COVID – Matter of Concern or Interest?
COVID has always been a matter of concern. However, various ‘COVID-causing’ variants constantly evolve or degrade (change) with time, requiring a constant vigil of the public health experts.
All viruses change with time. The same is the case with SARS-CoV-2 – the virus that causes COVID. It is natural for any virus to change with time as they spread and infect living beings. Once these variations become considerably distinct from the original disease-causing virus, the new ones are termed the variants.
Global agencies, including the World Health Organization (WHO) and Centres for Disease Prevention & Control, regularly examine the new variants detected to understand their intensity and accordingly classify & add/update/delete to the list of variants. Likewise, the variations and resulting variants of SARS-CoV-2 have been monitored consistently since the outbreak of COVID.
Broad Categorisation of Variants
Broadly, the variants are categorized basis three chief parameters, namely:
- Infection severity
- Transmissibility
- Immunity
Variant of Concern (VOC)
A VOC is a VOI that, on further assessment, has shown evidence of impacting global public health through one or more of the assessing parameters, i.e., transmissibility, severity of infection, and/or immunity. In other words, a VOC either:
- Impacts the effectiveness of available/ongoing measures, medicines, vaccines, etc., on public health, or
- Has an increased transmissibility rate, or
- Increases the severity of the disease/infection
Omicron is one such VOC, the various mutations of which were first detected in South Africa.
The variant Omicron B.1.1.529 was first reported to the WHO on 24th November 2021 and classified as the VOC on 26th November 2021. The Technical Advisory Group on Virus Evolution recommended the classification based on the changes in COVID epidemiology brought by it in South Africa.
| Variant Name (with lineages) | First detected in country | Time of detection | Impact on Severity | Impact on Immunity | Impact on Transmissibility | Type of Transmission |
| Omicron BA.1 | South Africa & Botswana | Nov. 2021 | Decreased | Increased | Increased | Community |
| Omicron BA.2 | South Africa | Nov. 2021 | Decreased | Increased | Increased | Dominant |
| Omicron BA.4 | South Africa | Jan. 2022 | Not known | Increased | Not known | Community |
| Omicron BA.5 | South Africa | Feb. 2022 | Not known | Increased | Not known | Community |
Omicron is the currently circulating VOC. Other VOCs that impacted earlier-
| Variant Name (with lineages) | First detected in country | Time of detection | Journey |
| Delta B.1.617.2 | India | Oct. 2020 | VOI – 4th April 2021VOC – 11th May 2021 – Still circulating |
| Gamma P.1 | Brazil | Nov. 2020 | VOC: 11-Jan-2021 – Last VOC – March 2022 |
| Beta B.1.351 | South Africa | May 2020 | VOC: 18-Dec-2020 – Last VOC – March 2022 |
| Alpha B.1.1.7 | United Kingdom | Sep. 2020 | VOC: 18-Dec-2020 – Last VOC – March 2022 |
Steps taken
For a VOC that is identified, a WHO Member State must:
- Submit the genome sequences and relevant metadata to GISAID or similar public database
- Report the initial infection cases reported with the particular VOC
- Enhance the understanding of the potential impacts of the VOC thorough assessments/investigations of various parameters
- Submit virus isolates via virus sharing initiatives
For a potential VOC, the WHO must:
- Assess the characteristics and public health risks in collaboration with the Technical Advisory Group on Virus Evolution
- Initiate additional lab assessments if required
- Share the new findings with the Member States and the public
- Update the relevant WHO guidelines if necessary
- Arrange sharing of virus isolates via WHO Biohub
Variant of Interest (VOI)
A VOI mostly has an in-vitro (presence is an artificial environment and not living beings) evidence of resulting in a significant impact on the three parameters of transmissibility, severity, and/or immunity to an extent of actually disturbing the real-time epidemiological situation of an area. However, the actual examination/evidence is still either uncertain or preliminary to classify as a VOC.
These are identified to have a major community impact in terms of transmission and other factors. There are currently no circulating VOIs, however, some previously identified VOIs include:
| Variant Name (with lineages) | First detected in country | Time of detection | Journey |
| Mu | Columbia | Jan. 2021 | VOI: 30-Aug-2021 – Last VOI – March 2022 |
| Lambda | Peru | Dec. 2020 | VOI: 14-Jun-2021 – Last VOI – March 2022 |
| Kappa | India | Oct. 2020 | VOI: 04-Apr-2021 – Last VOI – September 2021 |
| Iota | USA | Nov. 2020 | VOI: 24-Mar-2021 – Last VOI – September 2021 |
| Theta | Phillippines | Jan. 2021 | VOI: 24-Mar-2021 – Last VOI – July 2021 |
| Eta | Multiple countries | Dec. 2020 | VOI: 17-Mar-2021 – Last VOI – September 2021 |
| Epsilon | USA | Mar. 2020 | VOI: 05-Mar-2021 – Last VOI – July 2021 |
Steps taken
For a new potential VOI that is identified, a WHO Member State must:
- Keep the WHO updated on the same
- Submit the genome sequences and relevant metadata to GISAID or similar public database
- Enhance the understanding of the potential impacts of the VOC thorough assessments/investigations of various parameters
- Conduct relevant laboratory assessments
- Submit virus isolates via virus sharing initiatives
For a potential VOI, the WHO must:
- Assess the characteristics and public health risks
- Initiate additional lab assessments if required
- Review, monitor, & track the global spread and impact of VOI
- Arrange sharing of virus isolates via WHO Biohub
Variants Under Monitoring (VUM)
These are other variants of SARS-CoV-2 identified as signals through monitoring, screening, or intelligence. These might have properties similar to VOC, but the evidence of impact is either not yet established or is weak.
Currently, there is no variant under monitoring.
Steps taken
For a VUM, a WHO Member State must:
- Make more efforts towards the study of such circulating variants
- Submit the genome sequences and relevant metadata to GISAID or a similar public database
- Enhance the understanding of the potential impacts of the VOC thorough assessments/field investigations of various parameters
- Conduct relevant laboratory assessments
- Monitor the spread
- Submit virus isolates via virus sharing initiatives
For a VUM, the WHO must:
- Assess the characteristics and public health risks
- Monitor & track the global spread and impact of VOI
Variants’ Nomenclature
For the ease of reference, the WHO assigns a unique name to each variant. For the COVID variants (these were the ones that required priority dissemination of information to the public), the WHO adopted the Greek Alphabet nomenclature in May 2021.
Basics to stay safe from COVID Variants
Variants will come and go – important is to stay safe come what may ☺
One should:
- Wear masks, especially in public places
- Follow the vaccination routine
- Take care of apt ventilation of the place you stay/work in
- Take care of personal hygiene
- Sneeze or cough into a tissue or bent elbow
- Try to maintain some distance with others, if feasible
Stay Aware, Stay Healthy!
Avani Raj Arora