BQ.1.1 Covid-19 variant resistant to all monoclonal antibody treatments

You know that 1997 Backstreet Boys song that says “everybody, yeah.” Well, Omicron’s latest sub-variants of the 2022 Covid-19 coronavirus have been “antibody, no-oh”. A letter published in The Lancet Infectious Diseases The November 18 journal detailed how many of the Omicron subvariants currently circulating, namely BA.4.6, BA.2.75.2 and BJ.1, appear to be resistant to most monoclonal antibody treatments available. And the BQ.1.1 Omicron subvariant, which has become one of the two dominant versions of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the United States, appears resistant to everything available monoclonal antibody treatments. Yes, all.

BQ certainly doesn’t mean ‘shut up’, as the BQ.1.1 subvariant is now causing a stir, being responsible for around 24.2% of all new Covid-19 cases reported over the past week as The Not Too Different BQ.1 subvariant is responsible for 25.5% of them, according to the Centers for Disease Control and Prevention (CDC). If you do the math, that means these two Omicron subvariants now account for more than half of all reported Covid-19 cases, meaning they’ve passed BA.5 as a “dog alpha” versions of SARS-CoV-2. Therefore, you probably can no longer rely on any type of monoclonal antibody if you contract Covid-19. This is certainly bad news for anyone unable to obtain sufficient protection from vaccination against Covid-19, such as those with very weak immune systems.

It also blows a big hole in the arguments of those who say further precautions against Covid-19 are unnecessary because monoclonal antibodies are available. Such an argument held up just as well as a Brillo thong, because relying on a single Covid-19 precaution or treatment has always been a foolhardy approach. It’s like saying to someone, “You’re wearing underwear, why do you need pants or a skirt or a kilt?” Since the start of the pandemic, real pandemic experts have continued to advocate for a more “Swiss cheese” approach that still involves layering different Covid-19 interventions simultaneously, because each intervention has its holes. And as a general, you always want to find ways to cover your holes.

Monoclonal antibodies first attracted a lot of attention after Donald Trump received them when the then US President fell ill with Covid-19 in 2020, as I reported for Forbes at the time. Since then, various personalities have praised such treatments. For example, podcaster Joe Rogan, who railed against Covid-19 vaccination requirements and apparently resisted getting vaccinated himself, said he “threw the kitchen sink” against SARS-CoV-2 when he was infected in the fall of 2021. That probably didn’t mean he threw himself at an actual kitchen sink, which would have really hurt. But he mentioned that the proverbial “kitchen sink” included monoclonal antibodies.

Then there was Florida Governor Ron DeSantis’ entire ‘Early Treatment Saves Lives’ campaign (right). Although he has spent much of the pandemic pushing back on precautions designed to keep you from catching Covid-19, such as social distancing and face mask requirements, he has pushed to make treatments by monoclonal antibodies no longer available for Florida, as Zachary Snowdon Smith covered in early 2022 for Forbes. Isn’t it kind of like saying don’t brush your teeth but make sure everyone has access to fake teeth?

This was all before SARS-CoV-2 went completely mano a mano against monoclonal antibody treatments and apparently won. In the letter, a team from the Leibniz Institute for Primate Research in Göttingen, Germany (Prerna Arora, Amy Kempf, Inga Nehlmeier, Stefan Pöhlmann and Markus Hoffmann) and Friedrich-Alexander-University Erlangen-Nürnberg in Erlangen, Germany (Sebastian R Schulz and Hans-Martin Jäck) briefly described laboratory experiments in which they tested the extent to which monoclonal antibody treatments and cocktails of these treatments maintained different pseudovirus particles representing various versions of the SARS-CoV-2 (the BA.1, BA.4–5, BA.4.6, BA.2.75.2, BJ.1 and BQ.1.1 subvariants) of incoming cells.

This is what victory looks like. While bebtelovimab and cilgavimab worked very well against BA.4–5 pseudovirus particles, imdevimab and cilgavimab-tixagevimab worked only moderately well against them, and amubarvimab, romlusevimab, sotrovimab, casirivimab-imdevimab and amubarvimab-romlusevimab didn’t even get the job done at all. For BA.4.6, things were even worse: bebtelovimab did its job, but imdevimab, amubarvimab, casirivimab-imdevimab, cilgavimab-tixagevimab and amubarvimab-romlusevimab could not cut the mustard nor prevent the pseudovirus from entering the cells. Situation BA.2.75.2 was similar. Bebtelovimab worked well, while regdanvimab and sotrovimab did oopsies. On the other hand, nothing worked very well against BJ.1 pseudovirus particles. Casirivimab, tixagevimab, sotrovimab, and cilgavimab-tixagevimab had a moderate effect while amubarvimab, casirivimab-imdevimab, and amubarvimab-romlusevimab mostly fell flat on their monoclonal side. Then there were the BQ.1.1 pseudovirus particles. Borrowing the lyrics to Queen’s ‘Bohemian Rhapsody’, nothing really mattered. None of the monoclonal antibody treatments have been shown to be effective against this version.

It’s a reminder that SARS-CoV-2 isn’t like that guy who’s still resting on his high school laurels years after graduation. Viruses collectively continue to “learn” and improve to evade existing treatments. Now, it’s not like there’s just one virus taking Khan Academy classes, hiring a life coach, and reading self-help books. Instead, with a high mutation rate, viruses continue to generate newer and newer versions of themselves as they infect people and continue to replicate. Now, many of these new releases may be weaker than previous releases and do not spread quickly. However, with so many different versions of the virus, chances are that at least some of them will have “fitness advantages” over previous versions, being able to spread faster and gain previous treatments that worked well before. Therefore, we humans cannot be complacent as the Atlanta Falcons may have been after leading the New England Patriots to Super Bowl LI. Responding to the pandemic is like engaging in an arms race against something that has no arms but has spikes instead. Governments and companies must support more research to develop new monoclonal antibody treatments against Covid-19. At the same time, maintaining Covid-19 precautions such as vaccinations, use of face masks and social distancing can help reduce reliance on treatments and save them for when they are really needed. Overuse of treatments could more quickly select new SARS-CoV-2 variants resistant to these treatments. These variants might in turn be able to rock your body, yeah rock your body not well.

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