WHO issues standing recommendations for COVID, details Omicron EG.5 variant risk


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In a pair of new developments today, the World Health Organization (WHO) released standing recommendations for battling COVID-19 and released a risk assessment for the EG.5 Omicron variant, elevating it to a variant of interest (VOI) and noting that may drive a rise in cases and become dominant.

Standing recs cover 7 main areas

The new standing recommendations released today replace the temporary recommendations the WHO made in May, when Director-General Tedros Adhanom Ghebreyesus, PhD, declared the end of the public health emergency of international concern (PHEIC). The new recommendations were made by a review committee and were accepted by Tedros today. The temporary recommendations expired at the beginning of August.

At a media briefing today, Tedros said the risk of severe disease and death are vastly lower than a year ago due to increasing population immunity from vaccination or infection, along with early diagnosis and better clinical care.

However, he said the WHO still assesses the threat from COVID as high. "The virus continues to circulate in all countries, it continues to kill and it continues to change," he said.

The standing recommendations cover seven main areas and reinforce the guidance the group released in May, Tedros said. For example, the guidance urges countries to update their COVID plans, sustain and share surveillance, vaccinate the most at-risk groups, report data to the WHO, collaborate on research, deliver optimal clinical care, and provide equitable access to vaccines, testing, and treatment.

Tedros said the new recommendations are important, given those who have lost loved ones, people who remain at increased risk of severe disease or death, and long-COVID patients. "WHO will not forget about COVID-19, and nor can governments," he said. "Implementing these recommendations will not only help to protect against COVID-19, it will also help countries to prevent and respond to other diseases."

EG.5 could drive cases rises, overall threat currently low

In a related development today, the WHO's Technical Advisory Group on SARS-CoV-2 Virus Evolution today released its initial risk assessment on EG.5, which is currently the fastest growing variant in the Americas, Europe, and Western Pacific regions. The WHO had designated it as a variant under monitoring (VUM) on July 19 and today elevated it to a VOI alongside XBB.1.5 and XBB.1.16.

EG.5 carries an additional F456L mutation in the spike protein, compared to its parent XBB.1.9.2 and XBB.1.5 subvariants. The group noted that EG.5.1 has an additional spike mutation Q52H and represents 88% of available EG.5 sequences.

First reported in mid-February, the EG.5 proportions showed a notable rise between mid-June and mid-July, when they made up an estimated 17.4% of viruses.

The group said the overall public health risk is low, similar to the other VOIs, but it may spread globally and contributed to rising cases. "Several countries with rising EG.5 prevalence have seen increases in cases and hospitalizations, although at present there is no evidence of an increase in disease severity directly associated with EG.5," they said. With high confidence based on the evidence, they assessed the growth advantage risk as moderate.

For antibody escape, they put the risk at moderate, with low confidence based on work from one lab that used pseudotyped viruses. "Additional laboratory studies would be needed to further assess the risk of antibody escape," they wrote.

Currently, there is no evidence that EG.5 causes more severe disease, but the group pointed out that countries have substantially decreased reporting hospitalization and intensive care unit (ICU) data to the WHO. "Further, additional studies would be needed to further assess the impact of this variant on clinical outcomes," they added.

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