A SOUTH AFRICAN woman suffering from inadequately treated HIV, and who harbored COVID-19 for nine months saw the respiratory virus develop at least 21 mutations while in her body, according to a study.

Once the 22-year-old adhered to the anti-retroviral medication used to treat HIV and her immune system strengthened she was able to overcome the COVID-19 infection within six to nine weeks, the study, led by scientists from Stellenbosch and the University the University of KwaZulu-Natal showed. The research has not been peer reviewed.

The study adds to evidence that COVID-19 may mutate rapidly when harbored by immunosuppressed individuals, such as those not taking medication to treat HIV, and this may lead to the development of new variants. The beta variant, which the patient in the study was infected with, was discovered in South Africa, as was Omicron.

“This case, like others before, describes a potential pathway for the emergence of novel variants,” the scientists said, stressing that it was still a hypothesis. “Our experience reinforces previous reports that effective anti-retroviral treatment is the key to controlling such events.”

South Africa has the world’s biggest HIV epidemic with 8.2 million of its 60 million people infected with the virus, which weakens the immune system.

The coronavirus harbored by the patient in the study developed at least 10 mutations on the spike protein, which allows it to bind with cells, and 11 other mutations, the scientists said. Some of the changes were common to those seen in the Omicron and lambda variants while some were consistent with mutations that allow the virus to evade antibodies. — Bloomberg

AS RESIDENTS prepare for another Chinese New Year under COVID-19 restrictions, Omicron seems to have gotten the better of the city’s defenses, with a record number of new and untraceable infections.

Though the city has beaten back four previous waves of infection, returning to no COVID cases will be much harder this time, given it is facing Omicron, the most infectious and immune-evasive of variants.

“The horse has bolted, and I don’t think that the government is going to be able to get on top of this,” said David Owens, a family medicine specialist and honorary clinical assistant professor at the University of Hong Kong, where he has collaborated on COVID research. “This disease is just too transmissible.”

Chief Executive Carrie Lam is unlikely to give up completely on efforts to eradicate the virus while Chinese President Xi Jinping adheres to that policy in the mainland, but her government can’t deploy the blunt tools that China has used to lock down millions of people in cities like Xi’an and Tianjin.

The measures Hong Kong has deployed so far, including lockdowns of apartment buildings, closures of schools, restaurants, gyms and cinemas, and vaccine mandates, are already straining the limit of the city’s resources.

Without the ability to escalate measures, as China has done, or to back away from the COVID-Zero goal, as Singapore, Australia and others have, Hong Kong has no clear path forward.

“There is no way for a full-city lockdown to be sustained for any appreciable period to allow termination of transition links,” said Leung Chi-chiu, a former chairman of the Hong Kong Medical Association’s advisory committee on communicable diseases, adding that Hong Kong doesn’t have the testing capacity or community infrastructure for mainland-style lockdowns. “Without these, we will die faster than the virus,” he said.

HIDDEN CHAINS
While the city’s outbreak is minuscule by global standards, with fewer than 14,000 infections and just 213 deaths throughout the pandemic, Hong Kong on Jan. 27 set a record, with 164 new cases.

“It’s certainly not a situation that would give us the comfort or the assurance that it is under control,” Lam said at a briefing on Jan. 27. “We are expecting that, any time, we could have an exponential increase in cases and it could give rise to a massive community outbreak.”

Hong Kong has more than a dozen hidden chains of transmission silently spreading the pathogen, and government adviser David Hui estimated there are 90 untraceable cases.

Unlike former COVID-Zero stalwarts like Australia and Singapore, Hong Kong has resisted trying to get to some semblance of herd immunity through a combination of natural infection and vaccinations, since that would jeopardize Lam’s goal of reopening the border with mainland China.

Moreover, with just under half of people over 70 years old vaccinated, widespread infection would lead to soaring hospitalizations and deaths.

“We do not possess the prerequisites for living with the virus because the vaccination rate is not good, especially amongst the elderly,” Lam said. “I could not stand seeing a lot of old people dying in my hospitals.”

Officials instead are pursuing what they call “Dynamic Zero,” an approach that emerged from China and aims to work toward no new infections while acknowledging some may still occur.

A silver lining of the Omicron outbreak is that it’s giving Lam’s government the political backing to push much harder with vaccine mandates. The city will require vaccines for residents of nursing homes and from late February will ban most unvaccinated people from restaurants, gyms and bars.

“Zero-COVID is to buy time for boosting the vaccination rate, especially for high-risk groups,” said Lam Ching-choi, a doctor who is a member of the Hong Kong leader’s advisory Executive Council. “The recent trend is quite promising.”

There’s been a jump in pace since the Omicron outbreak, though Hong Kong’s vaccination levels especially among the elderly remain one of the worst of developed economies. About 80% of people 12 and above have received at least one shot, and officials have said the government won’t consider easing current restrictions until 90% of them are vaccinated.

The vaccination rate among people 80 and above is now at 31%, up from 19% in December.

The restrictions have battered Hong Kong’s reputation for openness and frustrated business lobby groups.

People returning from eight countries including the US, UK and Canada are banned until at least mid-February. Thousands of residents were locked inside their public housing apartments for days and officials have even euthanized several thousand hamsters after a Delta case in a pet store.

Hong Kong could make the decision to shift away from the zero-tolerance approach and accept some community spread, said microbiologist Siddharth Sridhar, an assistant professor at the University of Hong Kong. Unlike Singapore, which abandoned Covid Zero just before getting hit with the Delta wave, he said, Hong Kong could make the change when the less virulent omicron variant is dominant, which might ease pressure on the health-care system.

“We can potentially do this in quite a safe way,” he said. “It will take a lot of planning but it’s not a bad position to be in, honestly.”

However, after more than two years of focus on keeping daily cases at or near zero, officials haven’t communicated any clear exit plan for the pandemic, and it’s unlikely that Lam’s government can formulate one without Beijing’s sign-off.

With China firmly wedded to COVID Zero, the city’s health authorities will likely focus on more testing and lockdowns, said Nicholas Thomas, an associate professor at the City University of Hong Kong who has edited several books on pandemics and politics. He added that having a large number of people inoculated with the less-effective Sinovac Biotech Ltd. vaccine is an additional hurdle.

“The political decision to pursue zero-Covid above the realities on a globally-endemic virus leaves no room for any sort of policy innovation that would allow Hong Kong the space to live with the virus,” he said.  — Bloomberg