You can call it ‘The Kraken’, and everything else you need to know about the new Covid variant

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Jordan Heath-Rawlings Hello. It’s January. By now you should know what that means. The first cases of the very contagious Omicron subvariant, xBB.1.5, also known as Kraken, have been detected in Quebec. The latest subvariant is being dubbed Kraken, after the mythological sea monster. Experts say though it is proof positive the virus is still evolving, health officials are monitoring the so called Kraken variant, which is highly contagious. This pattern is depressingly familiar. A new COVID variant emerges in the winter. It starts to spread faster, it evades more immunity, it may or may not be more severe, and it grows to dominate the other strains. And then we wait. First, we wait to see how sick we get and if our hospitals will become overwhelmed. And second, we just wait for spring. Now, is this time the same or is it different? You may have noticed that this year we don’t have anywhere near the precautions we had when Omicron was rising to prominence in 2022. In fact, right now we barely have precautions at all. We also, however, have a huge chunk of the population fully vaccinated, and lots and lots of people have received a bivalent booster. On the other side, we also do not seem to have any society wide desire to alter our behaviour much in response to this new variant. So what happens now? A wave similar to Omicron last year? A blip? Nothing at all. What do we know and what don’t we know about X-B-B 1.5? Why are some people calling this variant the Kraken? And are we now allowed to start giving variants, cool nicknames like that? Really? Can we do that? I’m Jordan Heath Rawlings. This is The Big Story. Dr. Raywat Deonandan is a global health epidemiologist. He’s an associate professor with the Interdisciplinary School of Health Sciences at the University of Ottawa. And he’s somebody we call whenever this pandemic takes a new turn. Hello, Dr. Deanandan.

Dr. Raywat Deanandan Hello, how are you?

Jordan I’m doing well. Thank you for joining us, as always.

Dr. Raywat Deanandan It’s my pleasure. As always.

Jordan We’re talking, of course, because there is a new variant of COVID-19 I am seeing. It called XBB1.5. Why is it called that? And also, why are some people calling it the Kraken?

Dr. Raywat Deanandan So, for some reason, the WHO gives uninteresting alphanumeric names to Omicron subvariants like XBB and BA2. But there is a fellow named T. Ryan Gregory, who’s an evolutionary biologist at the University of Guelph, and he and his community of online virus trackers decided to give interesting names to these subvariants, among them Griffin for XBB, for example. And they chose the Kraken for XBB 1.5. And you probably know the Kraken is from mythology made famous mostly by the movie Clash of the Titans. And so they did so because they wanted people to pay attention. These alphanumeric strings don’t really capture your imagination. I like it. I think it’s a fun name. It’s more memorable and impactful. And with the Kraken you can share some fun. Liam Neeson memes at the same time it’s appropriately scary, but at the same time fun.

Jordan I have seen some doctors take issue with this, saying that it’s not appropriate to just let anybody who is not working for an official health body kind of quote unquote name a variant.

Dr. Raywat Deanandan Well, who owns these things? They aren’t owned by a particular organization. The variant is owned by nature and by those of us that infects. And to my mind, who’s better qualified to name these things than evolutionary biologists who study this thing and who focus on it? 24/7 this does not bother me in any way, shape or form. If it makes it more fun, if that’s the right word, and if it makes it more memorable and emotionally impactful for the world, then what’s the big deal? Fair enough. I mean, as the host of a podcast that has to make sense and hopefully not be too depressing about this, I definitely appreciate it. Mostly because I will never get the letters and numbers straight exactly. But I know from many conversations that you and I have had, that I’ve had with other epidemiologists, that there are new variants or sub variants of variants like Omar discovered all the time. Why has this one in particular call it whatever you want risen to be worth everyone’s attention. It’s because of one particular property. It is really, really transmissible. Looks like the most transmissible version of COVID so far. So it takes less of it to get you infected and therefore to get you sick. It may not be more serious of a virus in terms of the disease it causes, but it seems to evade any immunity you have, meaning the likelihood of reinfection is higher and the likelihood of becoming infected at any given time is higher. So for those people who are really important to avoid infection, which is most people, but also the immunocompromised and those who are vulnerable, this is bad news. You mentioned it may or may not be more serious.

Dr. Raywat Deanandan I know this is fairly early days for a variant like this, but what do we know about it so far and what don’t we know that we need to? We know it’s more transmissible. We know it’s a descendant of XBB, which arose sometime in October, which in turn was a descendant of BA2. We think it’s more contagious because it binds to receptors more easily. So far we found it in about 30 countries, including Canada. About 70% of the new cases in the Northeast USA, if not more, are caused by this. So the growth advantage it has is significant over other variants. We don’t know if it’s more serious. As you know, however, global COVID deaths have been inching upward of late and US hospitalizations have also increased. It’s unclear if that is due to XPB1.5 the Kraken, but it might be. We just don’t know. Even if it’s not more dangerous, in the sense that the case fatality rate or the hospitalization risk is higher because it is more likely to infect more people. That means the raw number of deaths and the raw number of hospitalizations are likely to increase, meaning this is likely to be a strain on society and the healthcare system depending upon exactly how much of a growth advantage it has. We don’t know as well how much compromising it will have of vaccines. It seems highly likely that our vaccines will continue to give us protection against the worst outcomes, and we also don’t know how much it’s going to compromise sensitivity of the rapid antigen tests. But it seems pretty likely that the test will still pick up this variant, at least to some extent. You mentioned that we have found it in Canada and that it’s quite prevalent in parts of the US. Do we know yet how much of our COVID cases are made up of this new variant? And if that’s growing fast, if it is growing at all. As of last week, the official count was 21 known cases in Canada. That sounds like a small number, and it is relatively a small number, but it’s a likely underestimate because nobody’s getting PCR tested anymore. And you don’t know the signature, the identity of your infected agent unless you have the PCR test. And it’s going to be growing. But the question is, exactly how much is it growing? We don’t know. We just don’t know. It’s possible that the scary narrative of hyper growth is overstated, but I think the responsible thing is to simply say there are some unknowns here. Let’s just keep our passions in check and let science enroll at its appropriate pace.

Jordan You mentioned there’s some scary headlines and certainly some scary Twitter threads. It also does seem, just to be frank, like this is a drill that we’ve all run through before. I mean, when you just sort of explained how even if it’s not more severe, the increased transmissibility means that it’ll put a strain on our system, that was exactly what we were talking about with Omicron last year. So I guess what I’m asking is, how concerned are you? How out of the normal is this for the natural kind of evolution of a virus like this?

Dr. Raywat Deanandan It’s always good to have a healthy dose of concern. If you’re vulnerable elderly, immunocompromised, et cetera, your chances of getting infected just increased. So we should be concerned for those people who are vulnerable. If you’re not vulnerable, then your chances of getting infected have also just increased. But we don’t know if your risk of bad outcomes has also increased. So premature concern, concern might be premature on that front. However, as I noted at the health systems level, I’m always concerned when the likelihood increases of more people being hospitalized. And that’s what a more transmissible variant means. So if the question is how concerned should we be, don’t panic. It’s not time to run through the streets pulling out our hair, but we should be on alert. And maybe it’s a time for the government to spend more money on things like surveillance and on strengthening our healthcare system as needs to be done. Anyway, I was going to ask this a little later in our chat, but since you just mentioned it, I’ll bring it up now. In terms of surveillance, last year with Omicron, we were looking at daily case numbers. Hospitalization numbers were sort of everywhere for the public to see percentage, positivity, all of that stuff. And you could kind of not that average people would be an expert, but you could kind of do risk assessment for yourself. And a lot of that to me, has just kind of vanished from public view.

Jordan Can we still find that stuff? How accurate is it? Like, how much do we know right now about the levels of this virus in Canada and Ontario compared to what we would have last year with Omicron?

Dr. Raywat Deanandan It’s much worse now, in my opinion, that sort of data, especially for public consumption, has mostly vanished. Mostly because most infected people aren’t getting PCR tests anymore. If anything you do in a rapid test and that isn’t entered into any database anywhere, but most people are becoming infected, don’t know it or don’t care, and aren’t reporting it. So we just don’t have the data right now. Two sources of data, maybe three, are a best bet. One is the hospitalization and the death data. That’s pretty solid. That gives us a sense of the waxing and the waning of the waves. The wastewater data is probably the best we have because it’s objective, but we haven’t got the infrastructure for wastewater testing in most of the country, just in some key urban areas. And also things something called sentinel surveillance where you have particular sites around the community that test people who walk through the door, for example, and we extrapolate from that. So all this essentially says that we don’t have a robust surveillance infrastructure for this kind of threat. And it’s something that I hope we focus on in coming months and years as we buckle in for the long covert adventure ahead. I think when you look at the lack of restrictions that are in place right now, we could all do with probably wearing more masks in public spaces and protecting each other a little bit better at the individual level.

Jordan But at a public health level, do you see this getting to the point where public health should consider implementing some kind of restrictions? And what would that look like, as you say, without the surveillance? Like, how do we know when it crosses that threshold?

Dr. Raywat Deanandan Oh, excellent question. How do we know when it crosses that threshold? Well, I guess wastewater is how do we tell and really the stresses on the healthcare system. I don’t see restrictions being imposed at any time in the future ever again. Frankly, the political will for it is absent. The public tolerance for it is also quite small. And frankly, you probably don’t need to if you do some other public health things like implement strategic mask wearing, mandatory mask wearing in public indoor settings. If you equip people with the right quality of masks, if you have people using Rapid Imagine tests strategically as a screening tool. If you have improved ventilation in key areas like schools you don’t need to be shutting down society anymore. We pretty much know what to do. And vaccination is also a fantastic tool that we continue to use. So the blunt answer is no, restrictions are not needed and I don’t think they’ll be implemented. The more nuanced answer is because we have these other public health tools. However, we’re not using these other public health tools as much as we could or should. I want to ask you about one. I was about to call it a theory, but I don’t think it’s necessarily fair to call it a theory. But I’ve seen it enough online that I wanted to get you to debunk it and explain it to us.

Jordan There are folks who are saying that just like with Omicron, it is our varying levels of vaccination and continually getting booster shots, and now a bivalent booster shot that is contributing to these rise of new and unique variants. Can you explain how that works or doesn’t work?

Dr. Raywat Deanandan I think it’s a fundamental misunderstanding of how evolution works. So this is about evolution and statistics. Every time a virus infects someone and replicates, that’s an opportunity for a mutation to occur. And mutations are random, they’re not directed in a particular direction. But if a mutation has an advantage randomly in the real world, then it will be selected for by the environment. So if a virus mutation suddenly is more hyper-transmissible or more likely to impact some sort of effect on the host, that allows a virus to live longer, that’s going to be selected for with future replication. And that’s when it becomes a newsworthy variant. Variants arise all the time. Not all of them are newsworthy. But here’s the thing vaccinated people are less likely to become infected in the first place, especially if you’ve been boosted. And if vaccinated people do become infected, they are less likely to have a long duration or serious illness. Both of those facts means that the opportunity for variants to arise is less so in vaccinated people than in unvaccinated. Now, I’m not saying that a variant can’t arise in an infected vaccinated person, it’s just more likely to do so in an unvaccinated person. And frankly, in my opinion, these variants keep arising because we did not vaccinate the world fast enough in 2021 when we had the chance in terms of vaccinations. And maybe this is something we just don’t know yet with this variant. But a lot of folks, probably not enough folks, have had their Bivalent vaccine.

Jordan Do we know? Because this is a sub variant of Omicron, if the Bivalent vaccine will offer better protection against this new variant particularly?

Dr. Raywat Deanandan We don’t know. This has not been studied in the lab as far as I know. Maybe there’s data floating out there that I’m not privy to. It seems likely that the Bivalent Jab, especially the one that derives from BA Two, will have a noticeable improvement effect on neutralizing immunity, meaning prevention of infection in the first place, at least for a while, because it’s dogged up to BA Two and its descendants, and the Kraken is a descendant of BA Two. So all signs point to the Bivalent vaccine offering some kind of advantage. How much of that advantage is measurable is unclear, but we’ll find out probably in the next few weeks.

Jordan Speaking of that, if people are due for or eligible for the Bivalent booster or another booster, is there a result of diminishing returns at some point by continually getting boosters every five or six months? In other words, if I’m offered another booster, should I go take it? Do I even have to think about it? Or is it just like, hey, more protection might as well can’t hurt?

Dr. Raywat Deanandan It’s a complicated question best answered by an immunologist, but there’s something called original antigenic sin or immune imprinting. That’s when, if you’ve been primed to have an immune reaction to a particular virus, then when future variants arise and infect you, you still start producing an immune reaction to the original version, not to the new one. And so boosting may be accentuating that effect, so it gives you a suboptimal response. Again, I’m not a vaccine expert on that front, so I can’t speak authoritatively, but that’s the concern that you can’t boost our way out of this simply by offering more and more frequent boosters because of that phenomenon. But there are ways around that as well, developing new and more interesting vaccines. Vaccines that target different portions of the virus, bivalent vaccines or trivalent vaccines, et cetera. So the scientists who develop vaccines are aware of that limitation, and the new developments are going to help hopefully avoid that eventually.

Jordan I want to end this conversation, and thank you for all your help so far by taking the long view, especially in light of the fact you just said buckle up for our long, COVID adventure, which is not especially hopeful. But I guess my question is what can we expect to see the rest of this viral season and beyond?

Dr. Raywat Deanandan Will this just become because I don’t expect this pandemic to be over in spring, even though it’ll get better, like I know the drill by now, I guess. Will this just kind of be our new normal in winter, for a few years at least? Again, impossible to say for sure. And one lesson from this pandemic is anytime someone expresses certainty, they are certain to be wrong. So it seems likely though, that we’re going to be living with a hyper endemic presence of this virus for some years to come until something radical happens like population immunity reaches a boiling point and we just dispense with the seriousness of this disease altogether. There was the Asiatic or Russian flu of 1890. Some people think it was a coronavirus pandemic. It was a very, very meaningful pandemic. It could have been an influenza virus, but it might be a coronavirus. If it was a coronavirus, as some people think, that coronavirus that is suspected to have caused it is today one of the handful of viruses that causes the common cold. So it’s possible what we’re seeing here is the emergence of a future common cold. We’re not there yet, but that might be happening, just don’t know. But in the next few seasons, it seems likely that we’re looking at challenging respiratory seasons. Right now we have a situation where the flu is leveling off, but our Er traffic is still high and our hospitals are still struggling. But a lot of that is health care system. A lot of that is our human resources challenges. So we have a lot of work to do, not just in combating viruses, but in fixing our health system and that will help enormously. And remember, we have vaccines that still work and better vaccines and therapies are around the corner, including mucosal vaccine that might stop transmission in his tracks. So this is not a time to be pessimistic and negative about this. In fact, it’s a time to be optimistic and to invest money in our biotechnology sector because I think they can do wonderful things. It would be impressive to see us invest a lot of money in a few sectors to get out of this. Dr. Raywat Deanandan and thank you so much for this, as always. It’s not pessimistic, it’s realistic.

Dr. Raywat Deanandan Thank you so much. It’s my pleasure.

Dr. Raywat Deanandan That was Dr. Raywat Deananden. And that was the big story. For more, you can head to The Big Storypodcast CA. You can find us on Twitter at the big Story. FPN. You can talk to us via email. Hello at The Big Storypodcast dot CA and if you have something to say that you wouldn’t mind us playing on the air, you can call us and leave a voicemail. That number is 416-935-5935. I should tell you here that we probably won’t play your voicemail if it’s just compliments, even though I would like to. It apparently seems very self centered. So fine. You can find this podcast in any podcast player and you can ask for it on a smart speaker by saying play The Big Story podcast. Thanks for listening. I’m Jordan Heath-Rawlings. We’ll talk tomorrow.