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March 30, 2022 09:22 pm

'We Study Virus Evolution. Here's Where We Think the Coronavirus Is Going.'

Sarah Cobey, who studies the interaction of immunity, virus evolution and transmission at the University of Chicago, Jesse Bloom and Tyler Starr, both of whom study virus evolution at Fred Hutchinson Cancer Research Center in Seattle, writing for The New York Times: It's impossible to say whether future variants will have more big Omicron-like jumps or more typical stepwise changes, but we are confident SARS-CoV-2 will continue to evolve to escape immunity. While transmissibility of viruses does plateau at a certain point, other human viruses that escape immunity keep doing so. The influenza vaccine has been updated annually for decades to chase viral evolution, and some influenza viruses show no sign of slowing down. Immune escape is an endless evolutionary arms race, because the immune system can always make new antibodies and the virus has a vast set of mutations to explore in response. For instance, Omicron has just a tiny fraction of the many mutations that have been observed in SARS-CoV-2 or related bat viruses, which are in turn just a small fraction of what lab experiments suggest the virus could potentially explore. Taking all this together, we expect SARS-CoV-2 will continue to cause new epidemics, but they will increasingly be driven by the ability to skirt the immune system. In this sense, the future may look something like the seasonal flu, where new variants cause waves of cases each year. If this happens, which we expect it will, vaccines may need to be updated regularly similar to the flu vaccines unless we develop broader variant-proof vaccines. And of course, how much all this matters for public health depends on how sick the virus makes us. That is the hardest prediction to make, because evolution selects for viruses that spread well, and whether that makes disease severity go up or down is mostly a matter of luck. But we do know that immunity reduces disease severity even when it doesn't fully block infections and spread, and immunity gained from vaccination and prior infections has helped blunt the impact of the Omicron wave in many countries. Updated or improved vaccines and other measures that slow transmission remain our best strategies for handling an uncertain evolutionary future.

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