Not Quite Over Yet: COVID-19 Variants on Rise in the U.S.

As the United States emerges from the COVID-19 pandemic, nobody really wants to hear (and few media outlets report) that the rapid emergence of immune escape COVID-19 variants pose a clear and present danger of a setback. Over three weeks, the percentage of genomic testing which was comprised of the Indian Double Mutation Variant, or Delta Variant, jumped from 1% to 7% in the U.S. The data was derived from Outbreak.info, a website operated by Scripps Research and funded by the NIC, the Centers for Disease Control and Prevention (CDC) and National Center for Data for Health. (The data are obtained from the World Health Organization’s (WHO) Global Influenza Surveillance and Response System (GISRS) Initiative.) The site contains the most up-to-date information and has state specific data. The site also reports that as of May 27 the Brazilian or Gamma Variant currently comprises 14% of the genomic sequenced specimens in the U.S.

Kevin Kavanagh, MD

There has been little coverage by the U.S. news media about these emerging variants in the U.S. In the United Kingdom, despite having less than twenty COVID-19 deaths per day, there has been consideration of delaying fully reopening. In regions where the Delta Variant is spreading, advisements have been made to continue to meet outdoors if possible, minimize travel, work from home, abide by social distancing, and for the entire population in the affected region to be tested twice a week. The strategy of frequent and blanket testing of the whole population is in stark contrast to the lackadaisical approach the U.S. has undertaken regarding these variants.

The best defense against immune escape variants is to become fully vaccinated. It requires 2 doses of the Pfizer or Moderna vaccine to provide protection. Remember, the vaccines were based on the wild type of virus and not the immune escape variants, so the plan is to boost your antibodies and immune response to a very high level.

Immunity from a previous infection may not provide protection from reinfection with an immune escape variant. In the city of Manaus, Brazil, a second wave by the Gamma Variant crushed the city after it was felt to have reached herd immunity. Studying blood donations, researchers have recently reported that 1 in 6 infected in Manaus with the Gamma Variant were previously infected with the wild type or original virus.

Source: Outbreak.info

Thus, even if you have already had COVID-19 you still should be vaccinated. There is ongoing research to determine if a single vaccine dose may suffice, but until this is known for sure, it is recommended that a full vaccination protocol is followed. It has been shown that two doses of a mRNA vaccine will “rapidly induce a much stronger and broader Ab response than SARS-CoV-2 infection”. And initial reports have found that two doses of the mRNA vaccine offers protection against both the South African (Beta) and Delta Variants.

Finally, we are flying blind in the U.S. when it comes to the variants. The samples which the U.S. sequences are often from high-risk patients and not necessarily samples from the community, to track spread. Over the last 60 days, Outbreak.info has reported 5800 viral sequences out of approximately 3 million COVID-19 infections in the U.S. This represents only 0.2% of all cases. We should be sampling at least 5% of all COVID-19 cases to adequately track the spread and emergence of variants.

We also must not set the measure of public health success at survival. Too many patients with COVID-19 are developing long-hauler’s syndrome. This has even been reported to occur in 10% to 30% of patients with mild to moderate disease. And although our current mRNA vaccines can prevent the majority of severe COVID-19 cases and deaths caused by immune escape variants, it is unknown if they will prevent long COVID from developing in those who have mild to moderate infections.

As long as the immune escape variants are on the rise in the U.S. and less than half of our population is fully vaccinated, the best advice is to continue public health strategies. Similar to the U.K., this could be a regional advisement, but unfortunately, we are not sequencing nearly enough infections to accurately track the spread of these variants.

And above all, we need to have everyone become vaccinated. That is the best way to stop the spread of the virus and help mitigate the possibility of a truly vaccine evading mutation from occurring.