This post is a request (hi Morgan)! We’ll be talking variants because, given the coverage they’ve received, there seemingly would be millions of reasons to be worried. I want to say to you right now, though: caution is of the essence, but the larger picture is quite hopeful indeed.
Variants
1. Resources
Variants are super confusing, so I found you a video made by the Wall Street Journal, it’s brilliantly made, and it explains how mutations on the spikes that constitute the crown that gives the coronavirus its name can render it more or less infectious. That’s the first thing you should watch. Go on, I’ll wait.
I’ve quit and resubscribed to NYTimes countless times because uuugh, but they’ve also made themselves indispensable with all these damned Covid trackers:
they’ve got one for cases / hospitalisations / deaths for every country in the world, it seems;
they’ve got another one for vaccines (glorious);
now they’ve got one for variants.
Hard to top that level of science coverage in the mainstream, but would we expect any less from an effort led by Carl Zimmer? No. No, we wouldn’t. It’s almost irritating.
You’ll see in both these resources graphics of the spike protein that shows the spikes and proteins and what they look like in the various versions — variants. One thing you may have heard, but bears repeating is that when the same change occurs independently in different lineages, virologists start to worry because convergence often points to an evolutionary advantage. If the same mutation starts showing up in different corners of the world, the virus may have found a better way to spread.
2. Real talk
It’s very hard to talk about variants, in large part because whilst experts are able to identify them and to see how they move through the population, it’s not obvious why their behaviour appears to be so different from that of historical strains. This is a reason I didn’t discuss them in detail before.
Those in the know at this point are doing little more than speculate: do they latch on to cells better? Do they require a smaller viral load? Do they cause longer infections, thereby giving the host more time to expose others? Do patients shed viral particles in higher numbers? All these are working hypotheses.
What we do know is that the variants we know best (U.K. B.1.1.7, South African B.1.351 and Brazilian P.1) do not seem to be more lethal than previous versions, only better at jumping from person to person.
So then the question becomes: can they evade immunity and cause reinfection? Brazil’s P.1 rang alarm bells on this front. Here’s what happened: after the first wave in April, the virus was estimated to have infected between 66% and 75% of the city of Manaus in the Amazon. Some experts went “Woohoo, herd immunity!” (don’t get me started). Ten months later, there was a new surge, which was so much worse it caused hospitals in that area to run out of oxygen. Whilst there was no systematic sequencing of variants there, they did identify the P.1 variant amongst the cases.
Meanwhile, experiments showed the South African variant carried mutations that made it possible for it to evade specific antibodies. The Brazil variant carries similar mutations (see resources above), which means specific antibodies probably cannot neutralise it as well as the “original” version of the virus.
Lately, in the U.S., they identified a group of seven new variants with the same mutation — they named them after birds. Remember the problem with convergence (see resources above)? Virologists don’t know what this new mutation does yet, but it is troubling. Now they’re just going to have to track their behaviour.
Lastly, a couple of (unreviewed) studies raised questions about a variant that appeared in California, CAL.20C: it seems to be spreading rapidly. One study showed it to have torn through the Mission in San Francisco. The other showed it was doing the same in Southern California. Those who carried it appear to shed a larger viral load. Still, experts say it’s not as easily spread as B.1.1.7, and if it does appear to evade some immunity, it’s not as bad as South Africa’s B.1.351. Regardless, it’s not great.
3. The good news
The other reason I haven’t dwelled (dwelt? dwull? dwollen?) on variants much in this newsletter is that thus far, none has been shown to be more lethal and none has been shown to be all that great at going around vaccine-induced immunity. This isn’t to say that their higher infectiousness isn’t a concern! But it means is that we’ve got plenty of ways to fight them:
First, and it bears repeating, the same safety measures we used before they came along are just as effective. Clean air, distance, masks, etc.: those still work, and must be used liberally.
This is important: specific antibodies are only ONE line of defence, and they may not even be the most important one. I know the press have focused on all the doom and gloom of variants and vaccines, BUT. So far, B.1.1.7, P.1, and B.1.351 have not been able to fully evade the shots. A reduction in efficacy doesn’t spell catastrophe because the jabs stimulate more than variant-specific antibodies. They also stimulate T-cells. I am not going to get into a detailed explanation about antibodies and B-cells vs T-cells, but it’s fascinating, and you should watch these entertaining videos on immunity (it’s a 1-2-3-parter, see all of them, T-cells are explained in the last one). Suffice it to say that “T-cells are the superstars in fighting Covid-19” (not my words) so anything that stimulates them will be protective. In this case, if a mild infection is a bit more likely to occur, the shots will still prevent severe illness and death.
The Johnson & Johnson single-dose vax appears to be really quite effective against Brazil’s P.1 and South Africa’s B.1.351 variants. This one also doesn’t need to be frozen like the mRNA shots.
“Still,” you’ll say. Yes. Yes, we all want a tailor-made solution, SO! For variant-enhanced boosters, the U.S. Food and Drugs Administration said vaccine makers won’t need to jump through all the hoops they jumped through when they developed the first-generation jabs. Instead, they’ll just be required to do smaller trials. Before you freak out, there is a precedent: this is the process the flu vaccine goes through each year.
This is meaningful even if you’re not in the U.S. because for better or worse, the Centers for Disease Control and the FDA still tend to set the tone for other agencies in the world, so it is likely authorities, where you are, will follow a similar protocol.
Meanwhile, the CDC are investing in tracking the variants, so at least in this giant country, we’ll get a clearer picture of what’s up. This is going to matter in other countries, too.
Pfizer-BioNTech already have plans to test a booster against the South African variant.
Moderna have now shipped their variant-specific jab to the U.S. National Institutes of Health for trials.
This is all going to happen at lightning speed. I hope this heartens you a bit.
How to use this: I’ll say it over and over again, like a mantra. The more you let a virus run, the more it will mutate. Stopping the virus is the only way of preventing it from becoming not just more contagious (too late for that), but also more dangerous. From what we know of the current variants, however, we’re in a great position to fight them. Caution, always and forever, BUT no panic.
🎥 Attitudes towards science
This was our event this week. It felt like a call to action for scientists to better communicate with facts, and a firm grasp of people’s humanity and emotions. Harvey Fineberg:
You start with evidence if you can, but evidence of both the head and the heart.
It’s hard to overstate how difficult it is for humans to understand probability because it’s frightfully exacting for us to live with uncertainty. A year into this crisis, this is something we all know about ourselves. But when we communicate about science, this is where we need to start. Stories and anecdotes are still the best way to convey statistics.
How to use this: I suspect frustration has reached a boiling point for you multiple times during this pandemic, as it has for me. All of us have family and friends who seem to be “stuck” in their understanding of the virus. Maybe they’re still disinfecting every surface daily whilst remaining oblivious to air quality. Maybe they still believe negative tests are a free pass to visit others. Maybe they cannot understand the meaning of “exponential growth,” no matter how many logarithmic scales you show them. Maybe they still wear masks with valves. Maybe they’ve lost it at you when you dare suggest that vaccines probably won’t let us party like it’s 2019, not right away. This is because most of us don’t know the process of making science. We all want clear answers and we all want OUT, NOW, but… we’re learning as we go. Recommendations change. It’s exhausting. That’s true for all of us. I know it’s hard to be patient, but at least we can laugh at ourselves:
🧊 S’il vous plaît… Dessine-moi un iceberg
That iceberg in your mind would never float the way you think it does. Draw an iceberg here and find out its estimated stable position. Here are mine:
How to use this: have fun, then smile knowingly at all the Hollywood representations of icebergs.