Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2023 Apr 10;15(4):944.
doi: 10.3390/v15040944.

Evolution of SARS-CoV-2 Variants: Implications on Immune Escape, Vaccination, Therapeutic and Diagnostic Strategies

Nur Zawanah Zabidi  1 , Hern Liang Liew  1 , Isra Ahmad Farouk  1 , Ashwini Puniyamurti  1 , Ashley Jia Wen Yip  1 , Vindya Nilakshi Wijesinghe  1 , Zheng Yao Low  1 , Julian W Tang  2 , Vincent T K Chow  3 , Sunil K Lal  1   4
Affiliations
Review

Evolution of SARS-CoV-2 Variants: Implications on Immune Escape, Vaccination, Therapeutic and Diagnostic Strategies

Nur Zawanah Zabidi et al. Viruses. .

Abstract

The COVID-19 pandemic caused by SARS-CoV-2 is associated with a lower fatality rate than its SARS and MERS counterparts. However, the rapid evolution of SARS-CoV-2 has given rise to multiple variants with varying pathogenicity and transmissibility, such as the Delta and Omicron variants. Individuals with advanced age or underlying comorbidities, including hypertension, diabetes and cardiovascular diseases, are at a higher risk of increased disease severity. Hence, this has resulted in an urgent need for the development of better therapeutic and preventive approaches. This review describes the origin and evolution of human coronaviruses, particularly SARS-CoV-2 and its variants as well as sub-variants. Risk factors that contribute to disease severity and the implications of co-infections are also considered. In addition, various antiviral strategies against COVID-19, including novel and repurposed antiviral drugs targeting viral and host proteins, as well as immunotherapeutic strategies, are discussed. We critically evaluate strategies of current and emerging vaccines against SARS-CoV-2 and their efficacy, including immune evasion by new variants and sub-variants. The impact of SARS-CoV-2 evolution on COVID-19 diagnostic testing is also examined. Collectively, global research and public health authorities, along with all sectors of society, need to better prepare against upcoming variants and future coronavirus outbreaks.

Keywords: COVID-19; SARS-CoV-2; coronaviruses; diagnostic testing; genetic variants; sub-variants; therapeutic approaches; vaccine evasion.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

References

    1. Worldometer COVID-19 Coronavirus Pandemic. [(accessed on 25 March 2023)]. Available online: https://www.worldometers.info/coronavirus/
    1. Hu B., Guo H., Zhou P., Shi Z.-L. Characteristics of SARS-CoV-2 and COVID-19. Nat. Rev. Microbiol. 2021;19:141–154. doi: 10.1038/s41579-020-00459-7. - DOI - PMC - PubMed
    1. Ludwig S., Zarbock A. Coronaviruses and SARS-CoV-2: A Brief Overview. Anesth. Analg. 2020;131:93–96. doi: 10.1213/ANE.0000000000004845. - DOI - PMC - PubMed
    1. Liu S.T.H., Lin H.-M., Baine I., Wajnberg A., Gumprecht J.P., Rahman F., Rodriguez D., Tandon P., Bassily-Marcus A., Bander J., et al. Convalescent Plasma Treatment of Severe COVID-19: A Propensity Score–Matched Control Study. Nat. Med. 2020;26:1708–1713. doi: 10.1038/s41591-020-1088-9. - DOI - PubMed
    1. Low Z.Y., Yip A.J.W., Lal S.K. Repositioning Ivermectin for COVID-19 Treatment: Molecular Mechanisms of Action against SARS-CoV-2 Replication. Biochim. Biophys. Acta BBA—Mol. Basis Dis. 2022;1868:166294. doi: 10.1016/j.bbadis.2021.166294. - DOI - PMC - PubMed

Publication types

Supplementary concepts