COVID-19 cases are definitely on the rise around the world and scientists are worried about a a new variant— the highly mutated BA.2.86 (or Pirola, as nicknamed in social media), as well as “subvariant of interest” EG.5/Eris, which I discussed in my previous blog. 

Although BA.2.86/Pirola cases worldwide are still very few, scientists are highly concerned because this new variant carries 34 mutational changes, including the crucial spike protein from BA.2—"reminiscent of the appearance of the omicron variant in late 2021” which caused problems during the last major surge.

As of August 23, the U.S. Centers for Disease Control and Prevention (CDC) has stated that nine (9) BA.286 variant sequences have been reported globally: in Denmark (3 cases); South Africa (2 cases); Israel (1 case); the United States (2 cases); and the United Kingdom (1 case).

In the U.S., CNN reported: “The two US sequences came from patients in Michigan and Virginia. The Michigan person is an older adult who has not been hospitalized, according to the state Department of Health. The person who tested positive in Virginia was a woman who had just returned from a trip to Japan and was identified through the CDC’s traveler-based genomic surveillance.” 

As of this writing, the World Health Organization (WHO) has designated BA.2.86/Pirola as a “variant under monitoring” (VUM), with “only three sequences available and based on the large number of mutations identified.”

Additionally, a recent risk assessment report released by the CDC on August 23 indicated the presence of the BA.2.86 variant in the preliminary testing of a wastewater sample.

This means that BA.2.86 has started to spread under the radar of detection systems for some time.

What is BA.2.86 or the Pirola COVID-19 Variant?

Nicknamed “Pirola,” BA.2.86 is “one of the 1,680 omicron lineages,” according to Dr. Rajendram Rajnarayanan, Assistant Dean of Research and Associate Professor at the New York Institute of Technology of Osteopathic Medicine at Arkansas State University.

"The emergence of BA.2.86 is reminiscent of the original omicron (BA.1) scenario, with major differences. During BA.1 times, we were actively testing, sequencing, and rapidly reporting data. However, since the end of the WHO Public Health Emergency of International Concern (PHEIC) in May and the USA's Public Health Emergency (PHE), COVID testing and genomic sequencing have been significantly reduced," said Rajnarayanan in a report from USA Today.

“BA.2.86 indeed carries the risk of becoming internationally widespread. As it spreads, it could accumulate more mutations. BA.2.86 possesses the characteristics of a successful lineage that could potentially outcompete existing variants,” he further added while noting the high population-level immunity in the U.S., “meaning BA.2.86 may not cause a surge like omicron BA.1 initially did.”

"These are still early days, so vigilance and preparation are key. Consider likely scenarios, as we've been living with COVID for over 3 years, and most of us know how to protect ourselves, (yet most of us may not practice or use tools at hand),” said Rajnarayanan.

According to the CDC’s risk assessment report on Immune Impacts:

“The large number of mutations in this variant raises concerns of greater escape from existing immunity from vaccines and previous infections compared with other recent variants. For example, one analysis of mutations suggests the difference may be as large as or greater than that between BA.2 and XBB.1.5, which circulated nearly a year apart. However, virus samples are not yet broadly available for more reliable laboratory testing of antibodies, and it is too soon to know the real-world impacts on immunity. Nearly all the U.S. population has antibodies to SARS-CoV-2 from vaccination, previous infection, or both, and it is likely that these antibodies will continue to provide some protection against severe disease from this variant. This is an area of ongoing scientific investigation.”

In terms of therapeutics, the CDC notes: “Examination of the mutation profile of BA.2.86 suggests that currently available treatments like Paxlovid, Veklury, and Lagevrio will be effective against this variant. Monitoring is ongoing and CDC will update this document as human data on the impact of this variant on therapeutics become available.”

“Based on BA.2.86’s mutation profile, the anticipated impact on molecular and antigen-based is low,” said the CDC further, with regards to diagnostics (tests).

Ongoing Investigations in the Scientific Community

While close monitoring by the WHO and CDC is ongoing, scientists are racing to learn more: they are testing more widely and are carefully studying this new variant at the molecular level. 

“Just like Omicron was a little out of left field, this BA.2.86 is a little out of left field. There is enough here to get us all to start paying attention,” Ashish Jha, a public-health researcher at Brown University in Providence, Rhode Island, and a former White House COVID-19 response coordinator, told Nature. 

“Another feature of BA.2.86 that has piqued scientists’ interest is its geographical distribution. None of the cases identified so far seem to be linked — including the three infections in Denmark, which were detected in different parts of the country,” Nature reported.

According to an “analysis of spike mutations in new second-generation BA.2 variant with many mutations” by Jesse Bloom of Bloom Lab (a scientist from Fred Hutch Cancer Center who studies evolution of proteins and viruses), there is a good chance that BA.2.86 will be able to escape neutralizing antibodies from boosters or vaccines, or a prior infection.

This means that BA.2.86 “might already be fairly widespread,” adding that “it’s got to have been transmitting a fair amount,” said Bloom.

That said, laboratories across the globe are currently analyzing patient and wastewater samples “to get a sense of how widespread BA.2.86 is.” 

“Virology labs in Denmark and the United Kingdom say that they are trying to isolate BA.2.86 from patient samples. Such work—and studies with safe models of SARS-CoV-2 created using pseudoviruses—will help researchers to gauge the variant’s ability to evade neutralizing antibodies triggered by previous infections and vaccines,” said Nature.

The key question is whether antibodies against the variant XBB.1.5, which is the basis of new boosters to be released in the Fall,  will work against BA.2.86 . If not, there will be an urgent need to develop an updated booster vaccine.

Should Myeloma Patients Be Concerned?

While it is too soon to tell, it is still likely that a COVID infection could pose a problem for myeloma patients who have weakened immune systems due to active myeloma or recent immune suppressive treatments. 

Currently, scientists feel that the chances of another major COVID-19 surge is still low. Nonetheless, it should be noted that some businesses are already reporting multiple infections among staff members and are again requiring high quality N95 masks at work. Serious medical problems are still low, but concern is definitely increasing.

The Bottom Line

It seems that COVID-19 still has some tricks up its sleeve. As I mentioned in my previous blog on the EG.5/Eris subvariant, myeloma patients need to practice caution and due diligence once again.

The primary new concern is whether these upcoming new boosters will be effective against the BA.2.86/Pirola variant and the EG.5/Eris subvariant. It is extremely important to wait and assess the benefits (or lack thereof) of these updated boosters.

Until these updated boosters become available, I will still firmly and strongly advise myeloma patients to stay updated on COVID-19 community levels in their area, wear reliable N95 masks in situations of risk (i.e., mingling with large groups in an indoor setting, or while traveling), and to get tested if symptoms emerge. 

We will keep you posted, as we gather more information and updates on the BA.2.86/Pirola variant, as well as the EG.5/Eris subvariant.

As always, stay safe and protected at all times.