a global platform for sharing coronavirus data. As of Tuesday morning, 96 of those sequenced cases came from the U.S.
“Thus far, we haven’t seen it start to gain ground” in the U.S., said Dr. Wesley Long, a pathologist at Houston Methodist in Texas, which has identified three cases of BA.2.
The mutant appears much more common in Asia and Europe. In Denmark, it made up 45% of all COVID-19 cases in mid-January, up from 20% two weeks earlier, according to Statens Serum Institut, which falls under the Danish Ministry of Health.
The quick spread of BA.2 in some places raises concerns it could take off.
“We have some indications that it just may be as contagious or perhaps slightly more contagious than (original) omicron since it’s able to compete with it in some areas,” said Dr. Wesley Long, a pathologist at Houston Methodist in Texas, which has identified three cases of BA.2. “But we don’t necessarily know why that is.”
An initial analysis by scientists in Denmark shows no differences in hospitalizations for BA.2 compared with the original omicron. Scientists there are still looking into this version's infectiousness and how well current vaccines work against it. It's also unclear how well treatments will work against it.
Doctors also don’t yet know for sure if someone who’s already had COVID-19 caused by omicron can be sickened again by BA.2. But they’re hopeful, especially that a prior omicron infection might lessen the severity of disease if someone later contracts BA.2.
The two versions of omicron have enough in common that it’s possible that infection with the original mutant "will give you cross-protection against BA.2,” said Dr. Daniel Kuritzkes, an infectious diseases expert at Brigham and Women’s Hospital.
Scientists will be conducting tests to see if antibodies from an infection with the original omicron "are able to neutralize BA.2 in the laboratory and then extrapolate from there,” he said.
The original version of omicron had specific genetic features that allowed health officials to rapidly differentiate it from delta using a certain PCR test because of what’s known as “S gene target failure.”
BA.2 doesn't have this same genetic quirk. So on the test, Long said, BA.2 looks like delta.
“It's not that the test doesn't detect it; it's just that it doesn't look like omicron,” he said. "Don’t get the impression that ‘stealth omicron’ means we can’t detect it. All of our PCR tests can still detect it.”
Doctors advise the same precautions they have all along: Get vaccinated and follow public health guidance about wearing masks, avoiding crowds and staying home when you’re sick.
“The vaccines are still providing good defense against severe disease, hospitalization and death,” Long said. “Even if you’ve had COVID 19 before — you’ve had a natural infection — the protection from the vaccine is still stronger, longer lasting and actually ... does well for people who’ve been previously infected.”
The latest version is another reminder that the pandemic hasn't ended.
“We all wish that it was over," Long said, ”but until we get the world vaccinated, we’re going to be at risk of having new variants emerge.”