Why new variants of COVID-19 have such confusing names

If you can name currently circulating variants of coronavirus without looking for them, your memory is better than most people’s — even those still paying attention to COVID-19.

Currently, the top five variants in the US are called BA.5 (accounting for about 39% of new cases of latest data from the US Centers for Disease Control and Prevention), BQ.1.1 (almost 19%), BQ.1 (16.5%), BA.4.6 (9.5%), and BF.7 (9%). Meanwhile, the XBB variant has been found in at least 35 countries and the European Center for Disease Prevention and Control observed variant called B.1.1.529.

This alphabet-soup nomenclature appears to be a significant departure from the Greek letter system of the World Health Organization (WHO), which was established in May 2021 to give people an easy and location-neutral way to refer to new options. While the Greek letter system that gave names like Alpha, Beta, and Delta didn’t replace existing scientific naming systems — such as those responsible for labels like BA.5 and XBB — it was intended to simplify public communication about important virus strains.

WHO assigns a new Greek letter to a variant only if it is significantly different from previous versions. And over the past year, we’ve seen flavor after flavor of Omicron, not entirely new iterations of the virus, explains Maria Van Kerkhove, WHO’s technical lead for COVID-19. That’s why we did not yet have a strain called Pi.

Dr. Peter Hotez, co-director of the Vaccine Development Center at Texas Children’s Hospital, called the newer strains “Scrabble variants” because many of them contain high-scoring Scrabble letters like Q and X. And he adds, because as they “kind of scratch the brain”.

“I’m a scientist who’s been developing coronavirus vaccines for the last decade, and it’s even a challenge for people like me” to follow them, Hotez says. They’re not just hard to remember. The names are enough to make the average person’s eyes glaze over – which isn’t great considering that much of the audience has already checked out of the pandemic.

However, Van Kerchow argues that the public probably doesn’t need to know all the nitty-gritty details of BQ.1 vs. BQ.1.1 vs. BF.7. “What the general public really needs to know is what does this mean for me in terms of risk? We will give new names using the Greek letters when those variants are significantly different from each other” in terms of severity, immune evasion or transmission, she says.

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But some experts say variant names have real implications for ordinary people. Hotez points out the new divalent boosters, which are formulated to target options BA.4 and BA.5. BQ.1 and BQ.1.1 are successors to BA.5, so vaccines probably also provide some protection against them, and this knowledge will perhaps provide additional motivation to obtain new vaccines. But partly because of their names, the average person probably doesn’t know that BQ.1 is related to BA.5, Hotez says.

T. Ryan Gregory, a professor of integrative biology at Canada’s University of Guelph, says the names of the alphabet soup are important for scientists to know because they convey information about how the virus evolved. But he thinks there should also be common names that the general public can use, just as there are scientific and common names for animal species. He is still advertised (unofficial) nicknames for the latter variants, calling BQ.1.1 “Cerberus”, BQ.1 “Typhon” and XBB “Griffon”.

If all the variants start to mix in the public mind, people may not register the emergence of new strains that they may be able to avoid immunity acquired from vaccinations or previous infections, says Gregory. A clearer understanding of circulating variants may also be important in healthcare settings, as some monoclonal antibody therapies do not work well against certain options, he adds.

Van Kerkhove says the WHO’s Technical Advisory Group on the evolution of the SARS-CoV-2 virus is working on a “more robust” method to assess when a variant should be given a new name, with a particular focus on immune evasion. The jump from Delta to Omicron was so dramatic that it was easy to give Omicron a new name, Van Kerchow says. But now that the virus is mutating in more subtle ways, it’s a more complicated decision. At the end of October, the advisory group voted against assigning new labels to XBB and BQ.1 as they are not sufficiently different from previous Omicron forms.

For variants that don’t meet the WHO threshold for a new Greek letter, the agency could at least use a more understandable naming system, Hotez suggests—perhaps starting with Omicron and then moving to Omicron 1, Omicron 2, etc. .n. . Van Kerkhove says the WHO has discussed this, but even this system comes with problems. There are currently about 300 Omicron sublines under review, she says, and “Omicron 300 sounds like a movie franchise.”

The public probably doesn’t need to know and discuss all of these options, Gregory says. But for strains that are widespread and account for a significant proportion of infections, it pays to have easy-to-understand names.

Right now, most people are either like, “Wow, it’s alphabet soup and I can’t keep track,” or, “Well, it’s all Omicron,” so it doesn’t matter when there’s a new variant, Gregory says. What society lacks—and needs, he says—is a shared vocabulary that would help everyone understand the pandemic as it continues to unfold.

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Write to Jamie Ducharme c [email protected].

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