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The ‘COVID-19 Pandemic’ remains an ‘Unprecedented Devastating Scourge of the 21st Century’ characterized by ‘Increasingly Rapidly Transmuting Pandemic Specifics’ with continuously emerging ‘New Normals’ signposting our ‘Humanity’ and some contributing to the seemingly evolving ‘Uncertainties’ making the ‘Global Pandemic Control’ an ‘Increasing Programmatic Mirage’. With the ‘Increasingly Evolving Uncertainties’ particularly concerning the ‘Pharmaceutical Interventions (Drugs/ Antivirals, Convalescent Plasma/ Serum, COVID-19 Vaccines/ Vaccinations etc)’ [1-11] in the ‘Global COVID-19 Pandemic Control’, a ‘Clarion Call’ by this Author has been disposed ‘Umpteenth Time’ for the World to uphold the ‘Non-Pharmaceutical Interventions (NPIs)’ [6,7,9,12-16] even as the World heads towards three years of the ‘COVID-19 Pandemic’ formally declared by the WHO on the 11th March 2020. A ‘Programmatic Difficulty’ with the ‘Global COVID-19 Pandemic Control’ resulting from the ‘Unresolved Evolving Uncertainties’ with the ‘Pharmaceutical Interventions’ and the absence of ‘Strict Compliance’ with the NPIs is the ‘Failure’ of the ‘Pandemic Containment and Mitigation Measures’ and consequent increasing ‘SARS-CoV-2 Transmissions’. The ‘Uncontrolled SARS-CoV-2 Transmissions’ are associated with increasing ‘Proliferations and Mutations’ with resultant increasing appearance of ‘SARS-CoV-2 Variants and Subvariants’. A current ‘SARS-CoV-2 Omicron Subvariant’ is the XBB.1.5.
A recent ‘Communication’17 reportedly updated information on the XBB.1.5 including its ‘Origin’ as a result of the ‘Recombination’ of two ‘Omicron Subvariants’: BA.2.10.1 and BA.2.75 and the ‘X’ is reportedly assigned to the ‘XBB.1.5’ as it is a ‘Recombination Resultant’ of ‘Two or more Sublineages[18]. It is reported that ‘Scientists’ gave a ‘Nickname’ to the XBB.1.5: ‘Kraken’[19]. The XBB.1.5 is reportedly, from Computational System Biology, derived from the addition of ‘F486P’ in the ‘Mutation’ of the ‘SARS-CoV-2 Spike Protein’ with less ‘Immune Escape Capacity’ than XBB.1 but it is more ‘Infectious’ because of increased ‘Binding Affinity’ to the ‘Human Cell Receptor ACE-2’ with ‘Increased Transmissibility’[17].
The WHO has reportedly documented the spread of XBB.1.5 to 38 Countries[20]. The UK Health Security Agency (UKHSA) reportedly predicts the XBB.1.5 will become the dominant ‘SARS-CoV-2 Subvariant’ in the UK[21]. The XBB.1.5 is also reportedly predicted by the European Centre for Disease Prevention and Control (ECDC) to be dominant in the European Union and the European Economic Areas[17]. The Centers for Disease Control and Prevention (CDC) in the United States reportedly predicts XBB.1.5 ‘Spreading Quickly’ to become increasingly dominant Globally[17].
Concerning the ‘XBB.1.5 and Disease Severity’, there is reportedly ‘Uncertainty’ by the WHO and ECDC[17]. There is also reportedly ‘Uncertainty’/ ‘Information Not Available’ concerning the ‘COVID-19 Vaccines and Protection’ and ‘Specific Vaccine Effectiveness’ but WHO suggests the Subvariant may have ‘High Immune Escape Capacity’[17]. The ‘Issue’ of ‘Hybrid Immunity’ was disposed in recent ‘Communications’[22,23] and with some critical perspectives communicated situate with the ‘Vaccination-Immunization-Protection Triad Transformation (VIP Triad Transformation)[24].
Concerning the ‘Hybrid Immunity’ with reported ‘Improved Protection’ from any combination of ‘Infection’ and ‘Vaccination’, the reported observations with some ‘SARS-CoV-2 Variants and Subvariants’ are not supportive[17]. There was reportedly ‘No Improved Neutralizing Antibody Titres’ against XBB.1.5.5 from 3 or 4 Doses of Pfizer/ Moderna mRNA Vaccines and BA.5 Infection or 3 Doses of the Chinese Coronavac and Infection with BA.1, BA.5, and BF.7 [17]. Therefore, the ‘Hybrid Immunity’ is another ‘Uncertainty’ in the ‘Persistently Enlarging Pool’ of ‘Unresolved Evolving Uncertainties’ in the ‘COVID-19 Pandemic’.
This ‘Communication’ is a modest ‘Contribution’ to the ‘Hybrid Immunity Conversation’ and a further ‘Clarion Call’ to continue upholding the NPIs in the ‘Global COVID-19 Pandemic Control’.
REFERENCES
1. Mahase E. Covid-19: Vaccine brands can be mixed in ‘extremely rare occasions’ says Public Health England. BMJ 2021; 372:n12
2. Eregie CO. COVID-19 Pandemic, beyond the ‘Vaccines Marathon Finish Line’ and ‘Post-Vaccine Approval Programmatic Haze’: The Evolving ‘2nd Dose Uncertainties’. https://www.bmj.com/content/372/bmj.n18/rr-12 of 24th January 2021
3. Eregie CO. COVID-19 Pandemic, beyond the ‘Vaccines Marathon Finish Line’ and ‘Post-Vaccines Approval Programmatic Haze’: The evolving ‘2nd Dose Uncertainties’; still more unfolding ‘Matters in the Work’. https://www.bmj.com/content/bmj.n18/rr-13 of 27th January 2021
4. Eregie CO. COVID-19 Pandemic, COVID-19 Vaccines and ‘2nd Dose Uncertainties’: Still unresolved evolving matters. https://www.bmj.com/content/372/bmj.n162/rr-3 of 8th February 2021
5. Eregie C.O. COVID-19 Pandemic, COVID-19 Vaccines and successful vaccination programmes: a further clarion call to observe research governance-related best practices and a critical look at preprints. https://www.bmj.com/content/376/bmj.o321/rr of 23rd February 2022
6. Eregie C.O. COVID-19 pandemic, Immunity and Infectivity: evolving facts support the imperative for sustained compliance with non-pharmaceutical interventions. https://www.bmj.com/content/378/bmj-2020-061402/rr-1 of 23rd July 2022
7. Eregie C.O. COVID-19 Pandemic and Rising COVID-19 Rates even among ‘Fully Vaccinated’ Persons: A Further Imperative for Emphasis on the Non-Pharmaceutical Interventions; ‘No One is Safe Until Everyone is Safe’. https://www.bmj.com/content/378/bmj.o1712/rr-1 of 11th August 2022
8. Eregie C.O. COVID-19 Pandemic, COVID-19 Vaccines and Boosters: More Unresolved Evolving Matters in the Works. https://www.bmj.com/content/375/bmj.n3011/rr of 17th December 2021
9. Eregie C.O. Covid-19 Pandemic, Reinfection, Reactivation and Covid-19 Rebound: Efficacy of Covid-19 Pharmaceutical and Non-Pharmaceutical Interventions; The Imperative to Guard Against Interventional Precocity in Downing Guards. https://www.bmj.com/content/377/bmj.o1365/rr of 15th June 2022
10. Bobrovitz N, Ware H, Ma X et al. Protective effectiveness of previous SARS-CoV-2 infection and hybrid immunity against the omicron variant and severe disease: a systematic review and meta-regression. Lancet Infect Dis 2023;18:S1473-3099(22)00801-5.doi:10.1016/S1473-3099(22)00801-5.
11. Torjesen I. Covid-19: Vaccination plus infection offers best protection, finds study led by WHO. BMJ 2023: 380:p171
12. Eregie C.O. COVID-19 Pandemic, COVID-19 Vaccines and Rapidly Transmuting SARS-CoV-2 Variants/ Sub-variants: The Quest for Pan-Sarbecoviruses Vaccine Variants; A Further Imperative to Guard Against Global Interventional Precocity in Downing Guards. https://www.bmj.com/content/377/bmj.o1257/rr-0 of 17th June 2022
13. Eregie C.O. COVID-19 pandemic, Immunity and Infectivity: evolving facts support the imperative for sustained compliance with non-pharmaceutical interventions. https://www.bmj.com/content/378/bmj-2020-061402/rr-1 of 23rd July 2022
14. Eregie C.O. ‘COVID-19 Pandemic and Rising COVID-19 Rates even among ‘Fully Vaccinated’ Persons: A Further Imperative for Emphasis on the Non-Pharmaceutical Interventions; ‘No One is Safe Until Everyone is Safe’’. https://www.bmj.com/content/378/bmj.o1712/rr-1 of 11th August 2022
15. Eregie C.O. ‘COVID-19 Pandemic, WHO COVID-19 Therapeutics Living Guidelines and uncertainties: Still further imperatives to rekindle ‘Multiparameter-Based Medicine (MBM)’ and uphold ‘Non-Pharmaceutical Interventions (NPIs)’’. https://www.bmj.com/content/370/bmj.m3379/rr-22 of 17th October 2022
16. Eregie C.O. ‘COVID-19 Pandemic, ‘COVID-19 Pharmaceuticals (including antivirals)’ and controversial efficacy: Further imperative to remain ‘Non-Pharmaceutical Interventions (NPIs)’-compliant’. https://www.bmj.com/content/379/bmj.o2441/rr-1 of 27th October 2022
17. Mahase E. Covid-19: What do we know about XBB.1.5 and should we be worried? BMJ 2023; 380:p153
18. Mahase E. Covid-19: Is the UK still tracking the virus-and other questions answered. BMJ2022;379:o2802. doi:10.1136/bmj.o2802 pmid:36400434
19. https://twitter.com/TRyanGregory/status/1611778593478017024
20. WHO. XBB.1.5 Rapid risk assessment. 11 January 2023. www.who.int/docs/default-source/coronaviruse/11jan2023_xbb15_rapid_risk_....
21. UKHSA. SARS-CoV-2 variants of concern and variants under investigation in England. Technical briefing 49. 11 January 2023.
22. Bobrovitz N, Ware H, Ma X et al. Protective effectiveness of previous SARS-CoV-2 infection and hybrid immunity against the omicron variant and severe disease: a systematic review and meta-regression. Lancet Infect Dis 2023;18:S1473-3099(22)00801-5.doi:10.1016/S1473-3099(22)00801-5.
23. Torjesen I. Covid-19: Vaccination plus infection offers best protection, finds study led by WHO. BMJ 2023: 380:p171
24. Eregie CO. COVID-19 Pandemic, ‘Hybrid Immunity’ and protection against SARS-CoV-2 infection and reinfection: the ‘Uncertainties’ are unending. https://www.bmj.com/content/380/bmj.p171/rr-0 of 7th February 2023
Professor Charles Osayande Eregie,
MBBS, FWACP, FMCPaed, FRCPCH (UK), Cert. ORT (Oxford), MSc (Religious Education), FAMedS, FIPMD
Professor of Child Health and Neonatology, University of Benin, Benin City, Nigeria.
Consultant Paediatrician and Neonatologist, University of Benin Teaching Hospital, Benin City, Nigeria.
UNICEF-Trained BFHI Master Trainer,
ICDC-Trained in Code Implementation,
*Technical Expert/ Consultant on the FMOH-UNICEF-NAFDAC Code Implementation Project in Nigeria,
*No Competing Interests.
Competing interests:
No competing interests
09 February 2023
Charles O. EREGIE
MEDICAL DOCTOR
Professor of Child Health and Neonatology, University of Benin and Consultant Paediatrician and Neonatologist, University of Benin Teaching Hospital, Benin City, Nigeria
Institute of Child Health, College of Medical Sciences, University of Benin, Benin City, Nigeria.
COVID-19 Pandemic, the subvariant XBB.1.5 and ‘Unresolved Evolving Uncertainties’: ‘Hybrid Immunity’ is yet another ‘Uncertainty’; re-affirming imperative to continue upholding Non-Pharmaceutical Interventions (NPIs) after almost three years of pandemic
Dear Editor
The ‘COVID-19 Pandemic’ remains an ‘Unprecedented Devastating Scourge of the 21st Century’ characterized by ‘Increasingly Rapidly Transmuting Pandemic Specifics’ with continuously emerging ‘New Normals’ signposting our ‘Humanity’ and some contributing to the seemingly evolving ‘Uncertainties’ making the ‘Global Pandemic Control’ an ‘Increasing Programmatic Mirage’. With the ‘Increasingly Evolving Uncertainties’ particularly concerning the ‘Pharmaceutical Interventions (Drugs/ Antivirals, Convalescent Plasma/ Serum, COVID-19 Vaccines/ Vaccinations etc)’ [1-11] in the ‘Global COVID-19 Pandemic Control’, a ‘Clarion Call’ by this Author has been disposed ‘Umpteenth Time’ for the World to uphold the ‘Non-Pharmaceutical Interventions (NPIs)’ [6,7,9,12-16] even as the World heads towards three years of the ‘COVID-19 Pandemic’ formally declared by the WHO on the 11th March 2020. A ‘Programmatic Difficulty’ with the ‘Global COVID-19 Pandemic Control’ resulting from the ‘Unresolved Evolving Uncertainties’ with the ‘Pharmaceutical Interventions’ and the absence of ‘Strict Compliance’ with the NPIs is the ‘Failure’ of the ‘Pandemic Containment and Mitigation Measures’ and consequent increasing ‘SARS-CoV-2 Transmissions’. The ‘Uncontrolled SARS-CoV-2 Transmissions’ are associated with increasing ‘Proliferations and Mutations’ with resultant increasing appearance of ‘SARS-CoV-2 Variants and Subvariants’. A current ‘SARS-CoV-2 Omicron Subvariant’ is the XBB.1.5.
A recent ‘Communication’17 reportedly updated information on the XBB.1.5 including its ‘Origin’ as a result of the ‘Recombination’ of two ‘Omicron Subvariants’: BA.2.10.1 and BA.2.75 and the ‘X’ is reportedly assigned to the ‘XBB.1.5’ as it is a ‘Recombination Resultant’ of ‘Two or more Sublineages[18]. It is reported that ‘Scientists’ gave a ‘Nickname’ to the XBB.1.5: ‘Kraken’[19]. The XBB.1.5 is reportedly, from Computational System Biology, derived from the addition of ‘F486P’ in the ‘Mutation’ of the ‘SARS-CoV-2 Spike Protein’ with less ‘Immune Escape Capacity’ than XBB.1 but it is more ‘Infectious’ because of increased ‘Binding Affinity’ to the ‘Human Cell Receptor ACE-2’ with ‘Increased Transmissibility’[17].
The WHO has reportedly documented the spread of XBB.1.5 to 38 Countries[20]. The UK Health Security Agency (UKHSA) reportedly predicts the XBB.1.5 will become the dominant ‘SARS-CoV-2 Subvariant’ in the UK[21]. The XBB.1.5 is also reportedly predicted by the European Centre for Disease Prevention and Control (ECDC) to be dominant in the European Union and the European Economic Areas[17]. The Centers for Disease Control and Prevention (CDC) in the United States reportedly predicts XBB.1.5 ‘Spreading Quickly’ to become increasingly dominant Globally[17].
Concerning the ‘XBB.1.5 and Disease Severity’, there is reportedly ‘Uncertainty’ by the WHO and ECDC[17]. There is also reportedly ‘Uncertainty’/ ‘Information Not Available’ concerning the ‘COVID-19 Vaccines and Protection’ and ‘Specific Vaccine Effectiveness’ but WHO suggests the Subvariant may have ‘High Immune Escape Capacity’[17]. The ‘Issue’ of ‘Hybrid Immunity’ was disposed in recent ‘Communications’[22,23] and with some critical perspectives communicated situate with the ‘Vaccination-Immunization-Protection Triad Transformation (VIP Triad Transformation)[24].
Concerning the ‘Hybrid Immunity’ with reported ‘Improved Protection’ from any combination of ‘Infection’ and ‘Vaccination’, the reported observations with some ‘SARS-CoV-2 Variants and Subvariants’ are not supportive[17]. There was reportedly ‘No Improved Neutralizing Antibody Titres’ against XBB.1.5.5 from 3 or 4 Doses of Pfizer/ Moderna mRNA Vaccines and BA.5 Infection or 3 Doses of the Chinese Coronavac and Infection with BA.1, BA.5, and BF.7 [17]. Therefore, the ‘Hybrid Immunity’ is another ‘Uncertainty’ in the ‘Persistently Enlarging Pool’ of ‘Unresolved Evolving Uncertainties’ in the ‘COVID-19 Pandemic’.
This ‘Communication’ is a modest ‘Contribution’ to the ‘Hybrid Immunity Conversation’ and a further ‘Clarion Call’ to continue upholding the NPIs in the ‘Global COVID-19 Pandemic Control’.
REFERENCES
1. Mahase E. Covid-19: Vaccine brands can be mixed in ‘extremely rare occasions’ says Public Health England. BMJ 2021; 372:n12
2. Eregie CO. COVID-19 Pandemic, beyond the ‘Vaccines Marathon Finish Line’ and ‘Post-Vaccine Approval Programmatic Haze’: The Evolving ‘2nd Dose Uncertainties’. https://www.bmj.com/content/372/bmj.n18/rr-12 of 24th January 2021
3. Eregie CO. COVID-19 Pandemic, beyond the ‘Vaccines Marathon Finish Line’ and ‘Post-Vaccines Approval Programmatic Haze’: The evolving ‘2nd Dose Uncertainties’; still more unfolding ‘Matters in the Work’. https://www.bmj.com/content/bmj.n18/rr-13 of 27th January 2021
4. Eregie CO. COVID-19 Pandemic, COVID-19 Vaccines and ‘2nd Dose Uncertainties’: Still unresolved evolving matters. https://www.bmj.com/content/372/bmj.n162/rr-3 of 8th February 2021
5. Eregie C.O. COVID-19 Pandemic, COVID-19 Vaccines and successful vaccination programmes: a further clarion call to observe research governance-related best practices and a critical look at preprints. https://www.bmj.com/content/376/bmj.o321/rr of 23rd February 2022
6. Eregie C.O. COVID-19 pandemic, Immunity and Infectivity: evolving facts support the imperative for sustained compliance with non-pharmaceutical interventions. https://www.bmj.com/content/378/bmj-2020-061402/rr-1 of 23rd July 2022
7. Eregie C.O. COVID-19 Pandemic and Rising COVID-19 Rates even among ‘Fully Vaccinated’ Persons: A Further Imperative for Emphasis on the Non-Pharmaceutical Interventions; ‘No One is Safe Until Everyone is Safe’. https://www.bmj.com/content/378/bmj.o1712/rr-1 of 11th August 2022
8. Eregie C.O. COVID-19 Pandemic, COVID-19 Vaccines and Boosters: More Unresolved Evolving Matters in the Works. https://www.bmj.com/content/375/bmj.n3011/rr of 17th December 2021
9. Eregie C.O. Covid-19 Pandemic, Reinfection, Reactivation and Covid-19 Rebound: Efficacy of Covid-19 Pharmaceutical and Non-Pharmaceutical Interventions; The Imperative to Guard Against Interventional Precocity in Downing Guards. https://www.bmj.com/content/377/bmj.o1365/rr of 15th June 2022
10. Bobrovitz N, Ware H, Ma X et al. Protective effectiveness of previous SARS-CoV-2 infection and hybrid immunity against the omicron variant and severe disease: a systematic review and meta-regression. Lancet Infect Dis 2023;18:S1473-3099(22)00801-5.doi:10.1016/S1473-3099(22)00801-5.
11. Torjesen I. Covid-19: Vaccination plus infection offers best protection, finds study led by WHO. BMJ 2023: 380:p171
12. Eregie C.O. COVID-19 Pandemic, COVID-19 Vaccines and Rapidly Transmuting SARS-CoV-2 Variants/ Sub-variants: The Quest for Pan-Sarbecoviruses Vaccine Variants; A Further Imperative to Guard Against Global Interventional Precocity in Downing Guards. https://www.bmj.com/content/377/bmj.o1257/rr-0 of 17th June 2022
13. Eregie C.O. COVID-19 pandemic, Immunity and Infectivity: evolving facts support the imperative for sustained compliance with non-pharmaceutical interventions. https://www.bmj.com/content/378/bmj-2020-061402/rr-1 of 23rd July 2022
14. Eregie C.O. ‘COVID-19 Pandemic and Rising COVID-19 Rates even among ‘Fully Vaccinated’ Persons: A Further Imperative for Emphasis on the Non-Pharmaceutical Interventions; ‘No One is Safe Until Everyone is Safe’’. https://www.bmj.com/content/378/bmj.o1712/rr-1 of 11th August 2022
15. Eregie C.O. ‘COVID-19 Pandemic, WHO COVID-19 Therapeutics Living Guidelines and uncertainties: Still further imperatives to rekindle ‘Multiparameter-Based Medicine (MBM)’ and uphold ‘Non-Pharmaceutical Interventions (NPIs)’’. https://www.bmj.com/content/370/bmj.m3379/rr-22 of 17th October 2022
16. Eregie C.O. ‘COVID-19 Pandemic, ‘COVID-19 Pharmaceuticals (including antivirals)’ and controversial efficacy: Further imperative to remain ‘Non-Pharmaceutical Interventions (NPIs)’-compliant’. https://www.bmj.com/content/379/bmj.o2441/rr-1 of 27th October 2022
17. Mahase E. Covid-19: What do we know about XBB.1.5 and should we be worried? BMJ 2023; 380:p153
18. Mahase E. Covid-19: Is the UK still tracking the virus-and other questions answered. BMJ2022;379:o2802. doi:10.1136/bmj.o2802 pmid:36400434
19. https://twitter.com/TRyanGregory/status/1611778593478017024
20. WHO. XBB.1.5 Rapid risk assessment. 11 January 2023. www.who.int/docs/default-source/coronaviruse/11jan2023_xbb15_rapid_risk_....
21. UKHSA. SARS-CoV-2 variants of concern and variants under investigation in England. Technical briefing 49. 11 January 2023.
22. Bobrovitz N, Ware H, Ma X et al. Protective effectiveness of previous SARS-CoV-2 infection and hybrid immunity against the omicron variant and severe disease: a systematic review and meta-regression. Lancet Infect Dis 2023;18:S1473-3099(22)00801-5.doi:10.1016/S1473-3099(22)00801-5.
23. Torjesen I. Covid-19: Vaccination plus infection offers best protection, finds study led by WHO. BMJ 2023: 380:p171
24. Eregie CO. COVID-19 Pandemic, ‘Hybrid Immunity’ and protection against SARS-CoV-2 infection and reinfection: the ‘Uncertainties’ are unending. https://www.bmj.com/content/380/bmj.p171/rr-0 of 7th February 2023
Professor Charles Osayande Eregie,
MBBS, FWACP, FMCPaed, FRCPCH (UK), Cert. ORT (Oxford), MSc (Religious Education), FAMedS, FIPMD
Professor of Child Health and Neonatology, University of Benin, Benin City, Nigeria.
Consultant Paediatrician and Neonatologist, University of Benin Teaching Hospital, Benin City, Nigeria.
UNICEF-Trained BFHI Master Trainer,
ICDC-Trained in Code Implementation,
*Technical Expert/ Consultant on the FMOH-UNICEF-NAFDAC Code Implementation Project in Nigeria,
*No Competing Interests.
Competing interests: No competing interests