COVID-19 Variants. by Dr.T.V.Rao MD

COVID-19 – Variants�emerging challenges�2022 - 2023 �Dr.T.V.Rao MD

1. COVID- 19 – Variants emerging challenges 2022 - 2023 Dr.T.V.Rao MD Dr.T.V.Rao MD 23-12-2022 Dr.T.V.Rao MD Covid 19 and Vaiatns 1

2. Progress of SARS-CoV- 2 virus Infections from 2019 to 2022 Since the SARS-CoV-2 virus first emerged in Wuhan, China in late 2019, its genetic material has experienced numerous changes, some of which have altered how easily it is transmitted, the severity of disease it causes and the performance of COVID-19 vaccines, diagnostics and treatments against it. These changes, or mutations, occur when a virus replicates or makes copies of itself. A virus that has mutated in this way is referred to as a variant. 23-12-2022 Dr.T.V.Rao MD Covid 19 and Vaiatns 2

3. COVID-19 pandemic and Multiple Variants Throughout the COVID-19 pandemic, several coronavirus variants have emerged as the virus, SARS-CoV-2, continues to mutate and evolve. Many of these variants’ mutations have little or no impact on how the virus affects humans. But others, such as the genetic changes in the delta variant, can make the coronavirus more transmissible contagious) than the original version of SARS-CoV-2 that was discovered in late 2019. 23-12-2022 Dr.T.V.Rao MD Covid 19 and Vaiatns 3

4. Clarifying terms You may hear different words used to describe new variants of SARS-CoV-2: Mutations Variants Strains Mutation d escribes the process through which the SARS-Cov-2 virus changes . Variants describes the version of the virus that has changed, through mutation, from the original virus. Strains i s used in the same way as the word variants. Dr.T.V.Rao MD Covid 19 and Vaiatns 4 23-12-2022

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6. Viruses regularly create new strains Viruses regularly create new strains . New strains are created when viruses make copies of themselves. When replicating, sometimes mistakes are made. Those mistakes create a slightly different version of the virus – the variant . Dr.T.V.Rao MD Covid 19 and Vaiatns 6 23-12-2022

7. We are still not clear in mantters related to variants Not yet clear whether Omicron is more easily spread from person to person compared to other variants, or whether infection with it causes more severe disease. 23-12-2022 Dr.T.V.Rao MD Covid 19 and Vaiatns 7

8. What is a new ‘strain’ of COVID-19 Variants or strains of viruses happen when there is a change / mutation to the virus’s genes (Johns Hopkins ). It’s normal and expected for RNA viruses like the coronavirus to evolve and change over time 23-12-2022 Dr.T.V.Rao MD Covid 19 and Vaiatns 8

9. SARS –CoV 2 to Omicron In November 2021, a variant of the SARS-CoV-2 coronavirus emerged, and was named omicron by the World Health Organization (WHO). WHO currently lists the omicron as a variant of concern. 23-12-2022 Dr.T.V.Rao MD Covid 19 and Vaiatns 9

10. How did the Omicron variant develop? When a virus is circulating widely and causing numerous infections, the likelihood of the virus mutating increases. The more opportunities a virus has to spread, the more opportunities it has to undergo changes. 23-12-2022 Dr.T.V.Rao MD Covid 19 and Vaiatns 10

11. What are the variants of Omicron? Circulating What are the variants of Omicron? "Currently subvariants of omicron are circulating, including BQ.1.1, BQ.1, BA.5, BF.7 and XBB 23-12-2022 Dr.T.V.Rao MD Covid 19 and Vaiatns 11

12. Do these changes make it more deadly? Not necessarily . Often, it is more advantageous for a respiratory virus to evolve so that it spreads more easily. Whilst, mutations that make a virus more deadly may not give the virus an opportunity to spread efficiently. So mutations in COVID-19 frequently favour being more infectious rather than being more deadly. However, more infections from a faster-spreading variant will mean more people to have serious reactions and thus more hospitalizations and deaths . 23-12-2022 Dr.T.V.Rao MD Covid 19 and Vaiatns 12

13. New Omicron strains impact on China Omicron strains that are particularly contagious, primarily BA.5.2 and BF.7, are currently wreaking havoc in China. The BF.7 virus, which according to WHO officials are the Covid virus that is spreading the fastest in Beijing, is having a devastating effect on the city's health networks as thousands of people rush to fever clinics in search of immediate treatment. 23-12-2022 Dr.T.V.Rao MD Covid 19 and Vaiatns 13

14. Concerns in India on new Variants The fresh surge in Covid cases in China has sent shock waves through the subcontinent, especially in India. As per news reports, China has been hit by omicron subvariant BF.7, which is spreading like wildfire and has already affected thousands across the country. 23-12-2022 Dr.T.V.Rao MD Covid 19 and Vaiatns 14

15. WHAT IS BF 7 According to World Health Organization (WHO), BF.7, which is a shorter term for BA.5.2.1.7, is the fastest spreading Covid virus. 23-12-2022 Dr.T.V.Rao MD Covid 19 and Vaiatns 15

16. How Does The BA.4 and BA.5 Differ From The Original Omicron Sister Variants? Several types of research on the latest variants confirm that the sub-variants BA.4 and BA.5 have a huge growth advantage over both BA.1 and BA.2, either owing to their ability to transmit faster from one person to another or their proficiency to escape vaccination acquired immunity. 23-12-2022 Dr.T.V.Rao MD Covid 19 and Vaiatns 16

17. What Is The L452R Mutation? The L452R mutation is defined as the change in the genome code at the position L452R. This mutation was also seen earlier in Delta, Kappa, and Epsilon and is known to enhance the virus’ ability to enter the human cells. These mutations have already been affirmed as responsible for faster infectivity and transmission rate and the ability to escape neutrality by monoclonal antibodies. Preliminary research even suggests that the BA.4 and BA.5 lineages may even be competent enough to bypass the immunity gained by the previous BA.1 lineage causing breakthrough infections. 23-12-2022 Dr.T.V.Rao MD Covid 19 and Vaiatns 17

18. Does The BA.4 and BA.5 Variants Pose A Threat In India? The existence of the BA.4 and BA.5 sub-variants was first ascertained in India by the INSACOG (Indian SARS-CoV-2 Genomics Consortium) on May 22, with cases in Tamil Nadu and Telangana coming to the surface. The cases were first detected in two patients from Telangana and Tamil Nadu, respectively 23-12-2022 Dr.T.V.Rao MD Covid 19 and Vaiatns 18

19. COVID A NEW STRAIN IN CHINA BF.7 variant The COVID situation in China shows that the BF.7 variant has the strongest transmission capacity. According to reports, the BF.7 Omicron variant easily infects people and spreads more quickly than other strains. Additionally, it is discovered that everyone is affected by the variant equally, regardless of vaccination history. 23-12-2022 Dr.T.V.Rao MD Covid 19 and Vaiatns 19

20. BF 7 variant causes Virus causes severe throat infections, runny nose, body aches, and a medium-to-high fever. According to official data cited in reports, elderly people with underlying illnesses and complications particularly those with cardiovascular disease, diabetes, and chronic respiratory diseases are more likely to experience severe cases. 23-12-2022 Dr.T.V.Rao MD Covid 19 and Vaiatns 20

21. What is the transmission rate of BF. 7? The COVID situation in China shows that the BF.7 variant has the strongest transmission capacity. According to reports, the BF.7 Omicron variant easily infects people and spreads more quickly than other strains. 23-12-2022 Dr.T.V.Rao MD Covid 19 and Vaiatns 21

22. Omicron subvariant BF. 7 behind China Covid spike already existed in India. Do we need to be scared? Omicron BF.7 is currently the dominant variant of Covid in China that is making people fall sick, overwhelming hospitals and piling up bodies in morgues. With the worsening situation in China, people all around the world are fearing another lockdown and a possible severe wave. 23-12-2022 Dr.T.V.Rao MD Covid 19 and Vaiatns 22

23. Will Covid variant BF.7 spark 4th pandemic wave globally? Know symptoms, how it is different from Delta compared to the deadly Delta variant which sparked the brutal second wave in India in 2021, the BF.7 sub-variant is highly transmissible. A new Covid-19 outbreak in China and some other parts of the world has triggered fears of a fresh global wave of the pandemic. The variant said to be responsible for the spike in cases in China is Omicron sub-variant BF.7. This variant was detected in India for the first time in October. 23-12-2022 Dr.T.V.Rao MD Covid 19 and Vaiatns 23

24. OMICRON BF. 7 SYMPTOMS The symptoms remain the same as with any other upper respiratory infection such as fever, cough, sore throat, and running nose. There is suspicion that this wave could kill one million people alone in China . 23-12-2022 Dr.T.V.Rao MD Covid 19 and Vaiatns 24

25. How do the symptoms of Omicron differ from previous COVID-19 variants? Headache, runny nose, scratchy throat? Such symptoms are the mainstay of many common winter illnesses, but early reports from South Africa that these – and/or a dry cough, body aches and night sweats – have been observed in some of those infected with the new Omicron variant, have prompted speculation that SARS-CoV-2 might be evolving to cause milder illness. 23-12-2022 Dr.T.V.Rao MD Covid 19 and Vaiatns 25

26. Situation updates n its latest situation report, published on 14 December, the WHO said: “The data on the clinical severity of Omicron remains limited. More information on case severity associated with Omicron is expected in the coming weeks due to the time lag between an increase in the incidence of cases and an increase in the incidence of severe cases, and deaths.” 23-12-2022 Dr.T.V.Rao MD Covid 19 and Vaiatns 26

27. Highly transmisable variants A person infected with this virus, even if they are asymptomatic, can transmit the virus to another 10-18 people. Only time will tell, what happens in the next few months 23-12-2022 Dr.T.V.Rao MD Covid 19 and Vaiatns 27

28. ARS-CoV-2 Viral Mutations: Impact on COVID-19 Tests The SARS-CoV-2 virus has mutated over time, resulting in genetic variation in the population of circulating viral strains, also called lineages. This genetic variation may impact the virus's properties such as transmission (for example, it may spread more easily) or the severity of symptoms on infected individuals (for example, it may cause more severe disease) 23-12-2022 Dr.T.V.Rao MD Covid 19 and Vaiatns 28

29. Diagnosis of Variants need Newer Molecular methods The presence of mutations in the SARS-CoV-2 virus in a patient sample can potentially impact test performance. Molecular, antigen, and serology tests are affected by viral mutations differently due to the inherent design differences of each test. The impact of mutations on a test's performance is influenced by several factors, including the sequence of the variant, the design of the test, and the prevalence of the variant in the population. 23-12-2022 Dr.T.V.Rao MD Covid 19 and Vaiatns 29

30. The FDA recommends clinical laboratory staff and health care providers who use SARS-CoV-2 tests note the following: Genetic variants of SARS-CoV-2 arise regularly, and false negative test results can occur. Consider negative results in combination with clinical observations, patient history, and epidemiological information. Consider repeat testing with a different EUA-authorized or FDA-cleared molecular diagnostic test (with different genetic targets) if COVID-19 is still suspected after receiving a negative test result. Test performance may be impacted by certain variants. 23-12-2022 Dr.T.V.Rao MD Covid 19 and Vaiatns 30

31. Current suggested Molecular Methods Tests with single targets are more susceptible to changes in performance due to viral mutations, meaning they are more likely to fail to detect new variants. Tests with multiple targets are more likely to continue to perform as described in the test's labeling as new variants emerge. Multiple targets means that a molecular test is designed to detect more than one section of the SARS-CoV-2 genome or, for antigen tests, more than one section of the proteins that make up SARS-CoV-2. 23-12-2022 Dr.T.V.Rao MD Covid 19 and Vaiatns 31

32. What Are The Symptoms Of BF.7? An infection with BF.7 subvariant will result in similar symptoms to other Omicron variants, which include fever, fatigue, and upper respiratory symptoms like cough, sore throat, and runny nose.In a few cases, patients experienced gastrointestinal symptoms like vomiting and diarrhoea. And people with a compromised immune system may suffer from a severe illness when affected by BF.7 subvariant. 23-12-2022 Dr.T.V.Rao MD Covid 19 and Vaiatns 32

33. Common Covid-19 Omicron symptoms that you may expect to experience t’s normal to experience the following with the omicron variant: A scratchy or sore throat Sneezing or a runny nose Fever a temperature of 38°C and over Tiredness A new or worsening cough (mare tauraki ) Shortness of breath Loss of smell Headache / Body aches Nausea/vomiting Diarrhoea or loose bowel movements 23-12-2022 Dr.T.V.Rao MD Covid 19 and Vaiatns 33

34. Infection control actions work Infection control actions work, and they work against the new strains of SARS-CoV-2 . These include following recommendations for use of PPE Source control Physical distance Ventilation Hand hygiene Cleaning and disinfection Dr.T.V.Rao MD Covid 19 and Vaiatns 34 23-12-2022

35. When to get help when ill with Omicron (and you need support with treating symptoms at home) increasing breathlessness while resting coughing up blood, become confused, have severe chest pain 23-12-2022 Dr.T.V.Rao MD Covid 19 and Vaiatns 35

36. HOW BEST WE CAN PREVENT Vaccines are an important tool in our fight against the pandemic, but, as we know, vaccines alone will not get any country out of this pandemic. We must scale up vaccination and at the same time implement public health and social measures, which have proven critical to limiting transmission of COVID-19 and reducing deaths,” 23-12-2022 Dr.T.V.Rao MD Covid 19 and Vaiatns 36

37. Public health and social measures Public health and social measures include surveillance and response such as testing, genetic sequencing, contact tracing, isolation, and quarantine. They include personal protective measures such as masks; physical distancing; avoiding crowded, closed and confined settings; ensuring hand hygiene and respiratory etiquette. Physical distancing measures include regulating the number and flow of people attending gatherings, maintaining distance in public or workplaces. 23-12-2022 Dr.T.V.Rao MD Covid 19 and Vaiatns 37

38. 2022 was a wake-up call for global health. Let's turn the tide in 2023. 23-12-2022 Dr.T.V.Rao MD Covid 19 and Vaiatns 38

39. MINISTRY OF HEALTH ADVISES TO WEAR MASKS AT ALL CRWODED PLACES 23-12-2022 Dr.T.V.Rao MD Covid 19 and Vaiatns 39

40. WE CAN SAVE MANY LIVES WITH SIMPLE METHODS ARE WE READY ? 23-12-2022 Dr.T.V.Rao MD Covid 19 and Vaiatns 40

41. Resources and Future Training sessions Project Firstline on CDC: https://www.cdc.gov/infection control/projectfirstline/index.html Project Firstline on Facebook: https://www.facebook.com/CDCProjectFirstline/ Twitter: https://twitter.com/CDC_Firstline YouTube: https://www.youtube.com/playlist?list=PLvrp9iOILTQZQGtDnSDGViKDdRtIc13VX To sign up for Project Firstline e-mails, click here: https://tools.cdc.gov/campaignproxyservice/subscriptions.aspx?topic_id=USCDC_2104 Dr.T.V.Rao MD Covid 19 and Vaiatns 41 23-12-2022

42. References WHO health and public health resources on Covid 19 NIH Mayo health resources Updates from CDC On COVID 19 FDA USA 23-12-2022 Dr.T.V.Rao MD Covid 19 and Vaiatns 42

43. The program file created by Dr.T.V.Rao MD for benefit of Medical Paramedical and Nursing professionals globally with many health and web based information Do not contain any conflict of Interest Dr.T.V.Rao MD [email protected] 23-12-2022 Dr.T.V.Rao MD Covid 19 and Vaiatns 43