Officials concerned COVID variants could overwhelm progress
With new, potentially more virulent strains of the novel coronavirus emerging across the United States, including in California, Imperial County health officials are warning the public not to become complacent, even as infection rates drop and the number of vaccinated residents increases.
Both of the county’s hospitals reported a significant drop in COVID hospitalizations during Thursday’s online press conference, with 77 positive patients between them. In fact, Pioneers Memorial Hospital recently announced it will be returning all of its outpatient services to their respective clinics effective today.
Numbers of deaths remain high, but Imperial County Health Officer Dr. Stephen Munday said that is to be expected because deaths lag behind other metrics.
Meanwhile, Imperial County Public Health Director Janette Angulo reported there were 6,700 first doses and 1,450 second doses of COVID-19 vaccines administered countywide as of Wednesday. Vaccine administration remains in Phase 1A, she said, with
Tier 3 inoculations having just begun.
Yet, despite this progress, health officials are bracing themselves for another surge. “Our big concern going forward will be the variants,” said El Centro Regional Medical Center’s Chief Medical Officer, Dr. Christian Tomaszewski. “We’re prepared for another surge even as we speak.”
He said even if the county is able to hit 2,000 vaccinations per day this month, a more virulent strain of the coronavirus could still result in a spike in patient counts.
It’s unknown whether any of the variants has showed up locally so far. Health Officer Munday said Thursday the health department has been sending out specimens from local cases for testing but the results were pending.
A variant that wreaked havoc in the United Kingdom, leading to a spike in cases and hospitalizations, is surfacing in a growing number of places in the United States.
Last week, another worrisome variant seen in Brazil surfaced in Minnesota. If these or other strains significantly change the way the virus transmits and attacks the body, as scientists fear they might, they could cause yet another prolonged surge in illness and death in the United States, even as cases have begun to plateau and vaccines are rolling out.
On the other hand, variants aren’t novel or even uncommon in viral illnesses. The viruses that trigger common colds and flus regularly evolve. Even if a mutated strain of SARSCoV-2, the virus that causes COVID, makes it more contagious or makes people sicker, the basic public health response stays the same: Monitor the virus, and any mutations, as it moves across communities. Use masking, testing, physical distancing and quarantine to contain the spread.
The problem is that the United States has struggled with every step of its public health response in its first year of battle against COVID-19. And that raises the question of whether the nation will devote the attention and resources needed to outflank the virus as it evolves.
Researchers are quick to stress that a coronavirus mutation in itself is no cause for alarm. In the course of making millions and billions of copies as part of the infection process, small changes to a virus’s genome happen all the time as a function of evolutionary biology.
“The word ‘variant’ and the word ‘mutation’ have these scary connotations, and they aren’t necessarily scary,” said Kelly Wroblewski, director of infectious disease programs for the Association of Public Health Laboratories.
When a mutation rings public health alarms, it’s typically because it has combined with other mutations and, collectively, changed how the virus behaves. At that point, it may be named a variant. A variant can make a virus spread faster, or more easily jump between species. It can make a virus more successful at making people sicker, or change how their immune systems respond.
SARS-CoV-2 has been mutating for as long as it has been known about; mutations were identified by scientists throughout 2020. Though relevant scientifically — mutations can actually be helpful, acting like a fingerprint that allows scientists to track a virus’s spread — the identified strains mostly carried little concern for public health.
Then came the end of the year, when several variants began drawing scrutiny. One of the most concerning, first detected in the United Kingdom, appears to make the virus more transmissible. Emerging evidence suggests it also could be deadlier, though scientists are still debating that.
The public knows more about the U.K. variant than others not because it’s necessarily worse, but because the British have one of the best virus surveillance programs in the world, said William Hanage, an epidemiologist and a professor at Harvard University.
By contrast, the United States has one of the weakest genomic surveillance programs of any rich country, Hanage said. “As it is, people like me cobble together partnerships with places and try and beg them” for samples, he said on a recent call with reporters.
Other variant strains were identified in South Africa and Brazil, and they share some mutations with the U.K. variant. That those changes evolved independently in several parts of the world suggests they might present an evolutionary advantage for the virus. Yet another strain was recently identified in Southern California and flagged due to its increasing presence in hardhit cities like Los Angeles.
The Southern California strain was detected because a team of researchers at Cedars-Sinai, a hospital and research center in Los Angeles, has unfettered access to patient samples. They were able to see that the strain made up a growing share of cases at the hospital in recent weeks, as well as among the limited number of other samples haphazardly collected at a network of labs in the region.
Not only does the
U.S. do less genomic sequencing than most wealthy countries, but it also does its surveillance by happenstance. That means it takes longer to detect new strains and draw conclusions about them. It’s not yet clear, for example, whether that Southern California strain was truly worthy of a press release.
So far, vaccines for covid appear to protect against the known variants. Moderna has said its vaccine is effective against the U.K. and South African strains, though it yields fewer antibodies in the face of the latter. The company is working to develop a revised dose of the vaccine that could be added to the current two-shot regimen as a precaution.
But a lot of damage can be done in the time it will take to roll out the current vaccine, let alone an update.
Even with limited sampling, the U.K. variant has been detected in more than two dozen U.S. states, and the Centers for Disease
Control and Prevention has warned it could be the predominant strain in the United States by March. When it took off in the United Kingdom at the end of last year, it caused a swell in cases, overwhelmed hospitals and led to a holiday lockdown. Whether the U.S. faces the same fate could depend on which strains it is competing against, and how the public behaves in the weeks ahead.
Already risky interactions among people could, on average, get a little riskier. Many researchers are calling for better masks and better indoor ventilation. But any updates on recommendations likely would play at the margins.
Even if variants spread more easily, the same recommendations public health experts have been espousing for months — masking, physical distancing and limiting time indoors with others — will be the best way to ward them off, said Dr. Kirsten Bibbins-Domingo, a physician and professor at the University of California-San Francisco.
“It’s very unsexy what the solutions are,” Bibbins-Domingo said. “But we need everyone to do them.”
Anna Maria Barry-Jester of Kaiser Health News (KHN) contributed to this report. KHN is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation, which is not affiliated with Kaiser Permanente.