Pirola variant – should we be worried about COVID-19 again?

COVID-19 cases are rising again and there’s a new highly mutated variant cropping up around the world. It feels like we’ve been here before …

Nicknamed Pirola, variant BA.2.86 has over 30 new mutations and has been discovered in several locations around the world. It has been linked to an outbreak in a nursing home in the UK, and is already thought to be spreading in the community.

But is it a reason to start worrying about COVID-19 again? In short, evidence to date suggests no, but that we should remain vigilant.

BA.2.86 was designated a “variant under monitoring” by the World Health Organization in August because of the large number of mutations it shows. A descendant of the Omicron strain, it shows significantly more changes than other versions that have emerged so far.

Heavily mutated viruses have the potential to be less detectable by immune systems and may have adaptations that make them better at spreading, infecting, or causing severe illness. Mutated forms of the virus have previously been at the route of waves of coronavirus infection, as was the case with the Omicron variant.

However, there is no evidence to suggest the variant is causing more severe illness, nor has it been linked to any deaths yet.

The impact of these mutations will become clearer as more data emerges, but scientists predict it may be harder for our immune system to recognize Pirola, and to mount a strong response. This is due to the simple fact that our immune system is less effective against versions of the virus that we have not been exposed to or immunized against.

The US Centers for Disease Control and Prevention (CDC) says the variant may be more capable than others of causing infection in people who have previously had COVID-19 and/or who have been vaccinated against it.

The variant has been detected in a number of countries so far, including Israel, Denmark, the UK, the US, South Africa, Switzerland, Thailand, Australia, Japan and South Korea. It’s unlikely to be limited just to these countries, though, as varying capabilities in genomic sequencing around the world mean it may not have been picked up yet elsewhere.

Initial evidence shows Pirola is not causing more severe illness and that existing tests and medications used for COVID-19 are effective. Pirola may however be more capable of causing infection and evading vaccines. Scientists are evaluating the effectiveness of the forthcoming, updated COVID-19 vaccines. Recommendations will be updated as more evidence becomes available and for the time being

For the moment, Pirola accounts for a tiny proportion of the cases currently, with variants including Eris and Fornax among the dominant forms around the world. And while in the US there has been a steady uptick of COVID related hospital admissions rates remain relatively low compared to other times during the pandemic with fewer people in the intensive care units.

Healthcare systems around the world are still feeling the impact of the pandemic, however, and ensuring we are prepared for the next one is high on government agendas. There was a high-level meeting dedicated to pandemic preparedness at the United Nations General Assembly in September, for example.

And the World Economic Forum’s Health and Healthcare Strategic Outlook sets out a vision for transforming health systems by 2035 based on four strategic pillars of equitable access and outcomes, healthcare systems transformation, technology and innovation, and environmental sustainability.

The make-up of COVID-19 vaccines has been updated since they were first rolled out to better reflect the most commonly circulating variants – or those of concern – at the time. Two major vaccine manufacturers say their updated COVID-19 vaccines are capable of generating a strong response against Pirola.

Several countries around the world are beginning their seasonal rollout of vaccines to at-risk populations, and in England, the vaccination programme has been brought forward “as a precautionary measure”.

It is also important to note that, unlike in the early days of the pandemic, there is a lot more immunity to the virus within the population based on exposure. In general, our immunity is based on a combination of vaccines and prior infection. And the CDC says there is evidence existing antibodies do have an effect against Pirola.

That said, vaccines do add an important level of protection to older and more vulnerable populations and people should come forward for vaccinations when they are offered.