COVID-19 Variants Make Infection Prevention Harder

Coronavirus disease 2019 (COVID-19) continues to hammer the United States. Just a few months ago, our current death rate and impending collapse of our healthcare system in many regions, would have been unimaginable. During Operation Warp Speed we saw a light at the end of the tunnel. We were expecting 20 million citizens to be vaccinated by the end of the year. Prior to that, I was even hoping for a much higher number. But the promised doses and preparation did not come to fruition. We distributed just over 12 million doses and have administered under 3 million vaccinations.

Many health departments are understaffed. In one Kentucky Public Health District, staffing has been cut almost in half over the last decade. Our stressed healthcare system has an inadequate infrastructure to administer the initial vaccine dose, let alone doubling the effort to administer the second dose.

Kevin Kavanagh, MD

Hence, there is discussion of only giving a single dosage or delaying the second dose of the vaccine. Delaying the second dose has been implemented in the United Kingdom, despite the objections of the British Medical Society. In the United States, there is also discussion regarding this strategy. Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases (NIAID), has voiced opposition, but there is a new push for it, possibly in the young. Of course, there is no solid data to indicate this strategy will be effective or safe. Pfizer has also stated that data is lacking for single-dose vaccinations.

Another emerging strategy is to cut the first dose in half for younger individuals. After a yearlong mantra that antibodies do not predict immunity, the justification is given that: “Earlier data showed that binding and neutralizing antibody responses were similar among participants under 55 who received either 100-microgram or 50-microgram doses.”

But no one can tell for sure if there will be significant memory cells generated or how long the immunity will last. Multiple past studies have observed that immunity may well be linked to the strength of the severity of infection, or initial immunological challenge.

Another problem with giving the young a lower vaccine dose, is that we will soon be dealing with a new viral strain, which appears to be taking on some of the characteristics of the 1918 flu. This strain is affecting more of the young. The strain also appears to be over 50% more transmissible. Neil Ferguson, a professor at the Imperial college stated: “Social distancing measures that worked against earlier strains of the virus were insufficient to control the spread of the new variant.”

Let us not forget that the young can become severely sick with SARS-CoV-2 and develop long-lasting disability. Myocarditis is becoming an even more important concern. Initial reports from Ohio State University, which found that 15% of college athletes who tested positive for the coronavirus, went largely unheeded. Now with the collapse and hospitalization of the SEC Preseason Player of the Year, Keyontae Johnson, from what appears to be myocarditis post COVID-19 infection, maybe the risks of COVID-19 in the young will be taken more seriously.

A more infectious virus which increasingly targets the young does not bode well for the non-scientific strategy of herd immunity and somehow protecting those at risk. We have gone from 50% of the adult population at risk for COVID-19 to possibly everyone.

As many in our population continue to ignore public health advice, the virus has been spreading and mutating, becoming more difficult to contain. Supplementing the staff and resources of our health departments is of utmost importance, possibly with the national guard. We need to be testing and vaccinating 24/7.

Infection preventionists are key in our fight to stop the virus. They need to spread the message and articulate the uncertainties of this new viral strain. They need to emphasize that it is just not the old who are at risk and employ stricter containment measures, making sure that N95 masks are available and there are ample complete air exchanges in buildings with air sanitization. Renewed attention also needs to be placed on transmission by fomites. Wiping down surfaces is of utmost importance since the primary mechanisms of spread of the new strain may also include surfaces.

For the public, a renewed emphasis needs to be placed on surface spread and social distancing, greater than 6 feet. This includes outdoor activities where the cold, dry air and cloudy skies may well promote the spread of the virus.

We are in for a rough few weeks. The good news is that the vaccine should still work, and we know how to stop the spread of this virus. It is up to us, and infection preventionists need to lead the way.