BA.2.86 Variant (Pirola): COVID Variant Spreading in US, but Risk Is Low According to Experts

The BA.2.86 COVID variant, unofficially known as Pirola is taking hold in the United States.

Between Oct. 28 to Nov. 25, 2023, its prevalence increased from 1 to around 9 percent in the United States, according to the U.S. Centers for Disease Control and Prevention (CDC).

The World Health Organization designated Pirola as a variant of interest on Nov. 21, yet it also found the public health risk posed by BA.2.86 to be “low at the global level (pdf).”

In an update published on Nov. 27, 2023, the CDC agreed with the WHO’s assessment “that the public health risk posed by this variant is low compared with other circulating variants, based on available limited evidence.”

Current Research Suggests Low Risk of Disease

Pirola is derived from BA.2, an earlier Omicron variant.

Other variants derived from BA.2 include XBB.1.5 which became the dominant strain in early 2023.

The current dominant variant is H.V.1, and it is derived from the variant EG.5, unofficially known as Eris, a previously dominant variant in the United States.

“At this time, BA.2.86 does not appear to be driving increases in infections or hospitalizations in the United States,” the CDC wrote.

Research outside of the United States similarly suggests that Pirola should not be more severe than current variants.

Researcher Yunlong Cao, who holds a doctorate in physical biochemistry from Harvard found that Pirola “exhibits lower cell infectivity” compared to XBB.1.5 and Eris.

A preprint study from Japan found that while Pirola may be more transmissible than Eris a previous dominant variant, it is less likely to cause disease.

Compared to Eris, Pirola has a significantly lower growth efficiency, meaning that it is less capable of replicating itself in the host, the authors wrote.

“This is not the second coming of omicron. If it were, it is safe to say we would know by now,” Bill Hanage, associate director and professor of epidemiology at Harvard wrote on X on Sep. 1 ,when the variant's prevalence was significantly lower.

Prior Infections Gives Immunity Against the New Variant

Compared to BA.2, its ancestral subvariant, Pirola has more than 30 mutations in its spike protein. The virus uses the spike protein to infect human cells.

The substantial number of mutations initially raised concerns among virologists, who feared this variant might partially evade earlier immunity from previous exposure, whether from natural infection or prior vaccination.

However, evidence is still lacking to predict if there will be more immune evasions as well as the severity of future Pirola cases.

Mr. Cao’s own research in mice who have been vaccinated or infected with XBB vaccines showed that the antibodies generated “cannot well recognize and neutralize BA.2.86,” he wrote in a thread posted on the social media platform, X.

However, Pirola had a low cell infectivity, which can affect the variant's transmission, he added.

In discussion of Mr. Cao’s findings, Mr. Hanage agreed that immune evasion is not a definite indication of more severe infection and transmission.

“Any hopeful virus has to have some immune evasion, because almost everyone has immunity,” he wrote.

The most recent research on Pirola's immune evasion abilities comes from a series of reports conducted by researchers at Columbia University.

The first study, published in Nature, tested Pirola, XBB1.5, and Eris spike proteins against antibodies produced from a breakthrough XBB infection.

These antibodies conferred robust neutralizing activity against Pirola. The authors also noted that Pirola's ability to evade immunity was no better than that of XBB1.5 and EG.5.

The same group of researchers then tested antibodies produced from the new XBB1.5 COVID vaccine against several variants, including XBB1.5, Eris, and JN.1, a derivative of Pirola. The findings were published in a preprint.

The authors found that, compared to all variants investigated, JN.1 was the most immune evasive against antibodies produced from the vaccine.

HV.1: The Current Dominant Variant

The current dominant subvariant is HV.1, a new variant derived from Eris.

Eris is currently the most dominant globally and HV.1 succeeded Eris as the dominating variant in the U.S. on Oct. 28, 2023.

Like Pirola, the WHO has classified HV.1 as a variant with low public health risk. The variant accounted for about 31.5 percent of all cases in the United States as of Nov. 25.

Is HV.1 More Dangerous Than Other COVID Variants?

The COVID-19 variants that gain dominance over others typically do so because they have evolved to become more transmissible.

“My general sense is that the Omicron progeny—the children, grandchildren, and great-grandchildren of Omicron—are, in general, pretty darn transmissible,” said William Schaffner, MD, a professor of infectious diseases at the Vanderbilt University School of Medicine.

However, he added, “they’re not severe. The reassuring information still comes from the immunologists telling us that so far, the vaccine that was created will continue to provide substantial protection against severe disease.”

HV.1 evolved from EG.5 variant, which is a member of the XBB. The updated vaccine is expected to protect against serious illness from HV.1 and other circulating strains, according to Kate Grusich, a public affairs specialist at the CDC. COVID-19 cases also haven’t become notably more severe since the variant’s emergence.

“Although HV.1 represents an increasing proportion of infections, indicators such as test positivity, hospitalization, and emergency department visits currently indicate an overall decreasing number of infections,” Grusich told Verywell via an email. 

Prevent illness in the first place

While we’re at it, let’s talk about getting your immune system into shape, and other evasive actions you can take to make sure you’re strong, healthy, and ready to fight off any virus coming your way this fall.

Follow our prevention protocol: Some easy things you can do include mouthwash and nasal spray, zinc supplements, Vitamins C and D, melatonin, quercetin or resveratrol, and elderberry.

Clean up your diet: It almost goes without saying, but what you eat and when you eat it has a profound effect on your overall health. Intermittent fasting and balancing your gut microbiome are key.

Get enough Vitamin D: There is a clear link between low vitamin D levels and the risk of infections and other illnesses. Fortunately, boosting your vitamin D with supplementation is fairly easy and inexpensive.

Reduce stress: Too much stress can create hormonal and other imbalances that suppress your immune system. Incorporate stress-reduction techniques into your daily routine for your overall well-being and to ensure you’re prepared to fight off infection.

Get good sleep: Sleep recharges your body so your systems can function properly. On average, adults need between seven and nine hours of sleep each night.

Get outside and get some fresh air: Spending about 30 minutes outdoors each day can help the skin synthesize vitamin D, and sunlight has many other great therapeutic powers too.

Many people have asked whether they should start up a prophylactic treatment of ivermectin again. On that front, our advice has not really changed: if you have significant comorbidities, lack natural immunity, or have a suppressed immune system you may want to try a twice-weekly dose of ivermectin at 0.2 mg/kg. Likewise, consider it if you are currently suffering from long COVID or post-vaccine syndrome and are not currently being treated with ivermectin. If you have an upcoming situation where you may have high possible exposure — such as travel, weddings, or conferences — taking daily ivermectin starting two days before departure and either daily or every other day during the period of high exposure is a reasonable approach.

Remember to immediately initiate daily ivermectin at treatment doses (0.4 mg/kg) at the first signs of any kind of viral syndrome. It bears repeating: Early treatment is essential!

Sources and References: 

https://www.theepochtimes.com/health/new-covid-variant-spreading-in-us-but-risk-is-low-experts-5537404

https://covid19.onedaymd.com/2023/11/hv1-variant-what-you-need-to-know.html

https://covid19.onedaymd.com/2023/08/eg5-variant-eris-variant-what-you-need.html