It seems every few weeks we hear about a new Covid variant, and it’s hard to know how concerned we ought to be.
A “recombinant” variant has emerged, dubbed “Omicron XE”, which is the result of two omicron strains merging together in a single host and then going on to infect others.
So what do we know about this new hybrid, and do we need to worry?
A bit about Omicron and its variants
Omicron is a variant of the SARS-CoV-2 virus that was first discovered in Botswana on November 11 2021 and designated a variant of concern by the WHO on November 26. Since this time, it has been transmitted worldwide and replaced Delta to become the dominant variant.
Omicron has since continued to evolve to have multiple different lineages, or genetically related subvariants. This includes the original Omicron BA.1 (B.1.1.529) and also BA.2 and BA.3.
BA.2 is more infectious than BA.1 and has now taken over or outcompeted BA.1 to become the new dominant form of the SARS-CoV-2 virus worldwide, with the WHO officially announcing this to be the case on March 22 2022.
The differences we have seen with Omicron relative to previous variants are explained by the relatively large number of mutations it has acquired, with 60 mutations not found in the original virus arising from Wuhan, China.
Among these mutations are 32 genetic changes in the spike protein. The spike protein is the part of the virus it uses to attach to human cells, as well as the target of the immune response against the virus, from both vaccines and prior infection.
BA.2 shares many of these same mutations as the original Omicron variant, but also has 28 unique genetic changes of its own. Four of these genetic changes are in the spike protein, which explains why some of its characteristics are different to the original Omicron variant (BA.1), including the fact it appears to be approximately 30 to 50% more infectious than BA.1.
What’s a ‘recombinant’?
Just as we have seen new variants arise, followed by the evolution of subvariants or different lineages, the SARS-CoV-2 virus has continued to change in other ways as well. In recent times we have seen not just spontaneous changes in the genetic code that have accounted for the changes described above, but also so-called recombinants.
A recombinant is where related viruses exchange genetic material to create offspring with genetic material from both parent viruses. This can arise when viruses of two different strains (or variants or subvariants) co-infect the same cell.
The genetic material of the viruses can get mixed and packaged together to make a new recombinant virus, with properties of either or both parent viruses. The properties of the recombinant virus therefore depend on which parts of the genetic material from the parent viruses make it into the new version – just like you might have your mum’s nose and your dad’s knees.
When Delta and Omicron recombine, the resulting progeny have been referred to as “Deltacron” (although more officially these are referred to as XD and XF). This type of recombinant was first identified in France in mid-February and seems to have a genetic sequence mostly the same as Delta, but with aspects of the spike protein from Omicron BA.1.
So what is XE and where is it spreading?
XE is a recombination of BA.1 and BA.2. There are many other BA.1 and BA.2 recombinants, including XQ in the UK, XG from Denmark, XJ from Finland and XK from Belgium.
While XE still comprises a small proportion of total sequenced cases, it has shown evidence of community transmission, at least within England where it was first detected in mid-January. There have now been just over 1,100 cases recorded.
It has also been identified in India, China and Thailand. Initially the growth rate for XE appeared to not be significantly different from BA.2, but more recent data from the UK suggests it has a growth rate of around 10 to 20% above that of BA.2.
This data remains preliminary and based on small numbers, so may change as we get more information. If it is true, then this means XE is likely to be slightly more contagious than BA.2, which was slightly more contagious than BA.1, which was more contagious than Delta.
Do we need to worry?
Our immune response that helps to protect against Covid-19 is generated by vaccination or from previous infection, and it mostly targets the spike protein. Given XE basically has the same spike protein as BA.2, it doesn’t appear our protection against XE will be significantly reduced.
While this is something public health agencies and expert groups certainly should monitor, and they are, it isn’t really something that is unexpected given the number of cases we continue to see worldwide. So it shouldn’t be a cause of extra concern for the general public.
The best way to slow the emergence of new variants, as well as recombinants, remains having as many people in the world protected by vaccination to reduce the pool of susceptible hosts in which these events can occur.
The World Health Organization has raised concerns about the spread of H5N1 bird flu, which has an “extraordinarily high” mortality rate in humans.
An outbreak that began in 2020 has led to the deaths or killing of tens of millions of poultry. Most recently, the spread of the virus within several mammal species, including in domestic cattle in the US, has increased the risk of spillover to humans, the WHO said.
“This remains I think an enormous concern,” the UN health agency’s chief scientist, Jeremy Farrar, told reporters in Geneva.
Cows and goats joined the list of species affected last month – a surprising development for experts because they were not thought susceptible to this type of influenza. US authorities reported this month that a person in Texas was recovering from bird flu after being exposed to dairy cattle, with 16 herds across six states infected apparently after exposure to wild birds.
The A(H5N1) variant has become “a global zoonotic animal pandemic”, Farrar said.
“The great concern of course is that in … infecting ducks and chickens and then increasingly mammals, that virus now evolves and develops the ability to infect humans and then critically the ability to go from human to human,” he added.
So far, there is no evidence that H5N1 is spreading between humans. But in the hundreds of cases where humans have been infected through contact with animals over the past 20 years, “the mortality rate is extraordinarily high”, Farrar said, because humans have no natural immunity to the virus.
From 2003 to 2024, 889 cases and 463 deaths caused by H5N1 have been reported worldwide from 23 countries, according to the WHO, putting the case fatality rate at 52%.
The recent US case of human infection after contact with an infected mammal highlights the increased risk. When “you come into the mammalian population, then you’re getting closer to humans”, Farrar said, warning that “this virus is just looking for new, novel hosts”.
Farrar called for increased monitoring, saying it was “very important understanding how many human infections are happening … because that’s where adaptation [of the virus] will happen”.
“It’s a tragic thing to say, but if I get infected with H5N1 and I die, that’s the end of it,” he said. “If I go around the community and I spread it to somebody else then you start the cycle.”
He said efforts were under way towards the development of vaccines and therapeutics for H5N1, and stressed the need to ensure that regional and national health authorities around the world had the capacity to diagnose the virus.
This was being done so that “if H5N1 did come across to humans, with human-to-human transmission”, the world would be “in a position to immediately respond”, Farrar said, calling for equitable access to vaccines, therapeutics and diagnostics.
“I’m not saying it’s society’s problem, but there should be recognition of the load that caregivers are taking.”
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Published Apr 18, 2024 • Last updated 7 hours ago • 4 minute read
Dr Lisa Walker is co-chair of the Enhancing Access to Care conference on Saturday.Photo by Ottawa Brain and Mind Research Institute /Handout
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When former CEO Bruce Wood was diagnosed with young onset Alzheimer’s disease in 2016, he made a point of talking publicly about the illness to help others. When he could no longer do so, that duty fell to his wife, Lisa Raitt.
The former senior federal cabinet minister, lawyer and mother has made speaking about her husband’s illness part of her busy life, even when it is difficult, which it often is. She sees it as a duty to help people better understand the disease and to support caregivers like her.
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“I always accept these invitations.”
Raitt will be keynote speaker at an Ottawa conference this weekend aimed at helping patients and their caregivers navigate the often complex systems of care once they are diagnosed with neurological illnesses such as Alzheimer’s.
The Enhancing Access to Care conference, sponsored by the University of Ottawa’s Brain and Mind Research Institute, will include sessions on barriers to accessing care for rural residents, the latest research for neurodegenerative illnesses, including Parkinson’s disease and dementia, information on the regional geriatric program and Raitt’s talk on the challenges of care for young-onset Alzheimer’s.
The conference is a recognition of the difficulties patients and their caregivers can have accessing the help they need.
Wood was diagnosed when he was 56 and Raitt was 47. It was a shock. Raitt said she wanted people to think about the fact that “sometimes it’s Alzheimer’s” — meaning possible symptoms shouldn’t be dismissed just because of a person’s age.
In the early days after his diagnoses, Wood’s disease seemed to move slowly, she said, and they were able to travel and “do all of our bucket-list things.” But then it progressed and life became increasingly difficult.
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“We had a very specific set of circumstances where Bruce was becoming very combative, not just aggressive, but aggressive that was threatening to our lives in the house. When you are in it, you can’t negotiate because you are drowning and just trying to keep your head up.”
Raitt said she thought it was important that people hear the realities of the disease “because I am not the only one who is going through this or went through this. I believe there’s an obligation for me to at least give some kind of colour to the reality so that others can recognize it.”
Wood is now in a long-term care home, something Raitt says she fought “with every fibre.” She acknowledges he is receiving better care than he could receive at home and that she probably waited too long to do so.
“I think what could have helped me is somebody saying they are better off in a long-term care facility because he gets better care than I could have provided.”
Raitt said she also hoped members of the medical community heard her story to start to think about the possibility of young onset Alzheimer’s when a patient had symptoms that might include increasing problems with planning, problem solving, attention and emotions.
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Wife, mother, lawyer and former MP and cabinet minister Lisa Raitt will be keynote speaker at the Enhancing Access to Care conference on Saturday.Photo by Ottawa Brain and Mind Research Institute /Handout
She also noted that the vast majority of caregivers, like her, are women. Raitt, a lawyer, belonged to a support group of caregivers in similar circumstances and says almost all of them decided to retire early because of the pressures of caring on top of their work.
“I didn’t have the choice to retire. I’ve got two kids in university and a husband with special needs. That takes extra cash — and I continue to work for my own sanity, too” she said. “But the reality is caregivers are the ones taking a load off society and society couldn’t function without us. I’m not saying it’s society’s problem, but there should be recognition of the load that caregivers are taking.”
The conference, which will be held Saturday at the RA Centre, is aimed at people with neurological conditions and their care partners. In addition to presentations, organizations will be on-site to offer information about other services available in the community, including from traditionally marginalized group “who might not know there are services specific to their needs,” said Dr. Lisa Walker, a clinical neuropsychologist who is co-lead of the uOttawa Brain and Mind Research Institute’s neurodegeneration pillar.
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It is the first event of its kind for the University of Ottawa Brain and Mind Research Institute. Typically, events are geared toward research, Walker said.
It is difficult living with neurodegenerative conditions, she said, and can be a daunting task to access care. Sometimes, it is available, but people don’t know how to find it.
She said the shortage of family doctors was an added burden for people to understand the supports available in the community. “There are many excellent services that people can access, but they don’t know they exist and can’t access them.”
Among them are services through the regional geriatric program and the Dementia Society of Ottawa and Renfrew County. One of the speakers will talk about Ontario 211, a help line to help people access social services, programs and community supports.
Walker said the conference would also address the burden on informal caregivers, as family members and friends who care for loved ones are called.
“It is a huge burden of care, both from a practical standpoint and an emotional standpoint.”
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Newfoundland and Labrador’s top doctor is warning people to stay up to date on whooping cough vaccinations after a small increase in cases this year.
The province usually sees three to four cases of the disease annually. Up to 10 cases have been reported already since January, however, prompting the province’s chief medical officer to raise the issue publicly.
The increase “generally means there’s a little bit more circulating in the community than what’s presenting for care and testing,” Dr. Janice Fitzgerald said Tuesday.
While officials aren’t overly concerned about a future spike in cases, Fitzgerald said, higher infection rates place infants in particular at risk.
Children under the age of one aren’t yet old enough for the whooping cough vaccine and don’t have immunity to the disease, Fitzgerald said. Infections in small children can be more severe and lead to pneumonia, neurological issues and hospitalization.
Fitzgerald said parents, grandparents and caregivers should check to ensure their vaccinations are up to date.
Whooping cough, also known as pertussis, causes a persistent nagging cough that’s sometimes severe enough to cause vomiting. Vaccines for the disease are offered in early childhood, during high school and in adulthood. Booster shots should be given 10 years after the high school dose, Fitzgerald said.
“Immunity can wane over time,” she said. “Pertussis does circulate on a regular basis in our community.”
The small increase in cases isn’t yet ringing alarm bells for undervaccination within the general population, she added, noting the province still has a vaccination rate over 90 per cent.
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