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A Pandemic by Any Other Name

By 09 February 2020 Chinse sources were using the term novel coronavirus pneumonia (NPC) for the disease. 2019nCoV was renamed COVID-19 by WHO on 11 February 2020. Official names were announced for the virus responsible for COVID-19 (previously known as “2019 novel coronavirus”) and the disease it causes. The official name for the disease is "coronavirus disease (COVID-19)" and the name of the virus is "severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)". Viruses, and the diseases they cause, often have different names. For example, HIV is the virus that causes AIDS. People often know the name of a disease, such as measles, but not the name of the virus that causes it (rubeola). From a risk communications perspective, using the name SARS can have unintended consequences in terms of creating unnecessary fear for some populations, especially in Asia which was worst affected by the SARS outbreak in 2003.

Foreign Ministry Spokesperson Zhao Lijian irritated Donald Trump on 12 March 2020 when he questioned the US on Twitter and raised the possibility that it was the US army that brought the virus to Wuhan in October 2019. Trump repeatedly and deliberately used the term "Chinese virus," which is considered racist by some. This showed that Trump and his team were panicking and misbehaving. They had not found any good way to take the pandemic and the market sentiment under control. As a result, they escalated conflicts with China, trying to escape Americans' questions over their incompetence, making China a target of anger.

Previous viral outbreaks in history ended up being called after the country where they were first detected – for example, the “Spanish flu” that decimated the world in the aftermath of the First World War, a century ago. From the very beginning of the current pandemic, however, the World Health Organization (WHO) has been cautious to avoid such labeling. The virus itself was designated SARS-CoV-2 (Severe Acute Respiratory Syndrome-CoronaVirus-2), and the disease it causes became coronavirus disease 2019, or Covid-19.

As the virus mutated, as viruses do, new strains that arose were initially named, as per tradition, after countries where they were detected, leading to reports of the “South African variant” or the “Indian strain.” But the WHO cracked down on that at the end of May 2021, rolling out a system based on the Greek alphabet. The stated goal was to make variant names “simple [and] easy to say and remember.” Another objective was to avoid calling variants by their places of detection, which the WHO said was “stigmatizing and discriminatory.” So, while health experts continue to refer to variants by their scientific designations, the rest of us get to deal with the Alpha, Delta, and now Omicron.

The WHO has divided the virus strains into three categories: Variants of Concern (VOC), Variants of Interest (VOI), and Variants under Monitoring (VUM). Only the first two categories get Greek names. Since the discovery of the new variant designated Omicron, there are five official VOCs and two VOIs (Lambda and Mu), with the rest considered VUMs. This is different from the US Centers for Disease Control and Prevention (CDC) categorization, which lists only Delta as a VOC, and the rest as VUMs. A Variant of Concern (VOC) is a variant for which there is evidence of an increase in transmissibility, more severe disease (e.g., increased hospitalizations or deaths), significant reduction in neutralization by antibodies generated during previous infection or vaccination, reduced effectiveness of treatments or vaccines, or diagnostic detection failures.

The US government SARS-CoV-2 Interagency Group (SIG) added a new class of SARS-CoV-2 variants designated as Variants Being Monitored. This class includes variants with substitutions of concern, including previously designated Variants of Interest (VOIs) or Variants of Concern (VOCs), that are no longer detected or are circulating at very low levels in the United States, and as such, do not pose a significant or imminent risk to public health in the United States. A Variant of High Consequence (VOHC) has clear evidence that prevention measures or medical countermeasures (MCMs) have significantly reduced effectiveness relative to previously circulating variants. By late 2021, no Variant of High Consequence (VOHC) had been identified in the United States.

The virus that causes COVID-19 is constantly changing over time. Sometimes these changes allow new variants to spread more quickly or effectively. If that occurs, the new variant may become more common relative to other variants that are circulating. In general, symptoms of COVID-19 tend to be similar across variants. The types of symptoms and how severe they are usually depend more on a person’s immunity than which variant causes the infection.

1. Alpha: The original mutation - The first documented mutation of the virus was designated in December 2020 and later dubbed Alpha (B.1.1.7). First detected in the UK earlier that year, it was estimated to be 40 to 80% more transmissible than the original virus, but led to no difference in overall mortality.
2. Beta: Three new spikes - The Beta strain (B.1.351) was actually detected in South African samples dating as far back as May 2020, but officially designated by the WHO only six months later, at the same time as Alpha. It has three mutations in the spike region, and is considered 20 to 30% more transmissible.
3. Gamma: Deadlier still - First recorded in Brazil in November 2020, the Gamma variant (P.1) has 17 amino acid substitutions, 10 of which are in the spike protein, and three of which are thought to be of concern. It was designated in January 2021, and is said to be up to 38% more transmissible and up to 50% deadlier than the original virus.
4. Delta: Red alert - Delta variant was found by experts to be as contagious as the virus that causes chickenpox. Variant B.1.617.2, known as Delta, was first detected in India. Designated in May 2021, it was until recently the most concerning strain of the virus. It has up to 17 mutations, including sub-lineages, and is considered 97% more transmissible, causing 85% more hospitalizations and a 150% uptick in mortality, on average.
5. Delta Plus - The Delta Plus variant is a mutant of the Delta variant and was first found in Europe in March 2021. The Indian government has classified Delta Plus as a variant of concern in the country. People affected with this variant experienced headaches, sore throats, runny noses, and fever.

6. Epsilon : The Epsilon (California) variant gained a higher profile in mid-2021 as cases of COVID-19 spike among the unvaccinated, driven in part by the widely spread Delta variant. In the lab, the Epsilon version proved to be more infectious than previous variants, and researchers discovered three changes in its spike proteins. The Epsilon variant was not a 'Variant of concern' (VoC) and continued to be a 'Variant of Interest' (VoI).
7. Zeta : The Zeta variant, also known as P.2(B.1.1.28.2), was first identified in Rio de Janeiro, Brazil. It shares the mutation E484K with the Gamma variant
8. Eta : , also known as lineage B.1.525, is SARs-COV-2 virus strain that carries the same E484K-mutation as found in the Gamma, Zeta, and Beta variants. Unlike Alpha, Beta, Gamma, it does not carry the N501Y mutations. Eta variant was not a 'Variant of concern' (VoC) and continued to be a 'Variant of Interest' (VoI).
9. theta : P3 (Philippines) was downgraded from the WHO list, though experts are still keeping tabs
10. Iota : The B.1.526 variant of SARS-CoV-2, also known as the lota variant, was first identified in New York City in November 2020. The variant has considerably higher transmissibility and immune escape potential than previously circulating variants and can increase the infection fatality rate by 62% - 82% among older adults.
11. Kappa : The B.1.617.1, which originated in India in October 2020, was designated as a variant of interest (VOI) by the World Health Organization (WHO) 04 April 2021. The Kappa variant was placed by WHO under the “deescalated category” as of September 2021.
12. Lambda : The lambda variant, or C.37, first showed up in Peru in December 2020. It spread to a few different countries — especially in Latin America — and shown up in several U.S. states in subsequent months. And it shares some of the mutations that make variants of concern more dangerous. The spike protein of the lambda variant of interest confer increased infectivity and immune escape from neutralizing antibodies elicited by CoronaVac
13. Mu : B.1.621, was first identified in Colombia in January 2021. The variant spread quickly across South America and has been detected in dozens of countries so far, including in thousands of samples in the US. The WHO reports that mu has a “constellation of mutations that indicate potential properties of immune escape” — basically, that it shares some of the changes that could make it harder for the immune system to catch.
14. nu - skipped - sounds like "new"
15. xi - skipped - sounds like "Xi Jinping"
16. Omicron BA.1: New fear - The variant just designated, called Omicron, or B.1.1.529, has a whopping 32 mutations of the spike protein, raising fears that it will be resistant to existing vaccines. Fewer than 100 cases had been detected by late November 2021, but it has reportedly already reached Europe from its initial nexus in southern Africa. Being a highly transmissible variant, Omicron led to a massive surge of cases all around the globe. “This variant has a large number of mutations, some of which are concerning,” the WHO said, adding, "preliminary evidence suggests an increased risk of reinfection with this variant as compared to other variants of concern." It often resulted in less severe infections than Delta, owing in part to its tendency to stay in the throat rather than attack the lungs.
17. > Omicron BA.2: First detected it in early December 2021in samples from South Africa, Australia, and Canada, BA.2 was making inroads in the U.S. It could slow or even reverse our recovery from the first Omicron wave. That was just a few weeks after officials from South Africa announced the first BA.1 cases. BA.2 is actually quite distinct from BA.1 on a genetic level—and those differences might make BA.2 more transmissible, but it doesn’t appear to reduce the effectiveness of the vaccines. By the end of March 2022 the BA.2 sub-variant of the Omicron coronavirus variant had become dominant globally, representing nearly 86 percent of all sequenced cases, according to the World Health Organization. First detected in the early days of January, the sub-variant, often referred to as the “stealth variant”, is even more transmissible than its highly contagious Omicron siblings, BA.1 and BA.1.1. A missing gene in BA.1 allowed it to be tracked by default through a common PCR test. BA.2 and another sibling, BA.3 – also increasing in prevalence but currently at low levels – can only be found by genomic sequencing. Even though BA.2 is more infectious than other Omicron sub-variants, according to studies, evidence suggests so far that it is not more likely to cause severe disease.
18. pi
19. rho
20. sigma
21. tau
22. upsilon
23. phi
24. chi
25. psi
26. omega
27. IHU - The new variant was discovered by academics at the IHU [ l'Institut Hospitalo-Universitaire ] Mediterranee Infection Institute in France. The IHU variant reportedly showrf strain carrying the N501Y mutation which existed in the Alpha variant. Scientists believed the new strain also carried E484K mutation making it vaccine-resistant.
28. NeoCov - A group of Chinese scientists from Wuhan issued a warning against a new variant of coronavirus named NeoCoV, which is said to be more lethal with a higher infection rate. Chinese researchers weighed in on the mortality rate stating that 'one in every three infected person dies', highlighting the higher death rate. Scientists said that NeoCoV was discovered in a bat population. The experts have warned against the potential risks, mentioning that further study and investigation are needed to understand the immune escape. 
29. the XE subvariant was first detected in the UK on 19 January 2022 and based on early data it has a community growth rate of 10 percent compared to the stealth BA. 2 subvariant. This means it could be 1.1 times more transmissible than the already highly transmissible BA.2. The XE subvariant is a cross between the BA. 1 and the BA. 2.

It was unclear why the WHO chose to go with Omicron, given the next letters in the Greek alphabet due for variant designations were Nu and Xi, both of which have been skipped. The pronunciation of "nu" is ambiguous relative to "new", and the pronunciation of "Xi" is ambiguous with the "shee" of Mandarin [eg Xi Jin-ping].

By August 2023 a few novel subvariants had attracted the worldwide attention of public health authorities: EG.5, colloquially known as "Eris"; FL.1.5.1, unofficially labeled "Fornax"; and BA.2.86, also known as "Pirola." However, the EG.5 variant has established itself as the predominant strain in countries such as the United States and the United Kingdom.

• BA.2.86, also known as "Pirola," was first detected in late July 2023 and has caused a limited number of infections globally. An expert mentioned that it has its roots in the omicron BA.2 sub-group, which led to significant virus outbreaks in early 2022. Pirola has captured the world's attention as it has more than 30 mutations on its spike protein, compared with its closest ancestor, BA.2. The spike protein plays a critical role during coronavirus infection, and it's the part of the virus that vaccines aim to neutralize. BA.2.86 presents more than 35 genetic variations compared to the Omicron XBB.1.5 subvariants, which held sway for most of 2023 and will be the primary focus of new COVID boosters in the autumn. In the CDC Nowcast posted Nov. 27, 2023, BA.2.86 is projected to account for 5-15% of currently circulating variants. The public health risk posed by this variant is low compared with other circulating variants, based on available limited evidence.
• EG.5 "Eris" represents a mutation of the SARS-CoV-2 virus, originating from the XBB or Gryphon lineage, which can be traced back to the Omicron variant. In its most recent assessment, the World Health Organization classified EG.5, encompassing the EG.5.1 subvariant, as a noteworthy viral strain warranting surveillance by countries. Although EG.5 could contribute to rising case numbers, the WHO emphasized that it presents a minor public health threat compared to other Omicron offshoots, as there is no indication of it causing critical health conditions.
• FL.1.5.1 "Fornax" is a derivative of the XBB variant lineage, and it possesses a mutation, F456L, with EG.5, which appears to be enhancing its transmission capabilities compared to other virus variants.
• XBB - Among the rapidly spreading Omicron variants right now, XBB comprises BQ.1.1, BQ.1, BQ.1.3, and BA.2.3.20, states Dr. Thomas Russo, M.D., Professor and the chief of infectious disease at the University at Buffalo in New York. According to a preliminary study published by researchers in China, XBB can evade the antibody defenses against these recently emerged COVID variants.

Based on the calculations of the CDC COVID Data Tracker, EG.5 contributed to 20.6 percent of the COVID-19 cases in the US in August 2023 (between August 5 and August 19), exceeding the prevalence of any other single SARS-CoV-2 variant. In that particular week, a variant named FL 1.5.1 (or Fornax) was reportedly spreading rapidly in the US and, making up 13.3 percent of cases, claimed the second spot, while a blend of other XBB mutations and offspring of Omicron trailed behind in varying percentage scores.

According to the WHO, the coronavirus continuously presents a substantial danger despite the formal end of the international public health emergency on May 5, 2023. The multilateral organization conveyed that numerous areas observed drops in the incidence of sickness and mortality linked to COVID-19. However, countries including Australia, Brazil, New Zealand, and South Korea had the highest recorded cases in the previous month. The agency pointed out that limited testing and reporting to the WHO make data monitoring difficult.