How Infection Preventionists Should Approach COVID Variants

In the past few months, we’ve identified four new variants of the SARS-CoV-2 virus that causes coronavirus disease 2019 (COVID-19). Identified in the United Kingdom (B.1.1.7), South Africa (1.351), Brazil (P.1), and Denmark (L452R), these variants have been an added concern to an already stressed health care and public health systems.

Genomic surveillance is not exactly a strong suit in the United States and as we work to rapidly upscale these efforts, in many ways we’re flying blind when it comes to understanding the true prevalence of novel or emerging strains.

Saskia v. Popescu, PHD, MPH, MA, CIC

Ultimately, what we are seeing is that some variants, B.1.1.7 for example, has increased transmission capabilities, meaning that the variant is more adapt and more efficient at spreading between people. The good news is that these new variants do not appear to be causing more disease or impact the routes of transmission. As the Centers for Disease Control and Prevention (CDC) notes, “Rigorous and increased compliance with public health mitigation strategies, such as vaccination, physical distancing, use of masks, hand hygiene, and isolation and quarantine, will be essential to limiting the spread of SARS-CoV-2 and protecting public health.”

For most of us working in infection prevention, none of this is particularly new—we’ve been reading up on it and trying to address the infection prevention aspects of it for weeks. Emphasizing that something is more transmissible but that the route of transmission is the same is particularly challenging, especially as we’re continuously getting new information in.

Truly, what these new variants drive home is that many are likely in circulation well before we realize it, so continued infection preventions are critical. More than just continued efforts, but really, vigilant. After 13 months of a pandemic, we are all fatigued. Health care workers especially are exhausted and continuing personal protective equipment (PPE) and all the other critical pieces to preventing COVID can be tough both at work and outside the health care setting. So how do we address novel variants in a moment of shear fatigue and frustration?

First, the attention and concern around these variants is hard to miss. This means that it’s important to get ahead of the misinformation or fear. Touching base with your microbiology lab to ensure there’s no concern for impact to testing efficacy is important as this is often a question. Second, how can we disseminate adequate information widely? Starting with our COVID-19 response teams and working it into rounding communication strategies can be effective.

For many of us, an internal webpage on COVID-19 information has been helpful too, so developing a one-page information sheet (with links to the CDC page) is also helpful to refer people to. Perhaps one of the most important pieces though, is building trust and this means acknowledging that we’re still learning more. There are pieces of novel variants that we’re still learning about, like the impact to therapies and how these variants might impact what we know about COVID-19, like reinfection. Being transparent about these unknowns is important but that doesn’t diminish what we do know – existing prevention strategies are effective. Ultimately, if we continue with vigilant infection prevention efforts this can combat when novel strains are circulating and before we understand the full picture. Preemptive and continued prevention efforts help us respond to emergent strains before we even realize what we’re dealing with. Fundamentally, it’s the continued efforts we need to focus on – practice makes permanence.