Hot Topics in Infection Prevention: Uganda Declares Ebola Outbreak Over, and “Kracken” Subvariants of COVID-19

Saskia v. Popescu, PhD, MPH, MA, CIC

Uganda Declares Ebola Outbreak Over!

Very good and exciting news – the outbreak of Ebola Sudan has officially been declared over in Uganda. Four months of containment efforts helped keep the cases at 143 and deaths at 55. First identified in September, this is the eighth outbreak the country has experienced since 2000. The director-general of the World Health Organization (WHO), Tedros Adhanom Ghebreyesus, “praised Uganda for its response to the virus. ‘Uganda has shown that Ebola can be defeated when the whole system works together, from having an alert system in place, to finding and caring for people affected and their contacts, to gaining the full participation of affected communities in the response,’ he said in a statement.”

Ebola outbreaks will continue to occur, stressing public health efforts, but the capacity for rapid response and international support speaks to our increasing skills in containment and collaboration.

What’s Going on With COVID-19?

We couldn’t have a “Hot Topics in IPC” without addressing the coronavirus in the room, right? As January is in full swing, it appears we may have avoided a harsh COVID-19 surge this winter. I’m surprised, as I think so many infection prevention specialists were, given the lax public health restrictions and sluggish desire for boosters. Cases are currently down 2% in the United States within the last 2 weeks, with a daily average of 63,000 cases. Test positivity is up 8%, hovering around 15%, and roughly 46,000 people a day are hospitalized with COVID-19 in the US, which is an increase of 12% in the last 2 weeks.

Immune system evasion and a high transmission capacity mean that scientists are closely watching XBB1.5.

Frustratingly, deaths are higher, sitting at 555 per day, which is an increase of 61%. If we look at a state-by-state example, Florida is seeing a spike in cases and is up by 90%, whereas California’s cases are down 33%. The US is a patchwork of both dropping and rising cases, with some states showing improvements. Washington, DC had a 53% decline in cases, whereas Alaska is experiencing an increase and has seen a 43% rise in cases.

Many conversations in the media and infection prevention circles have centered around the latest variant–a subvariant of Omicron called XBB1.5, which some individuals have dubbed “Kracken,” which isn’t very scientific. While XBB1.5 is rapidly spreading and is considered to be very transmissible, we’re still learning about how this new subvariant will behave. “By contrast, XBB.1.5’s defining feature and its main difference from XBB is a spike protein mutation known as F486P. This mutation gives XBB.1.5 a significant advantage, boosting infectivity while retaining XBB’s ability to sneak past human defenses. In other words, it’s less of a trade-off and more of a turbocharge.” Immune system evasion and a high transmission capacity mean that scientists are closely watching XBB1.5.

However, much of the hysteria is unnecessary and should be met with skepticism—including calling the subvariant “Kracken.” While it is a worrisome variant, it’s not one that entirely evades our immune system. As Jacob Stern noted, “For Stephen Goldstein, an evolutionary virologist at the University of Utah, the new names are not just unnecessary but potentially harmful. ‘It’s absolutely crazy that we’re having random people on Twitter name variants,’ he told me. For Goldstein, dressing up each new subvariant with an ominous monster name overplays the differences between the mutations and feeds into the panic that comes every time the coronavirus shifts form. In this view, distinguishing one Omicron sublineage from another is less like distinguishing a wolf from a cow and more like distinguishing a white-footed mouse from a deer mouse: important to a rodentologist but not really to anyone else.” In short, if “Kracken” is on the brain, perhaps turn to Clash of the Titans rather than the latest COVID-19 news.

P.S. Did you listen to music during COVID-19 lockdowns? Odds are, you had an improved mood!