Global leaders will convene in India this weekend for a two-day summit—quite possibly bringing with them various COVID variants surging in different parts of the world.
Will the gathering of G20 heads of state serve as a super-spreader event?
It may, but not more so “than any other conference,” Dr. Amesh Adalja, an infectious disease specialist and senior scholar at the Johns Hopkins Center for Health Security, told Fortune.
“Medical conferences of thousands of people are occurring all the time,” he said.
For the last year, various COVID variants have dominated different parts of the globe, creating more of a patchwork of epidemics than one consistent pandemic. While world leaders may end up “trading variants,” so to speak, in New Delhi, such swapping already occurs regularly through international travel. What’s more, COVID vaccines provide protection against severe disease, regardless of variant, Adalja said.
A chance to lead by example
But Raj Rajnarayanan—assistant dean of research and associate professor at the New York Institute of Technology campus in Jonesboro, Ark., and a top COVID variant tracker—says new variants like “Pirola” BA.2.86 can easily evade immunity from vaccination and prior infection.
Preliminary data shows that new boosters—slated for U.S. release by the end of next week—will be effective against BA.2.86 and other leading variants. But just how they will perform in the real world remains to be seen.
Rajnarayanan hopes heads of state in attendance “show leadership,” moving to “collectively fund vaccines and [viral] surveillance in all countries” and choosing to “follow common-sense COVID protocols.”
“A good chunk of the program should be conducted outdoors, with tests every day,” he told Fortune. “Everyone with symptoms should wear a proper mask, even with a negative test.”
The G20 did not immediately respond to Fortune’s request as to what, if any, COVID protocols would be followed during the event.
On Thursday Spanish President Pedro Sánchez announced on Twitter that he had tested positive for COVID and, while feeling well, would not attend the summit.
Esta tarde he dado positivo en COVID y no podré viajar a Nueva Delhi para asistir a la Cumbre del G-20.
— Pedro Sánchez (@sanchezcastejon) September 7, 2023
Me encuentro bien.
España estará magníficamente representada por la vicepresidenta primera y ministra de Asuntos Económicos y el ministro de Exteriores, UE y Cooperación.
U.S. President Joe Biden arrived in India on Friday for the summit, despite his wife, Jill Biden, testing positive for COVID on Monday night. The couple was together over the weekend at their home in Rehoboth, Del., after visiting Florida on Saturday to view damage from Hurricane Idalia, CNBC reported.
The president tested negative before traveling and was not experiencing symptoms, the news outlet said, citing White House press secretary Karine Jean-Pierre.
Hello, Delhi!
— President Biden (@POTUS) September 8, 2023
It's great to be in India for this year's G20. pic.twitter.com/JBJUAuAYYb
Low COVID circulation in India—as far as we know
The good news: Ahead of the summit, India is reporting low COVID circulation—though “surveillance is not on par with other G20 countries,” Rajnarayanan says. (The country, however, has “rolled out an amazing vaccination campaign,” he adds.)
Currently, Omicron spawn XBB.2.3—a World Health Organization “variant under monitoring,” its lowest level of alert—and GE.1 are the top circulating variants in India—according to reports, at least. With official WHO pandemic status having ended in May, viral surveillance is at an all-time low, making it difficult to accurately gauge the spread of COVID worldwide.
In contrast, fellow Omicron strains EG.5—a WHO “variant of interest,” its middle level of alert—and “Fornax” FL.1.5.1 were the top variants in the U.S. as of last week, according to the U.S. Centers for Disease Control and Prevention, comprising an estimated 22% and 15% of cases, respectively. The agency only provides biweekly updates on variant circulation.
Community spread of COVID is “high” in the U.S., with the current wave of infections approaching the peaks of the initial COVID wave, in addition to the Alpha and Delta waves, Jay Weiland, a leading COVID modeler, told Fortune on Friday. Weiland produces models based on wastewater data.
He estimates 720,000 new COVID infections are occurring in the U.S. daily, with 1 in every 460 people having been infected Friday, and 1 in 46 people currently infected.
September 8th US update:
— JWeiland (@JPWeiland) September 8, 2023
Community spread of Covid is "high", with a correction upwards last week as well. Current estimates:
🔸720,000 new infections/day
🔸1 in every 460 new people were infected today
🔸1 in every 46 people currently infected pic.twitter.com/HaLmGwxkas
COVID hospitalizations in the U.S. rose 16% from Aug. 20 through Aug. 26, the CDC reported on Friday—the latest period for which it made data available. Deaths rose 11% from Aug. 27 through Sept. 2, according to the agency.
The WHO last week reported a 38% increase in the number of cases globally, and a 50% decrease in the number of deaths. The figures, however, are inaccurate, the organization said in its latest situation report. That’s because 61% of countries haven’t reported any COVID cases in the past month. The 39% that did may include countries that only reported one case.
The WHO will transition its situation reports from weekly to monthly, with the next report due to be released Sept. 28, the organization said last week.
‘Pirola’ BA.2.86 continues growth
As of Friday, nearly 100 cases of highly mutated COVID variant “Pirola” BA.2.86 had been reported globally, according to Rajnarayanan. That’s up from 33 cases identified as of last Friday.
So far, the bulk of cases—36—have been identified in the U.K., followed by South Africa (16 cases), Denmark (12 cases), and the U.S. (7 cases).
No cases have yet been reported in India.
As of Sept. 4, 34 cases of the strain had been reported in the U.K.—28 from a single nursing home outbreak in Norfolk, according to a Friday situation report issued by the Health Security Agency. Fifteen percent of all cases were hospitalized, and the hospitalization status of 6% was unknown, according to the agency.
Regarding the nursing home outbreak, “an unusually high number of people became unwell,” the agency stated. While it’s too early to draw conclusions on how the variant will behave in the wider population, the incident “is an early indicator that it may be sufficiently transmissible to have impact in close-contact settings.”
Of the 33 nursing home residents who were sickened, at least 88% had received a spring booster four months ago, according to the agency. That booster wasn’t the updated version recently released in the U.K. and set for release soon in the U.S.
While much is still unknown about BA.2.86, one thing is certain: There is “some degree of widespread community transmission,” the agency said, “both in the U.K. and globally.”
Due to “limited and lagging” sequencing, it’s impossible to say how fast the variant is spreading and just how far it has dispersed. What is known: “The variant is now more globally dispersed than other lineages of similar age” this year, according to the agency.
BA.2.86’s growth rate—while impossible to nail down, given insufficient data—“appears to be significant but not alarming,” Weiland told Fortune. However, “there is still a lot of uncertainty [about] the actual growth rate.”
An enigma of a variant
The WHO last month announced that it had declared BA.2.86 a “variant under monitoring.” Shortly thereafter, the CDC announced that it, too, was tracking the variant, and that it had been detected in the U.S.—in Michigan—in addition to Israel and Denmark, where it had first been reported earlier in the week. The next day, the HSA said that the variant had been identified in England, and that it was “assessing the situation.”
Unlike most circulating variants, which evolved from Omicron spawn XBB, BA.2.86 is thought to have evolved from BA.2, a much earlier strain of Omicron that circulated in early 2022.
And it appears to be vastly different from its predecessors. So far, most widely circulating Omicron variants feature a small handful of mutations that make them slightly different from the last—usually a bit more transmissible. BA.2.86, on the other hand, features 30 or more mutations that separate it from other Omicron—mutations with the potential to make it considerably more immune-evasive, and able to more easily infect cells, according to Jesse Bloom, a computational biologist at Fred Hutch Cancer Center in Seattle and top variant tracker.
That makes BA.2.86 as different from other Omicron strains as the first Omicron was from the original strain of COVID found in Wuhan in 2019, Bloom asserts in a widely cited presentation he posted online.
Because of this, Pirola has the potential to become the next variant the WHO awards a Greek letter to—likely Pi, hence the nickname. Even if the international public health organization doesn’t award it a new moniker, it deserves one, because of the giant leap in viral evolution it represents, some experts say.
