HERE'S TO YOUR HEALTH: COVID-19, new variants and new vaccines
I'll use this column to discuss the new variants of Covid-19, as well as the newer vaccines that we will be seeing in the weeks ahead.
The three main variants you may have been hearing about are the UK (England) variant, the South African variant, and the Brazil (P1) variant, which were found roughly in that order. We have seen all three in the US, and all three are likely to be already spreading here. Although travel bans have been put in place, they will likely only serve to slow the spread by a little bit, initially.
The fact that there are new variations of the original virus is not surprising. Viruses have survived long term by mutating, and we see this frequently in the influenza (flu) virus. Small mutations occur every few years, requiring changes in the flu vaccine. Scientists expected changes, and there may have been a change in the virus that originally came to the US. “Our” virus matched more closely with the Italian version than the original Wuhan virus, suggesting that the main virus that came to New York initially came from Europe.
The UK variant appears to be 30% - 50% more contagious than the original US virus. It possibly is more deadly—the data are not clear on that yet. I expect, because it is more contagious, that it will ultimately become the dominant strain here in the US. So far, the vaccines that are available seem to work against this strain as well.
The South African virus has the same mutation as the UK variant, plus two additional mutations. These mutations make it able to somewhat “dodge” antibodies. This means that someone who has previously had Covid could then be infected by a virus with this mutation and become sick again. It also would mean that it could also dodge antibodies created by one of the vaccines.
The Brazil variant may be the most worrisome. It showed up in a city in the Amazon region (Manaus) which had already been hit hard by the original Covid virus (described as one of the worst outbreaks in the world). There were some estimates that 76% of the population had been infected with Covid, which should have caused “natural” herd immunity. About seven months later, there was, suddenly, a much larger and swifter second wave. It was found to be the P1 variant. This possibly could mean that “natural” Covid antibodies only last six months, but it also could mean that P1 is more infectious, and/or able to dodge “natural” antibodies (in this case, “natural antibodies” are antibodies caused by getting the disease). Also, the estimate of 76% may possibly have been way off and there was no herd immunity. In any case, the city's healthcare system was overwhelmed with this second wave within 24 hours. This variant of the virus, however, still requires much more study.
Vaccines vs. variants
How are the vaccines doing with protecting against these variants? Both Moderna and Pfizer vaccines seem to be doing well, though not quite as well as they were against the original virus. Both companies are working on a “booster shot” to cover against the variants (but, of course, that will mean a third shot).
You also will be hearing about the Johnson & Johnson vaccine. It has several advantages. It can be stored in a refrigerator, it is a one shot vaccine (so more people can be vaccinated), it is cheaper, and for those who are fearful of new technology, this technology has been used previously in vaccines. It's disadvantage: it is 57% effective against the South African strain of the virus, and 72% effective against the original Covid-19 (compared to 95% for Moderna and Pfizer). While that sounds worrisome, it is important to note that these percentages are about the prevention of getting the disease. The more important (and more serious) endpoints are: Does it keep you out of the hospital? and Does it prevent dying? The answer to both of these questions is “Yes!” — even for the South African strain. Like the previous two vaccines it works well in people over 65. It also seems to have fewer side effects, with most people having none at all.
So, it looks like we are going to have Covid and its variants with us for a while. It may end up being similar to the flu in one way — you may need to get a shot every year.
The one piece of good news; no matter what variant comes down the pike, no matter how lethal or infectious, and whether or not you get the vaccine, there are tools to keep you safe. Say it with me ... socially distance, wear a mask, wash your hands, and don't gather in large groups — it does work. Here's To Your Health!
Dr. Wayne S. Strouse, M.D., is a family doctor in Penn Yan.