COVID “Mega-variant” and eight criteria for a template to assess all variants

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By Daniel R. Lucey MD, MPH, FIDSA

Building on the Dec. 22 South African variant may be worse than UK variant: A template is needed for the variants to come post here, the following eight criteria are proposed to help create a template to assess the many variant SARS-CoV-2 viruses already found and those to come.

These eight criteria will need to be better quantified as more data becomes available after a variant is identified, and then determined whether it is a “variant of concern,” depending on assessment of these criteria (and likely more).

If all these possible criteria are met, then the term “mega-variant” is proposed.

The eight criteria are:

  1. More deadly: in adults and/or children (degree of increase to be quantified)
  2. More contagious (degree of increased transmissibility to be quantified)
  3. Re-Infections are frequent: by epidemiologic and/or virologic evidence
  4. Vaccine escape mutants (partial loss of vaccine efficacy to be quantified)
  5. Monoclonal antibody escape mutants
  6. Increased risk of “long-COVID”
  7. Increased risk of Multisystem Inflammatory Syndrome in Children: “MIS-C”
  8. In the future, when specific antiviral drugs (not antibodies or immune modulators) are proven to decrease mortality are found, then this #8 will be resistance to one or more of these (future) drugs.

Dr. Daniel Lucey

Daniel Lucey, M.D. MPH, FIDSA, FACP, is a Clinical Professor of Medicine at Dartmouth Geisel School of Medicine, Infectious Disease adjunct Professor at Georgetown Medical Center, senior scholar at Georgetown Law, Anthropology Research Associate at the Smithsonian Museum of Natural History and a member of the Infectious Diseases Society of America Global Health Committee. He served as a volunteer to outbreaks overseas including hands-on Ebola patient care in Sierra Leone and Liberia (Doctors without Borders) 2014, MERS 2013, SARS 2003, as well as HIV, H5N1, Zika, yellow Fever, and pneumonic plague 2017 (with WHO/USAID/CDC).  Since Jan. 6, 2020 he has contributed over 75 posts to Science Speaks on COVID-19 and traveled to China in February 2020. He initially proposed, then fundraised and helped design the content for 2018-2022 Smithsonian Exhibition on Epidemics due to zoonotic viruses. From 1982-1988 he trained at University of California San Francisco and Harvard and was an attending physician at the NIH (NIAID) in the 1990s while in the US Public Health Service.

2 thoughts on “COVID “Mega-variant” and eight criteria for a template to assess all variants

  1. Kathryn Love M.D.

    I am not seeing anything in medical news feed that addresses how these variants will affect the sensitivity of our tests. Please comment

  2. Julio Arroyo

    A “mega variant” would likely be equivalent to a recombinant virus, if so, its identity should be based primarily on its RNA code. There are just too many variables influencing the virus-host interaction, the end result of such interactions may vary by demographic, nutritional, co-morbid and pharmacological factors.


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