Q&A: What to expect from latest 'Kraken' variant

A new COVID-19 variant is generating cause for concern across the nation. Variation XBB.1.5 — referred to by some in the scientific community as the "Kraken" variant — is characterize by its high transmissibility. Existing vaccines, however, are still expected to provide protection against the emerging variant.

According to Dr. Eric Topol, director of the Scripps Research Translational Institute, there is no reason yet to believe that XBB.1.5 causes any more or less severe illness than existing strains of the virus. He joined Midday Edition on Wednesday with more on the latest COVID-19 news. This interview has been edited for clarity.

What are your thoughts on this revised guidance from the Pentagon that drops the vaccine mandate for troops?

Topol: Well, it's all part of a bigger picture, which is not just complacency, but capitulating to the virus as it continues to evolve. Instead of ratcheting up where we want to get people boosted and get back to our mitigation with things, like masks and distancing, we're going the opposite direction, just as this very difficult variant named XBB.1.5, which — I wish we had better names — but that is starting to really become dominant throughout the country. Already it is in the northeast, and it's destined to be here in San Diego as well.

That new variant is obviously generating concern. What can you tell us about XBB.1.5?

Topol: Well, it's talking to us. It's a very new type of variant which we had not seen before. It's a fusion or so-called recombinant of two previous variants that have come together and promote great spread, which initially was seen in Singapore, and then it got to New York where it added two very worrisome mutations to make it more spreadable. What we have is not just XBB, which is this fusion, but now we've got these two added mutations.

So it spreads quite easily, no less. It evades our immune response to a large degree, so it's not a good thing to have, and it's growing quickly in terms of New York and Massachusetts, Connecticut, New Jersey area, where a lot of hospitalizations have increased among seniors who are, of course, the most vulnerable. So that's the pattern that we're likely going to see in California in the weeks ahead, because right now this variant isn't in high proportion, it's less than 10% or so, whereas of course in the northeast it's 75% or higher. It's headed this way and we need to be gearing up.

Is illness any different with this particular virus? Any more severe? Less severe?

Topol: There's no data to support it's more or less severe, it's just that it spreads easily. And of course it's overtaken the variance that preceded it, all the other omicrons, including BA.5 and BQ.1.1. It's not good that we keep seeing this evolution, particularly now. It's finding these completely new paths, that is, this hybrid of two different variants. That's the first time. And the other thing just to note is this is the first U.S. variant to become dominant. Not just here, but it likely will be throughout Europe. And we're seeing countries in Asia that are already trending this way. So this is our American born variant, which is not a good thing.

I saw a headline the other day that said if you're one of those people who have not caught COVID already, you likely will with this new variant. Is that because of just how transmissible it is, or is there something else to this variant?

Topol: No, that's exactly right. It attaches to our receptors in our cells — the so-called H2 receptor — really well, and so that's how it gets its spreadability. That's why taking this virus seriously, and a bigger story, of course, is that we're likely to see even further evolution. And we've dropped down our genomic surveillance sequencing throughout the world, 90% reduction from what it was. We've got the China crisis, which is basically unmitigated spread through such a huge population. So we got a lot of things going against us right now, just when we wanted to start the new year in a very favorable way.

Against the backdrop of all that, Moderna is planning on charging anywhere from $110 to $130 for vaccine doses. What are your thoughts, and is it worth it?

Topol: First of all, both Pfizer and Moderna, I think, are egregious to raise the price fourfold from what it was when they sold it to the government. I think that's just horrific to take advantage of the situation. Why does it have to justify a fourfold increase from what it has been when the government was paying for it? Now, most people will have their insurance, if they have insurance, cover this added charge, but obviously this is just the greed of the pharma companies, unfortunately. Now, will people take it? Well, even now that it's free, people aren't taking the bivalent booster. And there's a lot of new data that's coming out, which I've just reviewed in a Substack, to show unequivocally that the bivalent booster has outperformed what we had expected. It's doing quite well against XBB.1.5 and the preceding variant, so called BQ.1.1. So if you get the bivalent booster, there really is added protection. That wasn't the plan, of course, that was fortuitous because it was directed against BA.5. So the boosters are important, particularly in people of a higher risk, such as people who are 65 or even 50 years of age and older, or those who have other medical conditions, even though there's broad benefit that's been seen across all ages, all adults, but paying for it isn't going to help getting people boosted.

The other thing, of course, is what about after four to six months of this booster? Then what do we do? That's where we aren't taking this seriously enough, getting next generation vaccines that are much more durable, lasting for years against all variants, and also the nasal vaccines. So we have to get that priority because we can't just expect people to get shots every four to six months and also have it to pay for.

What is the latest on a COVID nasal vaccine?

Topol: We're still waiting to see the data from the first approved major trial, randomized trial from India, the Barrett-Biotech. They haven't provided the data, even though it's approved by the regulatory agencies in India. And there are another several more vaccine large trials that are about to finish, which we'll get a read out from. I'm convinced that they will help us block infections. They won't be 100%. They may not last more than a few months, but taking a nasal spray every few months is a whole lot better than getting shots twice or three times a year. So I'm optimistic, but we're still some months out from seeing the data from trials and of course, getting it here in the U.S. because it hasn't been made to be any priority in this country, and it's being developed much more in countries like India, Mexico, China and other places.

We've been seeing some pretty drastic news coming from China for some time now. What do you think we can learn from how China is handling their COVID situation?

Topol: They took a very draconian policy all the way through to recent times, which kept COVID close to zero, but they didn't set up for the transition about when they were going to open things up. And so this is the problem. They didn't get vaccines, particularly for people who are 60 plus years of age, out at high levels. They were very disappointing. Their vaccines haven't worked as well against the omicron variants as the ones we have. So that's why they have such profound spread.

The hospitalizations and death numbers are extremely high, even though they're not transparent about that, and so they just in this last phase, they just let things go, just unfortunately. Because had they been able to work like many other countries that suppress COVID really well, like New Zealand, Australia and other places, and got the vaccines really out, with boosters the way they needed to, they would have been able to come out relatively unscathed. But that's not the issue here - they have such little infection induced immunity that that's taking a big toll there, and it's not done yet. That's going to go on for some time.

Finally, the focus of the House Committee on Coronavirus was recently shifted. What can you tell us about that?

Topol: Unfortunately, this is so political and so we now have with a Republican Congress majority interest in having hearings about the origins of the virus and all sorts of things that are just really unfortunate. That's not going to help anything right now except add to divisiveness, and this is not good. The undermining of the science is the last thing we need right now.