“New variant”, “care home outbreak”, “cases rising”: you’d be forgiven if the headlines around Pirola, or BA.2.86, the latest Covid strain to arrive in the UK, had triggered a severe case of pandemic deja vu. More than two years since the UK’s last lockdown, concerns over BA.2.86 – known to have infected dozens of people in the UK as of last weekend, including 28 at a Norfolk care home – have been rising. The worry is over what is “the most striking Sars-CoV-2 strain the world has witnessed since the emergence of Omicron”, according to Francois Balloux, professor of computational systems biology and director of the University College London Genetics Institute.
That Omicron outbreak resulted in almost half of all Britons getting infected with Covid last year, and we may be facing a repeat performance at what scientists say is the worst possible time. With temperatures falling (colder climes help the virus to thrive), schools and universities returning to large-scale indoor mixing – and at the outset of flu season – the overall rise in infections is already “translating to hospitalisations and deaths, increased NHS pressure, as well as more than a million suffering from long-term health problems under the umbrella term long Covid”, says Stephen Griffin, professor of cancer virology at the University of Leeds and a member of Independent Sage. “The NHS is buckling from continued underfunding and staff shortages.”
Pirola began raising red flags when first detected in Israel in July, with cases confirmed now in more than a dozen countries, including Denmark and the US. While the EG.5.1 (Eris) and XBB variants account for most Covid infections globally (and most of the more than 1m symptomatic Covid cases currently in Britain), Pirola, which descended from Omicron, is heavily mutated. This follows a pattern seen with Sars-CoV-2 since the beginning of the pandemic, explains Andrew Pekosz, professor of molecular microbiology and immunology at Johns Hopkins University. “They accumulate a few mutations that allow them to evade some of the antibodies induced by prior infection or vaccination, they spread for a few months, then they are supplanted by a variant that has picked up a few different mutations that also function to evade pre-existing immunity, and the cycle continues.”
With more than 30 mutations, Pirola is “very unique”, adds Pekosz, with the potential to be “more concerning” than the other circulating variants.
The government started its Covid vaccine rollout last week for over-65s and immunocompromised people, earlier than planned, as a “precautionary measure” in response to the World Health Organization declaring Pirola a “variant of interest”. Still, concerns remain about the efficacy of the jab for Pirola, with studies so far producing mixed results. Both Pfizer and Moderna last week said their jabs offered “strong responses” to the spike protein (which they target). However Griffin says “multiple preprint studies posted by reputable labs show this [Pirola] to be equally, or perhaps more, antibody evasive compared to the XBBs” – which “are among the most antibody-evasive strains ever encountered”.
The consensus is that it is too early to tell how useful the vaccine may prove, though some MPs are pushing for 50- to 64-year-olds to be immunised, either as part of the rollout or privately. With Covid becoming “more of a value-for-money exercise” for the government, according to Duncan Robertson, senior lecturer in management sciences at Loughborough Business School, they may be playing a risky game by reducing eligibility for “financial savings”.
Planning is all the more challenging given that the UK’s surveillance and testing regimen is now the thinnest since the pandemic began. This is “frustrating” says Robertson, as “the UK’s ability to detect new variants has been compromised by the effective ending of the Office for National Statistics Coronavirus Infection Survey. Not only did that give a very good indication of the level of Covid in the population, it also allowed the proportions of variants … to be estimated, which could have meant that the emergence of BA.2.86 could have been better tracked.”
The UK Health Security Agency has promised that Covid testing will be increased, “although details at the moment are scant”, says Griffin. He says that “lessons learned during the early part of the pandemic, and before, do seem to have been forgotten.”
Susan Michie, professor of health psychology at UCL and another Independent Sage member, agrees that as we find ourselves in a position where “we really can’t see what’s happening” because of the lack of testing, missteps of the past appear not to have been absorbed. “One of the things we’ve really learned from the mismanagement of previous pandemics, certainly in this country, is waiting too late to do something about it. Given the exponential growth of pandemics, it does mean that once you’ve waited until it’s an obvious problem, you’ve really got a problem.”
The NHS in August hit a record 7.6 million people on waiting lists, and has in recent months been beset by strike action leading to the cancellation of 839,327 hospital appointments. It “is really on its knees”, says Michie. “We just can’t afford to have any huge big influx into the NHS.”
This is more likely given what Griffin calls the current “vaccine-only strategy”, which appears not to address measures such as masks or social distancing, and “fails to recognise and account for airborne Sars-CoV-2 transmission, including in healthcare settings”. He adds: “Vaccine strategy appears to completely disregard long-term consequences of Covid, which is both undermining of those affected as well as a false economy.”
With most excluded from the vaccine programme, should we be returning to masking, and social distancing? Michie is firm that “we need to take a population-wide approach to reducing the level of infection”, with everyone playing their part, rather than the current attitude that vulnerable people should stay at home. “This is discriminatory, but also, it’s not effective,” she says; either pushing elderly people into greater loneliness and social segregation, which studies have shown can accelerate decline, or overlooking the estimated 1.8 million multigenerational households in Britain. Such households are more likely to be made up of poorer people or those from ethnic minorities, who suffered a “disproportionate impact” during the lockdown years, according to the King’s Fund. Telling already vulnerable communities to stay at home is only “increasing inequalities”, says Michie.
Watching how Pirola continues to spread is now critical. “We are at the start of a wave; how serious it’s going to be, we don’t know,” Michie says. She adds that it is also unclear whether Covid is becoming seasonal. “But we do know that there are other seasonal viruses like flu and RSV (respiratory syncytial virus), which do always ramp up over the winter months. We’re in a potentially dangerous situation.”
Others remain more hopeful.“We don’t really see it [Pirola] spreading fast so perhaps it isn’t as concerning a variant as it looks on paper,” says Pekosz.
Management is everything this time around, Robertson thinks, with the future of any potential outbreak now a matter for ministers. “To govern is to make choices. Let’s hope the government makes wise ones.”
