How new COVID variants have changed the response to the pandemic

By the end of 2020, there was strong hope that high levels of vaccination would see humanity finally prevail over SARS-CoV-2, the virus that causes COVID-19. In the ideal scenario, the virus would then be contained at very low levels without further social disturbances or a significant number of deaths.

But since then, new “worrying variants” have emerged and spread around the world, putting current pandemic control efforts, including vaccination, at risk of being derailed.

Simply put, the game has changed, and the successful global introduction of current vaccines is no longer in itself a guarantee of victory.

No one is really safe from COVID-19 until everyone is safe. We are in a race against time to ensure that global transmission rates are low enough to prevent the emergence and spread of new variants. The danger is that variants will emerge that may overcome the immunity granted by vaccination or previous infection.

Moreover, many countries lack the capacity to track new variants through genomic surveillance. This means that the situation may be even more serious than it seems.

As members of the LOVET COVID-19 Public Health Working Group, we call for urgent action in response to new variants. These new variants mean that we cannot rely solely on vaccines to provide protection, but must maintain strong public health measures to reduce the risk of these variants. At the same time, we must speed up the vaccination program in all countries in the same way.

Together, these strategies will provide “maximum control” of the virus.

What are the “variants of concern”?

Genetic mutations in viruses such as SARS-CoV-2 occur frequently, but some variants are referred to as “worrying variants” because they can reinfect people who have previously had an infection or vaccination, or are more transmissible, or can lead to more serious illness.

There are currently at least three documented SARS-CoV-2 variants of concern:

  • B.1.351, first reported in South Africa in December 2020
  • B.1.1.7, first reported in the UK in December 2020
  • P.1, first identified in Japan among travelers from Brazil in January 2021.

Similar mutations occur simultaneously in different countries, which means that even border control and a high vaccination rate cannot necessarily protect countries from domestic variants, including those of concern, where there is significant transmission to the community.

If there are high levels of transmission, and thus extensive replication of SARS-CoV-2, anywhere in the world, more worrying variants will inevitably emerge and more contagious variants will dominate. With international mobility, these variants will expand.

The experience of South Africa suggests that past SARS-CoV-2 infection offers only partial protection against variant B.1.351 and is transmitted by about 50% of existing variants. Variant B.1.351 has already been discovered in at least 48 countries as of March 2021.

The impact of the new variants on vaccine efficacy is still unclear. Recent real-world evidence from the UK suggests that Pfizer and AstraZeneca vaccines provide significant protection against serious diseases and hospitalizations from variant B.1.1.7.

On the other hand, variant B.1.351 appears to reduce the efficacy of the AstraZeneca vaccine against mild to moderate disease. We do not yet have clear evidence as to whether this also reduces efficacy against severe disease.

For these reasons, reducing community transmission is vital. No single action is enough to prevent the virus from spreading; we must maintain strong public health measures along with vaccination programs in each country.

Why we need maximum suppression

Each time a virus replicates, there is a possibility that a mutation may occur. And as we can already see around the world, some of the resulting variants risk compromising the effectiveness of vaccines.

That is why we called for a global strategy of “maximum suppression”.

Public health leaders should focus on efforts to maximize the rate of viral infections, thus helping to prevent mutations that may become new variants of concern.

The rapid introduction of the vaccine alone will not be enough to achieve this; continuous public health measures, such as face masks and physical distancing, will also be vital. Ventilation of enclosed spaces is important, some of which are under human supervision, some of which will require building adjustments.

Fair access to vaccines

Global equality in access to vaccines is also vital. High-income countries should support multilateral mechanisms such as the COVAX facility, donate surplus vaccines to low- and middle-income countries, and support increased vaccine production.

However, in order to prevent the emergence of worrying viral variants, it may be necessary to prioritize countries or regions with the highest prevalence and level of disease transmission, where the risk of developing such variants is greatest.

Those in control of health resources, services, and systems should ensure that support is available to health professionals to manage increased hospitalizations for shorter periods during surges without reducing care for non-COVID-19 patients.

Health systems need to be better prepared for future variants. Suppression efforts should be monitored:

  • genomic surveillance programs to identify and quickly characterize new variants in as many countries around the world as possible
  • rapid second-generation vaccine programs and increased production capacity that can support equity in vaccine distribution
  • vaccine efficacy studies on existing and new worrying variants
  • adapting public health measures (such as double masking) and recommitting to health system arrangements (such as providing personal protective equipment for health personnel)
  • behavioral, environmental, social, and systemic interventions, such as enabling ventilation, distancing between people, and effectively finding, testing, searching, isolating, and supporting.

Worrying variants of COVID-19 have changed the game. We need to recognize this and act if we as a global society want to avoid future waves of infections, but even more locks and limitations, and avoidable diseases and deaths.Conversation

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