What’s behind the recent rise of covid cases are in Germany?

It’s not the new variants — yet. Image
A number of variants possessing immune evasion mutations have been observed — BA.4.6, BF.*, BA.2.75.*, BQ.1.*

These variants make up around 20% of cases in Germany by Oct 1 — BF.7 (15%), BA.4.6 (3%), as well as other BF.*, BA.2.75.* variants and BQ.1.* (each <1%). Image
Here’s an overview of the zoo of variants, which all independently acquired the same mutations associated with immune evasion.

(Only some are found in Germany and part of our model.)
One of the fastest moving is BQ.1.1, which combines 5 of these mutations.

BQ.1.1’s fitness advantage is ~10-15% , around the same value that BA.5 had over BA.2 in spring ‘22.

Other variants have fitness 5-10%.

(The exact BQ.1.1 estimates for Germany are still uncertain.) ImageImage
But @TWenseleers has been calculating variant growth rates based on global data with similar results.
Beyond the dynamics of variant proportions, our model calculates the growth rate of total cases (all variants combined).

The overall growth rate depends on many factors, including variants, immunity and behaviour and is less predictable than the share of variants.
In September the total growth rate climbed from 0 to ~0.06 per day (~50% per week; the latest constant trend is a model precaution, note the wide CI).

In the same period, the share of the aforementioned variants increased to ~20%. This added ~0.01 to the daily growth rate. Image
So the recent upswing of covid cases seems mostly to be due to variant agnostic effects — seasonality, waning immunity, behaviour.

The projected rise of immune escape variants will add between 0.05-0.15 on top of the growth rate, which is bound to intensify the incoming wave.
Unfortunately, it looks like we’re set for a sizeable wave of cases due to these twin effects. Further modeling is required to assess how large the wave will be and also what its impact is going to be.
PS. All data from RKI, BQ.1* cases from cov-spectrum.org as they are not yet annotated in the current version of RKI’s data yet. Thanks to all contributors.

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More from @MoritzGerstung

Feb 2
Behind the scenes of the Omicron waves there are interesting lineage dynamics.

Omicron can be split into two main branches BA.1&2, and BA.1.1, an offshoot of BA.1.

BA.1 is most prevalent in the UK, but BA.1.1 is catching up.
All BA lineages have a growth advantage s over Delta/B.1.617.2*.

The advantage varies by lineage, over time and between countries.

BA.2 is fastest followed, by BA.1.1 and BA.1.

The growth advantage sets the slope at which the relative proportion of each lineage develops.
In late Nov and early Dec BA.1 and BA.1.1's share increased rapidly and subsequently slowed down with the lowest levels around Xmas.

At that time BA.2 was introduced and rose quickly, but its advantage over BA.1 came down since.

BA.2 is on track to be dominant in a few weeks.
Read 12 tweets
Dec 17, 2021
Der Omicron-Tsunami hat England erreicht und die Fallzahlen sind sprunghaft gestiegen.

Ist Deutschland im Vergleich gut gerüstet?

Kurz: Deutschland muss bei den Erstimpfungen und Boostern für Ältere nachlegen und eine Überlastung der Krankenhäuser verhindern.
Hintergrund: Omicron ist nicht nur hochansteckend, sondern kann auch Geimpfte und Genesene infizieren.

Diese erkranken zwar eher leicht, tragen allerdings zur Verbreitung mit bei.

Die Fallzahlen drohen in bisher unbekannte Höhen zu steigen.
Selbst wenn nur wenige Fälle schwer verlaufen, muss man angesichts der enormen Fallzahlen mit einer erheblichen Belastung für das Gesundheitssystem rechnen.

Schwere Verläufe sind insbesondere bei Ungeimpften und Älteren zu erwarten.

Read 18 tweets
Nov 26, 2021
Some thoughts about the punctuated evolution of variants of concern including B.1.1.529 in Southern Africa. 🧵

A shared characteristic of all known VOCs is that they appeared suddenly with a large number of mutations, many more than the incremental changes we see normally.
These mutations recurrently cluster in certain functional sites of the virus’ genome.

This is the signature of selection — while mutations occur more or less randomly, we preferentially see the subset that makes the virus fitter.

But why so many concomitant mutations at once?
While we will never know the exact circumstance of each VOC emergence, we do know that a similar pattern occurs in immunocompromised patients who have chronic infections.

This includes patients with leukaemia, but also AIDS

medrxiv.org/content/10.110…
nature.com/articles/s4158…
Read 10 tweets
Nov 25, 2021
🧵 zur neuen B.1.1.529 SARS-CoV-2 Variante, die vor einigen Tagen von Wissenschaftlern in Südafrika entdeckt wurde.

TL;DR: Die Variante bringt nahezu alle besorgniserregenden Merkmale mit sich, die wir in den letzten 1-2 Jahren gesehen haben.

1. B.1.1.529 hat mehr oder weniger alle Mutationen, die wir aus Alpha, Beta, Gamma und Delta kennen, gleichzeitig und noch weitere dazu.

2. In Südafrika setzt sie sich dem Anschein nach rapide und in unterschiedlichen Regionen gegen Delta durch.

Read 6 tweets
Nov 18, 2021
An update on 🦠 SARS-CoV-2 variants in England.

Today: AY.4.2.1, AY.98 and other introductions.

TLDR: It seems to be ok.
Background: The list of Delta sublineages has gotten longer – more than 121 AY.x lineages + sublineages.

This is thanks to the virus hunters @PangoNetwork spotting epidemiologically relevant variants across the 🌍.

These appear as colored branches at cov2tree.org
In England, @CovidGenomicsUK operates a very systematic sequencing programme, which allows to detect & characterise the spread of new lineages early.

Every Monday @jcbarret and his team release data from around 25,000 samples (~10% of cases) on covid19.sanger.ac.uk
Read 13 tweets
Oct 14, 2021
Just out - the rise and fall of SARS-CoV-2 lineages in England.

In the last 1.5yrs the UK has been a bell weather for SARS-CoV-2 evolution and genomic epidemiology thanks to the data sequenced by @CovidGenomicsUK and @sangerinstitute.

Let's recap. >>
nature.com/articles/s4158…
As any virus, SARS-CoV-2 accumulates mutations and undergoes an evolutionary journey where fitter variants succeed. Most mutations are neutral and enable us to define lineages, which derive from a single ancestor and share all its mutations. By now there are >1000 lineages. >>
As new variants emerge all the time it is important to characterise their behaviour as soon as possible and an essential question is whether one variant has a growth advantage over others, as this may change the future course of the epidemic. >>
Read 27 tweets

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