Omicron subvariants show resistance, putting some people at risk

Omicron in the making subvariants are resistant to key antibody treatments for HIV patients, kidney transplant recipients and other immunocompromised people, making them especially vulnerable to Covid this winter, the White House warned this week.

“With some of the new sub-variants emerging, some of the main tools we’ve had to protect the immunocompromised like Evusheld may no longer work. And that’s a big challenge,” Dr Ashish Jha, head of the White House Covid Task Force, said told reporters on Tuesday.

President Joe Biden on Tuesday warned the estimated 7 million adults in the US whose immune systems are compromised that they especially in dangerbut he could offer little in the way of reassurance beyond telling them to consult their physician as to what precautions they should take.

“New variants can render some existing protections ineffective for the immunocompromised,” the president said before getting a booster shot Tuesday. “Unfortunately, that means you could be at particular risk this winter. I urge you to consult with your doctors about the right steps to take to protect yourself, take extra precautions.”

The message contradicts repeated assurances from the White House that the US has all the vaccines and treatments it needs to fight Covid this winter, as public health officials expecting another wave.

While this may be true for the general population, it is not the case for people with weak immune systems. They include cancer patients, those who have had organ transplants, people living with HIV, and people taking medications for autoimmune diseases.

Evusheld is an antibody cocktail approved by the Food and Drug Administration for the prevention of Covid in people 12 years of age and older who have a moderately or severely weakened immune system. The medicine is given in two injections, before the infection, every six months.

Evusheld, made AstraZeneca, has helped fill a gap in protection for those with weak immune systems who cannot respond strongly to vaccines. The drug, plus several rounds of vaccinations, have led to a significant drop in hospitalizations among this cohort in recent months, according to Camille Kotton, an infectious disease expert who specializes in treating people with weakened immune systems.

“We’ve been in a good place for maybe a few months in terms of immunocompromised patients having good protection and then good treatment options,” said Kotton, a physician at Massachusetts General Hospital and a member of the independent Centers for Disease Control and Prevention. vaccine advisory committee.

But more immune-evasive omicron subvariants such as BA.4.6, BA.2.75.2, BF.7, BQ.1 and BQ.1.1 are resistant to Evusheld, according to the National Institutes of Health. Scientists at Columbia University, for example, found that Evusheld had completely lost its effectiveness against BA.4.6.

And BQ.1 and BQ.1.1 are likely resistant to bebtelovimab, a monoclonal antibody developed by Eli Lily to prevent people with compromised immune systems who contract Covid from developing severe disease, according to the NIH.

This makes people with compromised immune systems increasingly vulnerable as these subvariants increase in circulation in the U.S. As omicron BA.5 declines, this swarm of newer subvariants together account for about 38% of infections in the U.S., according to the CDC.

Although Pfizer’s antiviral drug Paxlovid remains effective against the omicron subvariants, people who have had organ transplants often can’t take the pill because of the way it interacts with other drugs they need, Kotton said.

“I am concerned that the near future will be a very challenging time for immunocompromised patients,” Kotton said. “Monoclonal antibodies in Evusheld will provide less protection, and bebtelovimab will provide an ineffective treatment for several emerging variants.”

And help is not on the way right now. Kotton said she is not aware of any monoclonal antibodies that are ready to replace those that eliminate the subvariants. Jha acknowledged at the White House on Tuesday that the U.S. has fewer and fewer treatment and prevention options for people with weak immune systems as Covid evolves. He blamed Congress for not approving $22.5 billion to fund the nation’s response to Covid because of Republican opposition.

“We had hoped that over time, as the pandemic progressed, as our fight against this virus progressed, we would expand our medicine cabinet,” Jha told reporters. “Because of a lack of funding from Congress, that medicine cabinet has actually shrunk and that’s putting vulnerable people at risk.”

Andrew Pekosz, a virologist at Johns Hopkins University, said finding ways to protect people with compromised immune systems is the most critical issue of the pandemic right now and needs to be addressed quickly.

“What we really need to work on is getting new antibody treatments out of the lab and into the clinic,” Pekosz said. “In the lab, scientists know what next-generation monoclonal antibodies look like.”

Kotton said people with compromised immune systems should be up to date on their vaccines, which means getting a new booster that targets omicron BA.5. Those who have been ongoing throughout the pandemic have received six shots so far.

Those starting from scratch would receive a primary series of three doses of Moderna or Pfizer with older-generation injectables, followed by a new booster that targets omicron, according to CDC guidelines.

People with compromised immune systems should continue to be cautious this winter, as immune-resistant subvariants of the omicron could start circulating as people gather for the holidays, Kotton said. But she noted that the group was more diligent in wearing masks and practicing mitigation measures to avoid the virus than the rest of the population.

The bigger problem is that the general population has largely moved on and is no longer taking basic precautions that could reduce transmission and protect the vulnerable — like wearing masks, Kotton said.

“If we all masked more in public, it would increase their safety and allow them to be more likely to safely return to many activities,” she said.

NBC News asked Jha on Tuesday if Biden’s speech to people with weakened immune systems to consult their doctors about precautions is an indication that the burden of responsibility has shifted to individuals instead of the larger community.

“As a society — as a caring society, we care about all Americans, especially the most vulnerable Americans,” Jha said. “So there remains, I think, a collective responsibility for all of us to care for our fellow Americans who are immunocompromised.”

The CDC recommends that people in communities where the level of risk for Covid is moderate self-test and wear a high-quality mask before meeting indoors with someone who is at high risk of getting sick. Those at high risk should wear a high-quality mask when indoors in public.

When Covid levels are high, people should generally consider wearing high-quality masks, and the vulnerable should consider avoiding non-essential indoor activities in public, according to the CDC. You can check your county’s Covid level on the CDC website.