“IT’S THE first time I’ve been concerned,” said Harvard immunologist Barry Bloom, in response to recent reports of the new coronavirus variants. “I’m now quite worried about them.”
Experts are wavering on earlier contentions that this coronavirus couldn’t mutate fast enough to evade existing vaccines and treatment drugs. Perhaps most indicative of new concerns, the manufacturers of the two vaccines available in the U.S., Moderna and Pfizer/BioNTech, have begun researching booster shots as well as ways to modify their vaccines.
The result is a race against time between a mutating virus—which is becoming both more infectious and more lethal—and the combined efforts of widespread vaccinations and public policy mitigation, like mask wearing. The resulting suspense is compounding already-high stress levels of the pandemic.
On mask wearing, the increased contagiousness of virus variants has led experts in the U.S. and elsewhere to recommend or require more protective options. U.S. infectious disease expert Anthony Fauci calls for double-masking—the more layers, the better, with the first layer being the most protective, such as N95 or KN95. Germany requires medical-grade (N95 or other surgical) masks in public.
“I think the next three months could be the worst part of the pandemic,” said Michael Osterholm, infectious disease specialist at the University of Minnesota. “I hope I’m dead wrong.”
[The threat from variants is] “what makes this moment dangerous,” writes Ezra Klein. The B.1.1.7 variant of coronavirus, first seen in Britain and now spreading throughout Europe, appears to be 30 to 70 percent more contagious, and it may be more lethal, too. It hit Britain like a truck, sending daily confirmed deaths per million people from about six per million in early December to more than 18 per million today.”
At the same time that hopes are rising as more people receive vaccinations, and as both numbers of cases and deaths decrease, the variants are heightening fear—specifically that the more contagious and thus more deadly British variant B.1.1.7. could overtake all other strains in the U.S. by March.
This yo-yo of hope and fear increases pressure to tolerate what’s known as cognitive dissonance—simultaneously keeping track of two conflicting ideas. As F. Scott Fitzgerald wrote in his 1936 essay “The Crack-Up,” according to Quartz: “the test of a first-rate intelligence is the ability to hold two opposed ideas in the mind at the same time, and still retain the ability to function.”
“Furious urgency” is what public health expert Ashish Jha at Brown University says is needed for the vaccination effort to stay ahead of the mutations, writes New York Times columnist Michelle Goldberg, who urges that the U.S. raise its vaccine goal to two million/day versus the current 1.5 million/day. By the middle of last week (January 27), only seven percent of the U.S. population had received both doses.
Meanwhile, the U.S. is “43 in the world” in its ability to monitor genetic variants, according to recently appointed Covid-response coordinator Jeffrey Zients. While creating a nationwide genetic monitoring system could cost millions of dollars now, future savings could be high both in costs of caring for sick people and in preventing untold numbers of deaths. Having the world’s worst outbreak makes the U.S. the world’s largest breeding ground for mutations. As the virus copies itself millions of times in each infected person, mistakes can happen—meaning that higher numbers of infections create more opportunities for the circulating virus to pick up more mutations more quickly.
The coronavirus genome is “a twisted strand of nearly 30,000 ‘letters’ of RNA… genetic instructions [that] force infected cells to assemble up to 29 kinds of proteins that help the coronavirus multiply and spread,” write Jonathan Corum and Carl Zimmer in the New York Times.
Mutations in the new variants can make the virus more easily transmissible by keeping protective antibodies from binding to it—or by making the virus “stickier” as it attaches to our cells.
Any mutation that allows the virus to infect more cells can make the infection more dangerous. British epidemiologist Neil Ferguson of Imperial College said there was a “realistic possibility” that the British variant could be 30% more lethal than the original version of the coronavirus—although in the absence of good data, that risk could be anywhere from zero to 65%.
Meanwhile, the South African variant B.1.351, which has been slow to reach the U.S., has appeared more adept at dodging antibodies created by the Moderna vaccine—resulting in a six-fold reduction in the antibodies’ effectiveness—as well as at reducing effectiveness of the soon-to-be-available Johnson & Johnson vaccine. As of last week, infections from the Brazil variant had just appeared in the U.S.
(Although the Johnson & Johnson vaccine appears to provide lower protection than the two currently in use in the U.S., its 66% effectiveness may be more a reflection of the strengthening of the variants because tests for this vaccine took place in areas of the world where the virus was already changing, as with the still-experimental Novavax vaccine, which had 89% effectiveness in Britain but less than 50% in South Africa.
Most recently in the U.S., a new homegrown variant, CAL.20C, is burgeoning in California and is likely responsible for the surge of cases in L.A. county. It has since appeared in New York and the DC area, as well as in Oceania. While much remains unknown about this variant such as its lethality or whether current vaccines will be effective against it, scientists suspect it is more contagious than existing strains.
Finally, coronavirus variants may pose problems for the new monoclonal antibody drugs, delivered intravenously, because the precise design that makes them so effective against the original virus could be exactly what makes them a poor match against the variants.
On the other hand, a very old drug, colchicine—conveniently administered by tablet—has proven to reduce the need for hospitalization by 25 percent, the need for mechanical ventilation by 50 percent and the risk of death by 44 percent.
Also on the good-news side, vaccines cause a “cushion effect,” a powerful immune response that remains protective even when the antibodies they created have diminished power against the new variants, according to Fauci. In addition to neutralizing antibodies, that immune response involves T cells, memory B cells and a host of other so-called “effectors.”
Well-Being Editor Mary Carpenter keeps us updated on Covid-19. To read more of her posts, click here.