Health & Wellbeing

COVID-19 variants: What comes after Delta?

COVID-19 variants: What comes ...
Currently there are 11 coronavirus variants named after characters in the Greek alphabet
Currently there are 11 coronavirus variants named after characters in the Greek alphabet
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Currently there are 11 coronavirus variants named after characters in the Greek alphabet
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Currently there are 11 coronavirus variants named after characters in the Greek alphabet
The current list of SARS-CoV-2 variants designated Alert for Further Monitoring
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The current list of SARS-CoV-2 variants designated Alert for Further Monitoring
The current list of SARS-CoV-2 variants designated Variants of Interest
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The current list of SARS-CoV-2 variants designated Variants of Interest
The current list of SARS-CoV-2 variants designated Variants of Concern
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The current list of SARS-CoV-2 variants designated Variants of Concern
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In the space of a few months the Delta variant has become the dominant strain of SARS-CoV-2 around the world. But what comes after Delta, how are new variants being named, and what are "Variants of Concern"?

For much of the first year of the pandemic researchers watched the SARS-CoV-2 virus mutate and change as it spread across the globe. This was expected. Viruses constantly mutate. In fact, genomic changes in a virus can be so pronounced from person to person scientists are able to track chains of transmission in stunning detail.

The vast majority of mutations initially seen with SARS-CoV-2 were relatively benign. No particular variant seemed to be outperforming any other. By the end of 2020, however, a new SARS-CoV-2 variant had become notably predominant in the United Kingdom.

Initially dubbed B.1.1.7 (also informally known as the UK or Kent variant) the variant’s rapid spread clearly indicated certain mutations had generated significant transmission advantages. Since then, researchers have been able to home in on the particular genomic features unique to this variant and flag other viral lineages with similar features.

In May, the World Health Organization (WHO) stepped in to help clarify the growing confusion over variant names. While scientists often referred to these new variants by their particular lineage label (B.1.1.7; B.1.351; B.1.617.2; etc), many found it easier to tag a variant by its place of origin (UK variant; South African variant; Indian variant; etc).

Noting the “stigmatizing and discriminatory” nature of labeling a variant with a geographical name the WHO introduced a universal naming system based on letters of the Greek alphabet. Scientific lineages were still still recommended for research purposes but national authorities and media outlets were urged to adopt these new, neutral labels.

But if novel variants are emerging all the time when does one attain an official label?

The WHO’s Technical Advisory Group on Viral Evolution has established three tiers of classification for novel SARS-CoV-2 variants: Alerts for Further Monitoring, Variants of Interest, and Variants of Concern.

Now that scientists are getting a grasp on what kinds of genomic mutations can significantly alter the severity or transmissibility of SARS-CoV-2, novel variants with the potential to become problematic can be detected sooner. These variants are labeled with an Alert for Further Monitoring.

The current list of SARS-CoV-2 variants designated Alert for Further Monitoring
The current list of SARS-CoV-2 variants designated Alert for Further Monitoring

The current working definition for this WHO designation is: “A SARS-CoV-2 variant with genetic changes that are suspected to affect virus characteristics with some indication that it may pose a future risk, but evidence of phenotypic or epidemiological impact is currently unclear, requiring enhanced monitoring and repeat assessment pending new evidence."

There are currently 13 circulating SARS-CoV-2 variants designated Alerts for Further Monitoring.

The next classification tier is a Variant of Interest (VOI). These variants have genetic changes known to influence virus characteristics and they have produced significant community clusters in several locations.

Only when a variant is classified a VOI is it labeled with a Greek alphabet character. There are currently four VOIs designated by the WHO.

The current list of SARS-CoV-2 variants designated Variants of Interest
The current list of SARS-CoV-2 variants designated Variants of Interest

The final tier is a Variant of Concern (VOC). A VOC is a variant that has demonstrated either a significant increase in virulence or disease severity.

So far, there are four official VOCs and they are mostly defined by their increases in transmissibility. A variant does not need to have spread significantly for it to be classified a VOC. If evidence is found a new variant can evade vaccines or current therapeutics it will be classified as a VOC.

The current list of SARS-CoV-2 variants designated Variants of Concern
The current list of SARS-CoV-2 variants designated Variants of Concern

Although there are currently eight official VOIs/VOCs, there are another three variants with Greek alphabet labels that have recently been reclassified down into the Alert designation. Epsilon, Zeta, and Theta were all previously classified as VOIs before being dropped down a designation as more epidemiological evidence was gathered.

The WHO says former VOIs/VOCs will retain their previous designation for the time being while they are monitored. So Epsilon, Zeta, and Theta currently still hold those labels, meaning 11 of the 24 characters in the Greek alphabet are currently used to designate SARS-CoV-2 variants.

The WHO labels are generally accepted by most governments around the world, although some regions do have their own variant classes. In the United States, for example, the Centers for Disease Control and Prevention (CDC) follow similar designations to the WHO with its own VOI and VOC categories.

The CDC does, however, present a tier of variant classification higher than VOC, called Variant of High Consequence (VOHC). It essentially covers variants with clear evidence of a significant reduction in vaccine effectiveness or variants that appear to present severe clinical disease. Reassuringly, there are no SARS-CoV-2 variants currently in this designation.

For those keeping score, Lambda is the latest variant to be given a WHO label in the VOI category. It was designated a Variant of Concern in June 2021 after significant spread was detected in Peru over the prior months.

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6 comments
6 comments
Brian M
Typical WHO political correctness over being sensible. It was a lot more informative to know and remember it was the UK, Brazil, Indian variant etc. but more importantly it
reinforced the dangers of international travel in spreading the virus.

Obviously removing geographical origins from the names is also good for the travel and aviation business that so kindly and continues to spread these variants around the world for us!
michael_dowling
The main thing I look for in articles like this one is news of variants that can evade the vaccines. Of course,that would be on CNN as well. With mRNA vaccines,fine tuning for VOCs is,I hope, much faster than with tradition vaccines. Traditional yearly flu vaccines don't require safety/effectiveness trials,so I assume a tweaked mRNA vaccine would be the same.
GOllieOlwagen
Can this virus, whatever variant it assumes, be eradicated if the whole world is devided into thousands of "isolation blocks" where no outside contact is permitted for a few weeks - clearing the blocks up one by one? Probably not a practical solution. But what else then? Our only hope, as we all know, would be creating new vaccines wiping this thing from the face of the earth
Charlie Channels
....easy.... Epsilon
bwana4swahili
Pathogens evolve to an equilibrium, i.e.: the greatest spread for the least damage. In other words, don't kill the host until you've multiplied and spread to the greatest number of next victims!! The SARS virus is not at its equilibrium yet and will continue to evolve until it reaches that point.
Karmudjun
Rich - nice synopsis. I haven't time to read the source articles but I have read some opinion pieces following this write up. You did a nice job as usual, I would have liked to have seen the Ro values or expected spread frequency.
The WHO, along with CDC and with almost every other country's healthcare institute don't need to be "sensible", they need to be specific. For example - if SARS-CoV-2 mutates in a 4-6 week period, how many unique novel SARS-CoV-2 variants should be called "Wuhan"? Scientists don't know either and the Greek alphabet make far more sense than labeling by country. Actually the B.1.617.2 is much more precise but we have to deal with lay people who are ALWAYS so sensible...so delta.
Mr. downling-Traditional yearly influenza vaccines REQUIRE safety/efficacy studies before release in the USA, we don't follow the European model of human guinea pigs. If you'd like to be informed, here is a source - I make my residents present on this:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4947948/
GOllieOlwagen - It is hoped that with vaccinated mothers & widespread (effective) vaccination campaigns we can stamp out "wild" pandemics of these SARS-CoV-2 variants. There may well need to be several generations of vaccines (the major players have tried to play catch up with the antigenic variations so they can tweak their current vaccines to the new variants) before we can breathe a sigh of relief. Consider the middle ages and decimation of populations by rogue infections - black death, small pox, measles, Typhus, - the list goes on! Somehow human populations rebounded from the decimation. Lets hope we don't go to the point England did with the Plague where old villages and towns were left with no one to bury their dead and succumbed to the ravages of nature. While a possibility with this "novel" pneumonia, it doesn't appear likely. Unfortunately, I'm a physician, not a psychic. I know, those titles do look similar, but the difference is important to each group!