Variants of SARS-CoV-2
Variants of severe acute respiratory syndrome coronavirus 2 are viruses that, while similar to the original, have genetic changes that are of enough significance to lead virologists to label them separately. SARS-CoV-2 is the virus that causes coronavirus disease 2019. Some have been stated to be of particular importance, due to their potential for increased transmissibility, increased virulence, or reduced effectiveness of vaccines against them. These variants contribute to the continued circulation of SARS-CoV-2.
, the variants of interest as specified by the World Health Organization are JN.1, and the variants under monitoring are KP.3, KP.3.1.1, JN.1.18, LP.8.1, NB.1.8.1, XEC and XFG.
Overview
The origin of SARS-CoV-2 has not been identified. However, the emergence of SARS-CoV-2 may have resulted from recombination events between a bat SARS-like coronavirus and a pangolin coronavirus through cross-species transmission. The earliest available SARS-CoV-2 viral genomes were collected from patients in December 2019, and Chinese researchers compared these early genomes with bat and pangolin coronavirus strains to estimate the ancestral human coronavirus type; the identified ancestral genome type was labeled "S", and its dominant derived type was labeled "L" to reflect the mutant amino acid changes. Independently, Western researchers carried out similar analyses but labeled the ancestral type "A" and the derived type "B". The B-type mutated into further types including B.1, which is the ancestor of the major global variants of concern, labeled in 2021 by the WHO as Alpha variant|alpha], Beta variant|beta], Gamma variant|gamma], Delta variant|delta] and Omicron variant|omicron] variants.Early in the pandemic, the relatively low number of infections resulted in fewer opportunities for mutation of the viral genome and, therefore, fewer opportunities for the occurrence of differentiated variants. Since the occurrence of variants was rarer, the observation of S-protein mutations in the receptor-binding domain region interacting with ACE2 was also not frequent.
As time went on, the evolution of SARS-CoV-2's genome led to mutant specimens of the virus, observed to be more transmissible, to be naturally selected. Notably, both the Alpha and the Delta variants were observed to be more transmissible than previously identified viral strains.
Some SARS-CoV-2 variants are considered to be of concern as they maintain their replication fitness in the face of rising population immunity, either by infection recovery or via vaccination. Some of the variants of concern show mutations in the RBD of the S-protein.
Definitions
The term variant of concern for SARS-CoV-2, which causes COVID-19, is a category used for variants of the virus where mutations in their spike protein receptor binding domain substantially increase binding affinity in RBD-hACE2 complex, while also being linked to rapid spread in human populations.Before being allocated to this category, an emerging variant may have been labeled a variant of interest, or in some countries a variant under investigation. During or after fuller assessment as a variant of concern the variant is typically assigned to a lineage in the Pango nomenclature system and to clades in the Nextstrain and GISAID systems.
Historically, the WHO regularly listed updates on variants of concern, which are variants with an increased rate of transmission, virulence, or resistance against mitigations, like vaccines. The variant submissions from member states are then submitted to GISAID, followed by field investigations of the variant. Updated definitions, published on 4 October 2023, add variants of interest and variants under monitoring to the World Health Organization's working definitions for SARS-CoV-2 variants. The updated definition of VUMs includes having a suspected epidemiological growth advantage or community transmission in at least two countries over a 2–4 week period; while the definition of VOIs requires known genetic changes related to greater epidemiological risk and a known growth advantage in at least two WHO regions and increasing prevalence, or other epidemiological evidence "suggest an emerging risk to global public health". A VOC, under the October 2023 definition, must satisfy the definition of VOIs and satisfy other criteria defining a risk to global health. Greek letter names for the variants are restricted to VOCs since March 2023.
Other organisations such as the CDC in the United States typically define their variants of concern slightly differently; for example, the CDC de-escalated the Delta variant on 14 April 2022, while the WHO did so on 7 June 2022.
, The WHO defines a VOI as a variant "with genetic changes that are predicted or known to affect virus characteristics such as transmissibility, virulence, antibody evasion, susceptibility to therapeutics and detectability" and that is circulating more than other variants in over one WHO region to such an extent that a global public health risk can be suggested. Furthermore, the update stated that "VOIs will be referred to using established scientific nomenclature systems such as those used by Nextstrain and Pango".
Notability criteria
Viruses generally acquire mutations over time, giving rise to new variants. When a new variant appears to be growing in a population, it can be labelled as an "emerging variant". In the case of SARS-CoV-2, new lineages often differ from one another by just a few nucleotides.Some of the potential consequences of emerging variants are the following:
- Increased transmissibility
- Increased morbidity
- Increased mortality
- Ability to evade detection by diagnostic tests
- Decreased susceptibility to antiviral drugs
- Decreased susceptibility to neutralising antibodies, either therapeutic or in laboratory experiments
- Ability to evade natural immunity
- Ability to infect vaccinated individuals
- Increased risk of particular conditions such as multisystem inflammatory syndrome or long COVID.
- Increased affinity for particular demographic or clinical groups, such as children or immunocompromised individuals.
Nomenclature
| PANGO lineages | Notes to PANGO lineages | Nextstrain clades, 2021 | GISAID clades | Notable variants |
| 19B | S | Contains "reference sequence" WIV04/2019 | ||
| ,,, | L | |||
| ,,, | ||||
| V | ||||
| 20A | G | Lineage B.1 in the PANGO Lineages nomenclature system; includes Delta/ | ||
| ,,,, | 20A | GH | ||
| 20C | GH | Includes Epsilon/ | ||
| 20G | GH | Predominant in US generally, Feb '21 | ||
| 20H | GH | Includes Beta/ | ||
| 20B | GR | Includes B.1.1.207 and Lambda | ||
| 20D | GR | |||
| 20J | GR | Includes Gamma/ | ||
| 20F | GR | |||
| 20I | GR | Includes Alpha/ | ||
| B.1.177 | 20E | GV | Derived from 20A |
SARS-CoV-2 variants are grouped according to their lineage and component mutations. Many organisations, including governments and news outlets, referred colloquially to concerning variants by the country in which they were first identified. After months of discussions, the World Health Organization announced Greek-letter names for important strains on 31 May 2021, so they could be easily referred to in a simple, easy to say, and non-stigmatising fashion. This decision may have partially been taken because of criticism from governments on using country names to refer to variants of the virus; the WHO mentioned the potential for mentioning country names to cause stigma. After using all the letters from Alpha to Mu, in November 2021 the WHO skipped the next two letters of the Greek alphabet, Nu and Xi, and used Omicron, prompting speculation that Xi was skipped to avoid offending Chinese leader Xi Jinping. The WHO gave as their explanation that Nu is too easily confounded with "new" and to avoid "causing offense" as "Xi is a common last name". In the event that the WHO uses the entirety of the Greek alphabet, the agency considered naming future variants after constellations.
Lineages and clades
While there are many thousands of variants of SARS-CoV-2, subtypes of the virus can be put into larger groupings such as lineages or clades. Three main, generally used nomenclatures have been proposed:- , GISAID—referring to SARS-CoV-2 as hCoV-19—had identified eight global clades.
- In 2017, Hadfield et al. announced Nextstrain, intended "for real-time tracking of pathogen evolution". Nextstrain has later been used for tracking SARS-CoV-2, identifying 13 major clades .
- In 2020, Rambaut et al. of the Phylogenetic Assignment of Named Global Outbreak Lineages software team proposed in an article "a dynamic nomenclature for SARS-CoV-2 lineages that focuses on actively circulating virus lineages and those that spread to new locations";, 1340 lineages had been designated.
Overview of historical variants of concern or under monitoring
The following table presents information and relative risk level for currently and formerly circulating variants of concern. The intervals assume a 95% confidence or credibility level, unless otherwise stated. As of 2021, all estimates were approximations due to the limited availability of data for studies. For Alpha, Beta, Gamma and Delta, there is no change in test accuracy, and neutralising antibody activity is retained by some monoclonal antibodies. PCR tests continue to detect the Omicron variant.Previously circulating and formerly monitored variants (WHO)
The WHO defines a previously circulating variant as a variant that "has demonstrated to no longer pose a major added risk to global public health compared to other circulating SARS-CoV-2 variants", but should still be monitored.On 15 March 2023, the WHO released an update on the tracking system of VOCs, announcing that only VOCs will be assigned Greek letters.
Previously circulating variants of concern (VOC)
The variants listed below had previously been designated as variants of concern, but were displaced by other variants., the WHO lists the following under "previously circulating variants of concern":Alpha (lineage B.1.1.7)
First detected in October 2020 during the COVID-19 pandemic in the United Kingdom from a sample taken the previous month in Kent, lineage B.1.1.7, labelled Alpha variant by the WHO, was previously known as the first Variant Under Investigation in December 2020 and later notated as VOC-202012/01. It is also known as 20I, 20I/501Y.V1, or 501Y.V1. From October to December 2020, its prevalence doubled every 6.5 days, the presumed generational interval. It is correlated with a significant increase in the rate of COVID-19 infection in United Kingdom, associated partly with the N501Y mutation. There was some evidence that this variant had 40–80% increased transmissibility, and early analyses suggested an increase in lethality, though later work found no evidence of increased virulence. As of May 2021, the Alpha variant had been detected in some 120 countries.On 16 March 2022, the WHO has de-escalated the Alpha variant and its subvariants to "previously circulating variants of concern".
B.1.1.7 with E484K
Variant of Concern 21FEB-02, described by Public Health England as "B.1.1.7 with E484K" is of the same lineage in the Pango nomenclature system, but has an additional E484K mutation. As of 17 March 2021, there were 39 confirmed cases of VOC-21FEB-02 in the UK. On 4 March 2021, scientists reported B.1.1.7 with E484K mutations in the state of Oregon. In 13 test samples analysed, one had this combination, which appeared to have arisen spontaneously and locally, rather than being imported. Other names for this variant include B.1.1.7+E484K and B.1.1.7 Lineage with S:E484K.Beta (lineage B.1.351)
On 18 December 2020, the 501.V2 variant, also known as 501.V2, 20H, 20H/501Y.V2, 501Y.V2, VOC-20DEC-02, or lineage B.1.351, was first detected in South Africa and reported by the country's health department. It has been labelled as Beta variant by WHO. Researchers and officials reported that the prevalence of the variant was higher among young people with no underlying health conditions, and by comparison with other variants it is more frequently resulting in serious illness in those cases. The South African health department also indicated that the variant may be driving the second wave of the COVID-19 epidemic in the country due to the variant spreading at a more rapid pace than other earlier variants of the virus.Scientists noted that the variant contains several mutations that allow it to attach more easily to human cells because of the following three mutations in the receptor-binding domain in the spike glycoprotein of the virus: N501Y, K417N, and E484K. The N501Y mutation has also been detected in the United Kingdom.
On 16 March 2022, the WHO has de-escalated the Beta variant and its subvariants to "previously circulating variants of concern".
Gamma (lineage P.1)
The Gamma variant or lineage P.1, termed Variant of Concern 21JAN-02 by Public Health England, 20J or 20J/501Y.V3 by Nextstrain, or just 501Y.V3, was detected in Tokyo on 6 January 2021 by the National Institute of Infectious Diseases. It has been labelled as Gamma variant by WHO. The new variant was first identified in four people who arrived in Tokyo having travelled from the Brazilian Amazonas state on 2 January 2021. On 12 January 2021, the confirmed 13 local cases of the new Gamma variant in the Amazon rainforest. This variant of SARS-CoV-2 has been named lineage P.1, and has 17 unique amino acid changes, 10 of which in its spike protein, including the three concerning mutations: N501Y, E484K and K417T.The N501Y and E484K mutations favour the formation of a stable RBD-hACE2 complex, thus, enhancing the binding affinity of RBD to hACE2. However, the K417T mutation disfavours complex formation between RBD and hACE2, which has been demonstrated to reduce the binding affinity.
The new variant was absent in samples collected from March to November 2020 in Manaus, Amazonas state, but it was detected for the same city in 42% of the samples from 15 to 23 December 2020, followed by 52.2% during 15–31 December and 85.4% during 1–9 January 2021. A study found that infections by Gamma can produce nearly ten times more viral load compared to persons infected by one of the other lineages identified in Brazil. Gamma also showed 2.2 times higher transmissibility with the same ability to infect both adults and older persons, suggesting P.1 and P.1-like lineages are more successful at infecting younger humans irrespective of sex.
A study of samples collected in Manaus between November 2020 and January 2021, indicated that the Gamma variant is 1.4–2.2 times more transmissible and was shown to be capable of evading 25–61% of inherited immunity from previous coronavirus diseases, leading to the possibility of reinfection after recovery from an earlier COVID-19 infection. As for the fatality ratio, infections by Gamma were also found to be 10–80% more lethal.
A study found that people fully vaccinated with Pfizer or Moderna have significantly decreased neutralisation effect against Gamma, although the actual impact on the course of the disease is uncertain.
A pre-print study by the Oswaldo Cruz Foundation published in early April found that the real-world performance of people with the initial dose of the Sinovac's Coronavac Vaccine had approximately 50% efficacy rate. They expected the efficacy to be higher after the 2nd dose. As of July 2021, the study is ongoing.
Preliminary data from two studies indicate that the Oxford–AstraZeneca vaccine is effective against the Gamma variant, although the exact level of efficacy has not yet been released. Preliminary data from a study conducted by Instituto Butantan suggest that CoronaVac is effective against the Gamma variant as well, and as of July 2021 has yet to be expanded to obtain definitive data.
On 16 March 2022, the WHO has de-escalated the Gamma variant and its subvariants to "previously circulating variants of concern".
Delta (lineage B.1.617.2)
The Delta variant, also known as B.1.617.2, G/452R.V3, 21A or 21A/S:478K, was a globally dominant variant that spread to at least 185 countries. It was first discovered in India. Descendant of lineage B.1.617, which also includes the Kappa variant under investigation, it was first discovered in October 2020 and has since spread internationally. On 6 May 2021, British scientists declared B.1.617.2 as a "variant of concern", labelling it VOC-21APR-02, after they flagged evidence that it spreads more quickly than the original version of the virus and could spread quicker or as quickly as Alpha. It carries L452R and P681R mutations in Spike; unlike Kappa it carries T478K but not E484Q.On 3 June 2021, Public Health England reported that twelve of the 42 deaths from the Delta variant in England were among the fully vaccinated, and that it was spreading almost twice as fast as the Alpha variant. Also on 11 June, Foothills Medical Centre in Calgary, Canada reported that half of their 22 cases of the Delta variant occurred among the fully vaccinated.
In June 2021, reports began to appear of a variant of Delta with the K417N mutation. The mutation, also present in the Beta and Gamma variants, raised concerns about the possibility of reduced effectiveness of vaccines and antibody treatments and increased risk of reinfection. The variant, called "Delta with K417N" by Public Health England, includes two clades corresponding to the Pango lineages AY.1 and AY.2. It has been nicknamed "Delta plus" from "Delta plus K417N". The name of the mutation, K417N, refers to an exchange whereby lysine is replaced by asparagine at position 417. On 22 June, India's Ministry of Health and Family Welfare declared the "Delta plus" variant of COVID-19 a variant of concern, after 22 cases of the variant were reported in India. After the announcement, leading virologists said there was insufficient data to support labelling the variant as a distinct variant of concern, pointing to the small number of patients studied. In the UK in July 2021, AY.4.2 was identified. Alongside those previously mentioned it also gained the nickname 'Delta Plus', on the strength of its extra mutations, Y145H and A222V. These are not unique to it, but distinguish it from the original Delta variant.
On 7 June 2022, the WHO has de-escalated the Delta variant and its subvariants to "previously circulating variants of concern".
Previously circulating variants of interest (VOI)
Epsilon (lineages B.1.429, B.1.427, CAL.20C)
The Epsilon variant or lineage B.1.429, also known as CAL.20C or CAVUI1, 21C or 20C/S:452R, is defined by five distinct mutations, of which the L452R was of particular concern. From 17 March to 29 June 2021, the CDC listed B.1.429 and the related B.1.427 as "variants of concern". As of July 2021, Epsilon is no longer considered a variant of interest by the WHO, as it was overtaken by Alpha.From September 2020 to January 2021, it was 19% to 24% more transmissible than earlier variants in California. Neutralisation against it by antibodies from natural infections and vaccinations was moderately reduced, but it remained detectable in most diagnostic tests.
Epsilon was first observed in July 2020 by researchers at the Cedars-Sinai Medical Center, California, in one of 1,230 virus samples collected in Los Angeles County since the start of the COVID-19 epidemic. It was not detected again until September when it reappeared among samples in California, but numbers remained very low until November. In November 2020, the Epsilon variant accounted for 36 per cent of samples collected at Cedars-Sinai Medical Center, and by January 2021, the Epsilon variant accounted for 50 per cent of samples. In a joint press release by University of California, San Francisco, California Department of Public Health, and Santa Clara County Public Health Department, the variant was also detected in multiple counties in Northern California. From November to December 2020, the frequency of the variant in sequenced cases from Northern California rose from 3% to 25%. In a preprint, CAL.20C is described as belonging to clade 20C and contributing approximately 36% of samples, while an emerging variant from the 20G clade accounts for some 24% of the samples in a study focused on Southern California. Note, however, that in the US as a whole, the 20G clade predominates, as of January 2021. Following the increasing numbers of Epsilon in California, the variant has been detected at varying frequencies in most US states. Small numbers have been detected in other countries in North America, and in Europe, Asia and Australia. After an initial increase, its frequency rapidly dropped from February 2021 as it was being outcompeted by the more transmissible Alpha. In April, Epsilon remained relatively frequent in parts of northern California, but it had virtually disappeared from the south of the state and had never been able to establish a foothold elsewhere; only 3.2% of all cases in the United States were Epsilon, whereas more than two-thirds were Alpha.
Zeta (lineage P.2)
Eta (lineage B.1.525)
The Eta variant or lineage B.1.525, also called VUI-21FEB-03 by Public Health England and formerly known as UK1188, 21D or 20A/S:484K, does not carry the same N501Y mutation found in Alpha, Beta and Gamma, but carries the same E484K-mutation as found in the Gamma, Zeta, and Beta variants, and also carries the same ΔH69/ΔV70 deletion as found in Alpha, N439K variant and Y453F variant. Eta differs from all other variants by having both the E484K-mutation and a new F888L mutation with leucine. As of 5 March 2021, it had been detected in 23 countries. It has also been reported in Mayotte, the overseas department/region of France. The first cases were detected in December 2020 in the UK and Nigeria, and as of 15 February 2021, it had occurred in the highest frequency among samples in the latter country. As of 24 February 56 cases were found in the UK. Denmark, which sequences all its COVID-19 cases, found 113 cases of this variant from 14 January to 21 February 2021, of which seven were directly related to foreign travel to Nigeria.As of July 2021, UK experts are studying it to ascertain how much of a risk it could be. It was then regarded as a "variant under investigation", but pending further study, it was anticipated to possibly become a "variant of concern". Ravi Gupta, from the University of Cambridge said in a BBC interview that lineage B.1.525 appeared to have "significant mutations" already seen in some of the other newer variants, which means their likely effect is to some extent more predictable.
Theta (lineage P.3)
On 18 February 2021, the Department of Health of the Philippines confirmed the detection of two mutations of COVID-19 in Central Visayas after samples from patients were sent to undergo genome sequencing. The mutations were later named as E484K and N501Y, which were detected in 37 out of 50 samples, with both mutations co-occurrent in 29 out of these.On 13 March, the Department of Health confirmed the mutations constitutes a variant which was designated as lineage P.3. On the same day, it also confirmed the first COVID-19 case caused by the Gamma variant in the country. The Philippines had 98 cases of the Theta variant on 13 March. On 12 March it was announced that Theta had also been detected in Japan. On 17 March, the United Kingdom confirmed its first two cases, where PHE termed it VUI-21MAR-02.
On 30 April 2021, Malaysia detected 8 cases of the Theta variant in Sarawak.
As of July 2021, Theta is no longer considered a variant of interest by the WHO.
UK