Covid-19 virus is constantly changing through mutation. According to the U.S. Center for Disease Control (CDC) new variants of the Covid-19 is not an unexpected phenomenon but is typical of a coronavirus such as Covid-19. Typically, variants emerge and disappear but in other cases they persist and may have unique characteristics which could be worse than the original covid-19 virus. Here are a few emerging variants that are of great concern to scientists around the world.
UK Variant- B.1.1.7– Identified in the fall of 2020 in the UK and also detected in December 2020 in the U.S., this variant may be associated with an increased risks of deaths. Additional studies are being done to confirm how severe this variant is and whether new vaccines can protect people from this variant. The primary mutation in U.K. was identified as N501. Recently this mutation has been complicated with detections of new strains of E484K found in parts of U.K. The N501 modification may create more complications as it is noted to enhance the binding of the covid-19 virus to the cell and may spread faster and more resistant to antibodies.
South Africa Variant- B.1.351-was detected in early October 2020 and subsequently per CDC was detected in late January 2021 in the USA. This is another potent variant resulting in a significant spike of covid-19 spread in South Africa. Early data indicates it is far more contagious (as high as 50%) then the primary covid-19 virus. This variant has an unusually high rate of mutations especially in the core point which is commonly referred as the spike protein. This is the point which the virus uses to attach to and ultimately infect human cells. Scientists have also detected two specific mutations in this variant (N501 and E484K) which are both highly transmissible. The N501 mutation in South Africa has common traits with the UK variant. The E484K mutation poses other concerns for the scientific community as it is known to have more resistant to antibodies that normally protect the population from the mainstream covid-19 infections. The E484K is also noted to change the shape of the “spike” protein thereby reducing the effectiveness of antibodies.
Brazil Variant-P1 was identified in January 2021. It has reportedly 17 unique mutations. Early data indicates that portions of Brazil where this variant has been widely detected such as in Manuas (the largest city in the Amazon region) is experiencing high degree of transmissibility.
The Brazil variant has also been identified in the U.S. at the end of January 2021. Another interesting research noted by scientists is that there are three main mutations observed in the Brazil variant. They are K417T, E484K, and N501Y. As noted earlier, the E484 and N501 are also detected in the South African and U.K. variant. Therefore, preliminary data suggest that this variant may have the same or closely similar affects as the U.K. and South African variants.
The 452R California variant was identified last year by local health officials. This variant has been responsible for a substantial spike in covid cases throughout California during the Christmas holidays. Scientists are noting high infection rate from this variant. In just one county (Alameda) they reported covid cases with variant 452R jumped from 3.8% to 25%. This variant was also identified in other areas of California such as Los Angeles and was responsible for a huge surge in covid cases. Further research is being conducted. As reported by UC San Francisco, multiple agencies are working to better understand the impact of this variant, including the effects of new vaccines in controlling this type of a variant.
New York variant
The New York variant B.1.526 was originally identified back in November’2020. Current research indicates that this variant has at least two mutations namely the E484K and S477N. Health scientists are taking this variant seriously. The E484K mutation (part of the South African and Brazilian variant) is a potent mutation known to evade vaccines. The S477N mutation is also of concern as it tightly binds the virus to human cells. According to Columbia University researchers the New York variant is widespread throughout the NY metro area. CDC is aggressively pursuing genomic surveillance research to examine viral genomics within the various regions of the United States.
How effective are Vaccines against these Variants?.
Since these variants were detected just a few months ago, there are no significant pier reviewed clinical studies or data that can provide scientifically proven response to their effectiveness. There are initial assessments however that may give us some possible clues. For example a recent Oxford study finds the AstraZeneca vaccine to be 75% effective against the new variant. Moderna, a U.S. based biotech company that recently introduced its covid-19 vaccine based on messenger RNA (mRNA) technology is also indicating positive response on emerging strains and variants. In fact, Moderna this week announced three different booster shots to combat these variants. Pfizer, another messenger RNA (mRNA) vaccine producer has also indicated a positive response against the new strains in in its initial in vitro study. Safety and efficacy are the two key aspects of these boosters to address these variants.
Another major player in the vaccine development is Johnson & Johnson (which has done more extensive clinical studies in South Africa) found its vaccine to be 57% effective. The company is doing additional research to seek alternative boosters against the new variants. Since the new variants are just coming out, additional clinical data must be collected to evaluate the effectiveness of the vaccines and supportive or enhanced boosters that might be needed to address the above three main variants or other variants of Covid-19 in the future. This is an ongoing challenge and is expected to continue for the next 2-3 years.
What we don’t know and where do we go from here
Even with the projected efficacy of new boosters or targeted vaccines on the new covid-19 variants we still do not know the effects of these treatments on various demographic and racial populations globally. Clinical studies are essential as to how new vaccines or modified boosters would be effective on these groups. In addition, we do not know as to how often people have to be administered with these vaccines or boosters. We have a long way to go before a stabilized system of controls can be globally understood. TexasCovid recommends clinical antibody studies of patients who have received the vaccines to determine how strong these vaccines are in terms of antibodies. This data needs to be collected over a long time period.
The pandemic is so far ahead of our ability to fight and therefore any solutions or alternatives may be outdated or ineffective due to emerging new variants. Due to these concerns, FDA is considering allowing vaccine manufacturers such as Moderna & Pfizer to proceed with boosters and modified vaccines without extensive clinical trials. As per their new directive (issued on Feb 22, 2021) the FDA recommendations include a speedy process for the manufacturers to develop modified covid vaccines. Essentially, FDA wants to speed up the process without detailed vetting due to the rapid spread concerns of these variants. The challenge for the scientists is to diagnose variants that are particularly transmissible and are showing ability to escape immunity.
What can we do with these uncertain times?
The only option for all of us is to not allow the replication of covid-19. Mutations of covida-19 only happens when we allow it to replicate. That requires us to first control the spread of the primary covid-19 disease by vaccinating the population and keep other mechanisms intact such as masking, social distance etc. Only then we can stay ahead of this novel virus.
By Syed Aman, MBA