Wednesday, August 24, 2022

Virtually no patients infected with either the BA.1 or BA.2 sublineages experienced symptoms or disease

Academic journal article below

COVID-19 Disease Severity in Persons Infected With Omicron BA.1 and BA.2 Sublineages and Association With Vaccination Status

Adeel A. Butt et al.

Infection with the SARS-CoV-2 Omicron variant is associated with less severe disease compared with the Delta variant.1-3 Two main Omicron sublineages—BA.1 and BA.2—have variable geographic distribution. In Qatar, BA.1 was initially predominant but was quickly replaced by BA.2 as the predominant sublineage. This study sought to determine and compare the severity of SARS-CoV-2 infection among persons infected with these sublineages.


The study was approved by the institutional review boards of the Hamad Medical Corporation, Weill Cornell Medicine−Qatar, and Qatar University. A waiver of informed consent was granted because of the retrospective nature of the data retrieval. This retrospective cohort study followed Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline.

Using the national COVID-19 database in Qatar, we identified all COVID-19 infections diagnosed between December 19, 2021, and February 6, 2022, in adults (≥18 years). We matched each patient with BA.1 infection with a patient with BA.2 infection, including by age, sex, nationality, comorbidities, and vaccination status. Additional analyses were conducted after excluding all persons with a prior documented infection and all vaccinated persons. The primary outcome was COVID-19 case severity, criticality, and fatality using the World Health Organization guidelines4,5 as assessed by trained medical personnel who reviewed the patients’ medical charts.

Based on national surveillance data, infections between December 19, 2021, and February 6, 2022, were classified as Omicron infections. The BA.1 sublineage infection was proxied as S-gene target failure (SGTF) using the TaqPath COVID-19 Combo Kit (Thermo-Fisher Scientific) while BA.2 sublineage was proxied as a non−SGTF.


From 24 301 total cases of BA.1 and 125 687 of BA.2, we were able to form 20 812 matched pairs of patients (median age [IQR], 35.0 [28.0-44.0] years; 47.9% women; 85.5% with no comorbidities). Of this final sample, 18.7% of patients were unvaccinated and 8.8% had received a booster dose in each group. Severe, critical, or fatal outcomes were recorded in 33 (0.2%) of patients with BA.1 and 36 (0.2%) of those with BA.2 (P = .25; Table 1). All patients with BA.1 and 35 of 36 (97.2%) with BA.2 were among those who had not received a booster dose (Table 1). In conditional logistic regression analyses accounting for exact matching, vaccination with 2 vaccine doses more than 3 months prior to infection (adjusted odds ratio [aOR], 0.22; 95% CI, 0.13-0.36) or with a booster dose (aOR, 0.02; 95% CI, 0.00-0.14) were associated with a significantly lower risk of any composite severe, critical, or fatal outcomes. Prior natural infection was not associated with a lower risk of these outcomes (aOR, 0.29; 95% CI, 0.04-2.14; Table 2); stratification by the sublineage yielded similar results.

We repeated the analyses after excluding those with prior documented SARS-CoV-2 infection and those who were vaccinated. The results mirrored our primary analyses, with a lower risk among the vaccinated, particularly among patients who had received a booster dose.


The findings of this study provide reassurances at multiple levels. First, 99.8% to 99.9% of patients infected with either the BA.1 or BA.2 sublineages experienced no symptoms or mild disease. Second, there was no difference in the severity of illness between BA.1 and BA.2 sublineages infections. Among individuals who had received a booster vaccine dose, only 1 person experienced any severe, critical, or fatal outcome.

This study’s data set was derived from the Qatar National COVID-19 database with complete polymerase chain reaction testing and vaccination records. Outcomes were obtained from individual medical charts by trained independent reviewers. However, BA.1 and BA.2 sublineage ascertainment was based on proxy criteria—presence or absence of SGTF using the TaqPath Kit.6 Some Omicron infections may have been misclassified as Delta infections, but this is unlikely because Delta incidence was low during the study.

In conclusion, SARS-CoV-2 infection with the Omicron variant sublineages BA.1 and BA.2 was rarely associated with severe, critical, or fatal disease. There is no discernable difference in severity of BA.1 vs BA.2 infections. Risk of severity is further mitigated by vaccination, particularly the receipt of a booster dose.


Fauci, a flawed figurehead

So farewell, Anthony Fauci, the unfortunate face of America’s pandemic response. Well, not so unfortunate – the doctor is stepping down as head of the US National Institute of Allergy and Infectious Diseases this December, riding off into the sunset with a reported $350,000 per year golden parachute, the largest pension in US federal history.

Fauci has developed something of a reputation for baffling the public – whether it be for contradictory advice on the efficacy of masks or herd immunity or vaccines. Even his resignation announcement was confusing:

I will be leaving these positions in December of this year to pursue the next chapter of my career… While I am moving on from my current positions, I am not retiring.

Fauci will be 82 in December. America’s gerontocracy just refuses to budge. In fairness, Fauciwasa pretty good doctor in his prime. Republicans tried to attack him over his handling of Aids, but his record on that public health crisis stacks up pretty well.

During the Covid pandemic, however, Fauci made the mistake a lot of experts made: he equated himself with the entire concept of science as a way of giving his pronouncements an aura of infallibility. ‘Irepresent science,’ he said, as a response to criticism after he repeatedly said his institute didn’t fund ‘gain of function’ virology research in Wuhan, when in fact it did.

Of course Fauci wasn’t the evil mastermind that so many deranged cynics say he was – even if he did dismiss the idea that Covid originated in a lab as a mad conspiracy theory when private emails suggested he may well have known otherwise. Maybe Fauci was just a lot like Donald Trump or Joe Biden: old, faltering, and heavily influenced by the people around him – someone who craved public approval above all. The boring truth about him probably isn’t that he is involved in any sinister conspiracy, it’s that he ignored evidence that didn’t help him and got swept along by a wider zeitgeist instead.

Much like Biden, Fauci perfectly represents that stubborn generation of Americans who have been running their country for decades. As their competence and faculties fade, their grip on power only tightens.He became head of NIAID at just 43, then held the role for almost 40 years.

Fauci appeared to enjoy being the main character of this pandemic rather too much. Commentators fawned over him when he looked so conspicuously uncomfortable next to Trump in those now infamous press conferences when the President rambled wildly about the virus.

Fauci fandom quickly reached cultish levels. The Mayor of Washington, DC said his birthday should renamed ‘Dr. Anthony S. Fauci Day’. He appeared on the cover of Time magazine twice. He also appeared on the cover of magazines such People, InStyle and others. But, like health experts almost everywhere else, Fauci simply pinballed from one official narrative to another. Often there was little to no change in the actual science, just a war-time sense that the public must be scared or reassured for their own good.

In February 2020, he warned that 20 per cent of Covid cases would require hospitalisation, a blunder (shared by many) that did more than anything to fuel the mass lockdowns of spring 2020. In March, Fauci criticised masks for the – accurate, it turns out – reason that face coverings don’t really do much other than make people ‘feel’ safer. He then said his real priority was saving masks for health workers. By summer, however, he had become a big masking fan. In May 2020, he said ‘I want to make it be a symbol for people to see that that’s the kind of thing you should be doing,’ By 2021, Fauci said that the bizarre practice of double masking was ‘common sense’.

At times, Fauci almost admitted that he was essentially making up health advice to manipulate the public into doing what he decided was best. For instance, when it came to herd immunity, Fauci said: ‘When polls said only about half of all Americans would take a vaccine, I was saying herd immunity would take 70 to 75 per cent… Then, when newer surveys said 60 per cent or more would take it, I thought, “I can nudge this up a bit,” so I went to 80, 85.

But Fauci’s biggest blunder probably wasn’t anything specific he said about masks, or infection rates, or vaccines. It was his broader failure to speak scientific sense when he had the visibility and credibility to at least try. He could have pointed out that cyclical lockdowns for years on end were ineffective and unworkable, but he never really did. He could have called out the hypocritical idea that the Black Lives Matter protests or riots ought somehow to be exempt from social distancing regulations because they were politically fashionable. But he didn’t.

Angry right-wingers now babble about arresting Fauci or suggest that his retirement is an attempt to dodge Congressional testimony after the midterms. Democrats, meanwhile, write mad children’s books about him. His fans and his enemies give him too much credit. In the end, Fauci didn’t actually create mask guidelines or impose lockdowns. He wasn’t doing any substantial work on creating or testing a vaccine. He just became the mascot for a kind of Covid mania. And he loved every second.




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