The next few months may be a tight race between the BQ.1.1 and XBB.1 SARS-CoV-2 variants.

- Globally BQ.1.1 grew ~12% faster than BA.5, ranging from ~10% in Belgium to ~15% in Germany.

- XBB.1 grew >20% faster than BA.5 in Singapore, ~13% in the U.S., but only ~7% in Denmark. Brazil’s estimates are highly uncertain due to sparse rece
The current uncertainty of XBB.1’s growth rate makes it an open race.

- XBB.1 dominance in Asia seems given.

- BQ.1.1 is widespread in Europe and North America, so it is likely that it will keep its higher share.

- The rest of the world could see either outcome I think.
The distinct regional spread has has been noted before by @TWenseleers and others.
BQ.1.1 and XBB have very distinct spike mutations.

- BQ.1.1 derives from BA.5.

- XBB is a recombination of two BA.2 lineages (presumably during co-infection of the same individual).

- Neutralisation of XBB by vaccine/infection derived antibodies was found to be weaker.
Coming back to current incidences.

- At ~40%, France has one of the highest shares of BQ.1.1 and its effect will be felt from now on.

- France may thus become an early indicator how the BQ.1.1 wave plays out in Europe, on the back of the current BA.5 driven surge.
The analysis was done using our genomicsurveillance workflow, github.com/gerstung-lab/g…

Data from GISAID provided in aggregated form by cov-spectrum.org. Thanks to all contributors.

Thanks to @CorneliusRoemer and @TWenseleers for many discussions.
Code and an analysis summary can be found here: github.com/gerstung-lab/S…

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More from @MoritzGerstung

Oct 13
What does your medical history tell you about future cancer risk?

And how much can be learned from knowing the medical history of an entire nation?

New preprint from the lab. 🧵

medrxiv.org/content/10.110…
Background:

- Cancer is one of the leading causes of mortality in the Western world.
- Tumours develop over a long time before becoming detectable.
- Early detection improves survival rates, but current screening is limited to few cancer types.

cancerresearchuk.org/about-cancer/c…
Knowing who is at greater risk of developing cancer helps cancer screening as tests can be used in a targeted fashion.

This becomes more relevant as blood-based multi-cancer early detection tests are being trialled.

cell.com/cancer-cell/fu…
Read 15 tweets
Oct 12
An update on BQ.1.1 and other SARS-CoV-2 variants in Germany with fresh variant classification in @rki_de’s latest variant release.

There have been n=69 BQ.1.1 cases detected in Germany. Together with BQ.1 (n=124) it is estimated to contribute ~5% of cases on Oct 10. Image
BQ.1.1 remains the fastest spreading variant in agreement with last week’s estimates.

BQ.1 and BN.1 (n=36) — a derivative of BA.2.75.5 — are spreading at somewhat lower rate (likely because BQ.1.1 has an additional immune escape mutation). Image
The rapid spread of BQ.1 and BQ.1.1 indicates that they will reach 50% of cases in November (range Oct 30 to Nov 25).

(While I’m fairly confident about the next 1-2 months, the situation at Christmas could already be a different one as there are a number of contenders.) Image
Read 5 tweets
Oct 5
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.)
Read 10 tweets
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

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