The Perfect Enemy | BQ.1.1 Covid-19 Variant Resistant To All Monoclonal Antibody Treatments
December 9, 2022
Read Time:6 Minute

You know that 1997 Backstreet Boys song that goes “everybody, yeah.” Well, the latest 2022 Covid-19 coronavirus Omicron subvariants have been going, “antibody, no-oh.” A letter published in The Lancet Infectious Diseases journal on November 18 detailed how many of the currently spreading Omicron subvariants, namely the BA.4.6, BA.2.75.2, and BJ.1 ones, appear to be resistant to most available monoclonal antibody treatments. And the BQ.1.1 Omicron subvariant, which has become one of the two dominant versions of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the U.S., seems resistant to all of the available monoclonal antibody treatments. Yes, all of them.

BQ certainly doesn’t stand for “be quiet,” as the BQ.1.1 subvariant is now causing a commotion, being responsible for an estimated 24.2% of all new reported Covid-19 cases over the past week while the not-too-different BQ.1 subvariant has been the culprit behind 25.5% of them, according to the Centers for Disease Control and Prevention (CDC). If you do the math, that means that these two Omicron subvariants are now comprising over half of all reported Covid-19 cases, meaning that they have overtaken the BA.5 as the “alpha-dog” of SARS-CoV-2 versions. Therefore, you can probably no longer rely on any type of monoclonal antibody should you get Covid-19. That’s certainly bad news for anyone not able to get enough protection from Covid-19 vaccination such as those who have very weak immune systems.

It’s also pokes a big old hole in the arguments of those who have been saying that other Covid-19 precautions are not needed because monoclonal antibodies are available. Such an argument has held water about as well as a Brillo pad thong since relying on any single Covid-19 precaution or treatment has always been a foolhardy approach. Doing so has been akin to telling someone, “you have underwear on, why do you need pants or a skirt or a kilt?” Ever since the start of the pandemic, real pandemic experts have continued to advocate for more of a “Swiss cheese” approach that entails always layering on different Covid-19 interventions simultaneously because each single intervention has its holes. And as a general, you always want to find ways to keep your holes covered.

Monoclonal antibodies first got a lot of attention after Donald Trump received them when the then-U.S. President got sick with Covid-19 back in 2020, as I reported for Forbes back then. Since then, various personalities have touted such treatments. For example, podcaster Joe Rogan, who’s railed against Covid-19 vaccination requirements and apparently resisted getting the vaccine himself, said that he “threw the kitchen sink” against the SARS-CoV-2 when he got infected in the Fall of 2021. This presumably did not mean that he threw a real kitchen sink at himself which would have really hurt. But he did mention that the proverbial “kitchen sink” did include monoclonal antibodies.

Then there was Florida Governor Ron DeSantis’s (R) whole “Early Treatment Saves Lives” campaign. While he’s spent much of the pandemic pushing against precautions designed to prevent you from getting Covid-19 such as social distancing and face mask requirements, he did push for making monoclonal antibody treatments more available for Florida, as Zachary Snowdon Smith covered in early 2022 for Forbes. Isn’t that a bit like saying don’t brush your teeth but let’s make sure everyone has access to fake teeth?

All of that was before the SARS-CoV-2 went fully mano a mano against the monoclonal antibody treatments and apparently ended up winning. In the letter, a team from the Leibniz Institute for Primate Research in Göttingen, Germany (Prerna Arora, Amy Kempf, Inga Nehlmeier, Stefan Pöhlmann, and Markus Hoffmann) and the Friedrich-Alexander University of Erlangen-Nürnberg in Erlangen, Germany (Sebastian R Schulz and Hans-Martin Jäck) briefly described laboratory experiments in which they tested how well monoclonal antibody treatments and cocktails of such treatments kept different pseudovirus particles representing various versions of SARS-CoV-2 (the BA.1, BA.4–5, BA.4.6, BA.2.75.2, BJ.1 and BQ.1.1 subvariants) from entering cells.

Here’s what winning looks like. While bebtelovimab and cilgavimab did work very well against the BA.4–5 pseudovirus particles, imdevimab and cilgavimab–tixagevimab only worked moderately well against them and amubarvimab, romlusevimab, sotrovimab, casirivimab–imdevimab, and amubarvimab–romlusevimab didn’t evenget the job done at all. For the BA.4.6 , pseudovirus particles things were even worse: bebtelovimab did its job but imdevimab, amubarvimab, casirivimab–imdevimab, cilgavimab–tixagevimab, and amubarvimab–romlusevimab couldn’t cut the mustard or stop the psuedovirus from entering cells. The BA.2.75.2 situation was similar. Bebtelovimab did work well, whereas regdanvimab and sotrovimab went oopsies. By contrast, nothing worked very well against the BJ.1 pseudovirus particles. Casirivimab, tixagevimab, sotrovimab, and cilgavimab–tixagevimab had somemoderate effect while amubarvimab, casirivimab–imdevimab, and amubarvimab–romlusevimab essentially fell flat on their monoclonal face. Then there was the BQ.1.1 pseudovirus particles. Borrowin the words of Queen’s “Bohemian Rhapsody,” nothing really mattered. None of the monoclonal antibody treatments proved effective against that versio.

This is a reminder that the SARS-CoV-2 is not like that guy still resting on his high school laurels years after graduation. The viruses collectively are continuing to “learn” and get better at evading existing treatments. Now, it’s not as if there’s a single virus out there taking Khan Academy courses, hiring a life coach, and reading self-help books. Instead, with a high mutation rate, the viruses keep generating newer and newer versions of themselves while they infect people and keep replicating. Now many of these newer versions may be weaker than previous versions and quickly fail to spread. However, with so many different versions of the virus out there, chances are at least some of them have “fitness advantages” over previous versions, being able to spread faster and get past treatments that formerly worked well. Therefore, we humans can’t get complacent like the Atlanta Falcons may have gotten after leading the New England Patriots in Super Bowl LI. The pandemic response is like engaging in an arms race against something that has no arms but has spikes instead. Governments and businesses need to support more research to develop new monoclonal antibody treatments against Covid-19. At the same time, maintaining Covid-19 precautions such as vaccination, face mask use, and social distancing can help decrease reliance on treatments and save them for when they are really needed. Overuse of treatments could more rapidly select for newer SARS-CoV-2 variants that are resistant to these treatments. These variants in turn might be able to rock your body, yeah rock your body not right.