There is light at the end of the COVID-19 tunnel, but the tunnel has gotten a whole lot more dangerous.
I'm talking about the relatively new UK variant of the virus, which is much more transmissible than other variants. Even though there is no evidence that it causes more severe disease, the increased transmissibility is much worse than increased lethality in terms of the number of additional people who will die or suffer long-term consequences.
Researchers at Imperial College London just posted a pre-print that goes over their research on B.1.1.7., which is the “user-friendly” designation for the new variant. We could call it the Brexit strain, UK Covid, or BoJo's revenge. Here is what we know.
B117 spread rapidly in southeast England from November 1 to December 15, going from under 10% prevalence to over 80% prevalence during that time. During this period, social distancing measures were in place, but schools were open. Other strains of the virus were more or less controlled or growing slowly during this time, but the variant strain was not, and in fact it was growing rapidly in residents under 19 years disproportionately.
The increased prevalence in genetic surveys corresponds with increased transmission rates in regional populations (in the UK). There are many other variants (mutations happen all the time) and even other variants that increase in prevalence, but the combination of increase prevalence and increased transmission tracking that increased prevalence is evidence of increased transmissibility.
The transmission is significantly higher than other strains both over time and when looked at within different geographic units. This means it is not a one-off random event where a strain emerged as numbers increased and the one had no effect on the other. On average, the B117 strain is 50-75% more transmissible than other strains.
The increased transmissibility is probably associated with two attributes of the strain that researchers have noted. First, the spike protein used to bind to human cells has a mutation that changes its shape slightly to bind even closer. Second, people with the B117 strain are observed to have higher levels of virus shed in the nose and throat. Either or both of these could contribute to the increased transmission rates.
The B117 variant has been confirmed in California and Colorado and shorthand methods of identifying the strain without full genomic characterization indicate it is spreading widely, and especially in Massachusetts, Florida, and Ohio. As it continues to grow, faster than other strains, it will likely become dominant and increase the rate of spread, even if social distancing practices are kept the same as they are currently. It may already be driving some of the patterns we are seeing in California.
The emergence of this strain, and the significant increase in danger that it represents, prompt a few observations.
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Mutations like this, which spread because the confer an advantage to the virus, are the inevitable result of the scale at which this virus has run wild. Keeping spread low until cures and vaccines are developed is intended to keep people alive first, but also to minimize the probability of the emergence of such strains. Some countries, using science and self-discipline, succeeded in doing so. Others essentially let it run out of control and provided the needed conditions for this worsening of the virus, which now spreads to the rest of the world.
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All of this work is currently in the pre-print stage, and some understanding and conclusions may change with further research and review. Nevertheless, because we are dealing with a virus spreading exponentially, action has to be taken now, on partial information, because waiting for the full story means waiting for it to be too late.
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Transmission among school-age children, at school, appears to have played a significant role in the spread of this variant. They are far less likely to die, but they do spread the variant back into the community and kill other people. The Imperial College team is quite clear that they do not believe that B117 can be contained without shutting down in-person instruction. Anyone who is arguing that in-person schooling needs to be resumed because of a low mortality rate in people <19 needs to rethink the role that children play in viral spread and evolution. Kids will rebound from less structured education for a year or two; the people killed by such ignorant thinking will not.
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Things that may have kept you safe from COVID-19 thus far may not be sufficient for B117. As long as one is interacting in spaces where there are other people or where other people have been who might be infective, there is a risk of exposure. Approaches that worked before have a greater chance of failing with greater viral loads and a slightly different viral structure. Now is the time to get a surgical mask or N95 mask if you've been using cloth. Any mask still helps, but to get us all through to the time when we have vaccinated our way out of this plague, even greater efforts will be necessary.
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Vaccines can be updated (if necessary) to address new strains but there needs to be robust and coherent vaccine delivery infrastructure. Unfortunately, the last week has taught us that the lame duck Administration's plan was, as it was before, to foist everything off on the states and blame the states for mistakes. That has to change, and it will, on January 21.