The coronavirus could get worse

‘In the worst-case scenario, a variant could arise that would “make it like the vaccines did not exist,” Hanage [Bill Hanage, an epidemiologist at the Harvard School of Public Health] said. But at the moment, “there is no such variant like that.” And it would probably be extraordinarily difficult for one to manifest. Even the most evasive variants we know of—the ones that have stumped certain antibodies—aren’t fully duping vaccinated bodies, which harbor a slew of other immunological guards. Hanage also pointed out that many people’s immune systems have been trained on different triggers—distinct brands of vaccines, unique variants, or some combination thereof. A new version of SARS-CoV-2 would find skirting all of those blockades at once to be nearly impossible.

‘Viruses aren’t infinitely mutable; sometimes, to keep themselves in contention, they must make sacrifices. Several experts told me they’re hopeful that the coronavirus might struggle to max out both transmission and immune evasion at once, requiring some sort of trade-off between the two. Some of the most powerful anti-coronavirus antibodies target SARS-CoV-2’s spike protein, which the virus uses to unlock and enter our cells. If the virus altered the protein to sidestep those antibodies, it might make itself less recognizable to the immune system. But it could also hurt its ability to infect us at all.’

Read here (The Atlantic, Aug 25, 2021)

When will the Covid-19 pandemic end? McKinsey & Co update August 2021

‘This article updates our perspectives on when the coronavirus pandemic will end to reflect the latest information on vaccine rollout, variants of concern, and disease progression. Among high-income countries, cases caused by the Delta variant reversed the transition toward normalcy first in the United Kingdom, during June and July of 2021, and subsequently in the United States and elsewhere. Our own analysis supports the view of others that the Delta variant has effectively moved overall herd immunity out of reach in most countries for the time being. The United Kingdom’s experience nevertheless suggests that once a country has weathered a wave of Delta-driven cases, it may be able to resume the transition toward normalcy. Beyond that, a more realistic epidemiological endpoint might arrive not when herd immunity is achieved but when COVID-19 can be managed as an endemic disease. The biggest overall risk would likely then be the emergence of a significant new variant.’

Read here (McKinsey & Co, August 23, 2021)

Some personal insights into the Covid-19 situation in Malaysia — Amar-Singh HSS

‘This article offers some personal insights into the Covid-19 situation in the country. One concern is that the public in some states behave as though the worsening outbreak is confined to the Klang Valley, or only to selected states. This is a dangerous assumption as the situation is worsening in the whole nation. The lack of adequate data hampers the public’s appropriate response to the deepening crisis.’

The following matters are discussed:

• ICUs bed occupancy is at critical levels nationwide
• Mortality rate is rising
• Younger persons are dying and mutations spreading
• When will the current outbreak peak?
• What are the implications of these trends?
• What is possibly going to happen?
• What can we do as the general public?’

Read here (The Malay Mail, May 23, 2021)

Indian Covid mutant more contagious, but not vaccine resistant: Top WHO scientist

“Surge in India increases chances of more dangerous variants emerging. Prelim data shows that Indian variant is more contagious. There is heterogeneity in India in terms of spread of Covid-19. WHO is concerned about number of cases and deaths in India. Globally, cases and deaths have plateaued, not in South Asia. South East Asia is seeing case rise owing to India. Overall numbers hide what is going on, need to go deeper in state, local level data,” she said.

‘Speaking on efficacy of vaccines available in India, she assured, “There is no enough data to show that double mutant is vaccine resistant. All the available vaccines today in India and elsewhere prevent severe disease and death even if you get up the infection. You are not going to end up in the ICU critically ill. The message is take the vaccine whichever is available and you eligible for it. If your turn is there, please take it.”

Read here (Yahoo, May 10, 2021)

Why the world should worry about India

‘The world’s largest vaccine producer is struggling to overcome its latest COVID-19 surge—and that’s everyone’s problem...

‘None of the Indian government’s missteps absolve the world from caring about what happens to the country, nor should they. Beyond the obvious moral reasons are practical ones too. As I have repeatedly written before, uncontrolled outbreaks anywhere pose a threat everywhere, including vaccine-rich countries such as the United States. Perhaps the biggest concern right now, in India and elsewhere, is the threat posed by more transmissible variants and their potential ability to overcome vaccine immunity. Though virtually every known variant, including those from Britain, Brazil, and South Africa, has been identified in India, in some states the Indian strain has become the most prevalent.

“It’s very similar to what we saw in Manaus,” Christina Pagel, the director of clinical operational research at University College London, told me, referring to the badly hit Brazilian city. She noted that “it’s not a coincidence that these variants are arising in populations that have developed immunity through infection.”

Read here (The Atlantic, Apr 26, 2021)

Brazil coronavirus strain: Variant three times more deadly for those aged 18-45, research shows

‘The new coronavirus variant sweeping through Brazil, and spreading to other nations around the world, is proving to be up to three times more deadly for young people, according to research. 

‘It is also spreading more quickly among younger people with cases among Brazilians in their 30s, 40s, and 50s are up by 565 per cent, 626 per cent and 525 per cent respectively since the beginning of January, according to Brazilian public health institute Fiocruz. In comparison, during the same periods the increase in the overall population was much lower at 316 per cent, suggesting the virus infections are making “a shift to younger age groups”. There is also growing evidence shows that young people are not only more likely to get infected with the new strain – dubbed P. 1 – but also to die from it.’

Read here (News.com, Apr 6, 2021)

New Covid variants have changed the game, and vaccines will not be enough. Lancet Covid-19 Commission calls for global ‘maximum suppression’

‘Put simply, the game has changed, and a successful global rollout of current vaccines by itself is no longer a guarantee of victory... No one is truly safe from COVID-19 until everyone is safe. We are in a race against time to get global transmission rates low enough to prevent the emergence and spread of new variants. The danger is that variants will arise that can overcome the immunity conferred by vaccinations or prior infection.

‘What’s more, many countries lack the capacity to track emerging variants via genomic surveillance. This means the situation may be even more serious than it appears.

‘As members of the Lancet COVID-19 Commission Taskforce on Public Health, we call for urgent action in response to the new variants. These new variants mean we cannot rely on the vaccines alone to provide protection but must maintain strong public health measures to reduce the risk from these variants. At the same time, we need to accelerate the vaccine program in all countries in an equitable way. Together, these strategies will deliver “maximum suppression” of the virus.’

Read here (The Conversation, Apr 6, 2021)

Download report here (Lancet Covid-19 Commission Taskforce on Public Health,  March 2021)

Covid-19 variants: Five things to know about how coronavirus is evolving

The Sars-CoV-2 virus is changing in ways that are making it more transmissible, increasing the severity of disease it causes and allowing it to infect people who should have immunity. These variants are causing concern among global health experts, particularly as there are signs that some vaccines may be less effective against them. 

Here are five things to know about the new Covid-19 variants:

1. The virus is always changing but occasionally makes an evolutionary leap
2. These are variants of SARs-CoV-2, not new strains
3. Chronic infection cases and higher levels of population immunity may have enabled the virus to evolve
4. Sequencing has played a crucial role in tracking new variants
5. Vaccines are already being changed to deal with variants

Read here (Horizon, Mar 29, 2021)

Covid-19 is different now: Our response to Covid-21 cannot be myopic

‘We are at an inflection point that will change the reality of this disease. The most insidious future is one in which we fail to change our moral benchmarks, and end up measuring the danger of COVID-21 by the standards of 2020. If wealthy countries with early access to vaccines abandon continued, global coronavirus-vaccination efforts as their cases fall or when the disease becomes milder for them, a still-severe disease could haunt the world indefinitely—and lead to rebounds everywhere.

‘Avoiding this myopia is the central challenge of COVID-21. It extends to the systemic problems highlighted by this pandemic. Much of the damage the virus has wrought has come indirectly, by exacerbating food and housing insecurity, for example, or restricting access to medical care. The Biden administration has elevated science and begun to focus on comprehensive approaches to prevention. No longer is federal leadership hawking hydroxychloroquine, suggesting injections with “disinfectant,” or stoking xenophobic sentiment. But this sudden sense of order is a beginning, not an end.’

Read here (The Atlantic, Mar 27, 2021)

The coronavirus variants don’t seem to be highly variable so far

‘No doubt you’ve heard about the novel coronavirus variants that are evolving around the world. There now appear to be more than a dozen versions of SARS-CoV-2, which are of varying degrees of concern because some are linked to increased infectivity and lethality while others are not. It’s easy to be overwhelmed by this diversity and to fear that we’ll never achieve herd immunity. Yet evidence is growing that these variants share similar combinations of mutations. This may not be the multifront war that many are dreading, with an infinite number of new viral versions.’

Read here (Scientific American, Mar 24, 2021)

Rare Covid reactions might hold key to variant-proof vaccines

 ‘Some people mount an immune response able to fend off a menagerie of coronavirus variants...

‘Some of the vaccines that have been administered to millions of people might already be triggering variant-resilient immune responses. In another March preprint, a long-running COVID-19 study in Seattle, Washington, reported that after receiving a single dose of an mRNA vaccine, participants who had previously been infected with SARS-CoV-2 produced heaps of antibodies that can neutralize B.1.351, as well as an earlier circulating variant8. Those people also produced much higher levels of antibodies than typically seen even in those who have received two vaccine doses.

‘Leonidas Stamatatos, an immunologist at the Fred Hutchinson Cancer Research Center (FHCRC) in Seattle who co-led the study, suspects that a single vaccine dose boosted the levels of pre-existing antibodies that were capable of recognizing diverse variants. It’s not clear how to mimic this response in people who haven’t had COVID-19. One possibility is that a lag of several months between infection and vaccination was responsible, and that its effect could be replicated with another vaccine dose, given six months or a year after the first two, says Andy McGuire, an FHCRC immunologist who co-led the study.’

Read here (Nature, March 19, 2021)

'Covid is taking over': Brazil plunges into deadliest chapter of its epidemic

‘[André] Machado saw several explanations for the torrent of cases he and other doctors are now seeing, including political mismanagement and the slackening of social distancing measures, principally among the young. In recent months such containment efforts have largely collapsed, with schools and businesses reopening and Bolsonaro’s tourism minister even urging citizens to start holidaying again.

‘But the doctor suspected a third, more troubling element was also at work: an enigmatic and apparently more contagious variant called P1 that is thought to have emerged in the Amazon region in late 2020 but is now circulating across Brazil, including in the southern state of Rio Grande do Sul, where Machado works.’

Read here (The Guardian, Mar 13, 2021)

Multitude of coronavirus variants found in the US — but the threat is unclear

‘For the scientists who have spent the past year poring over hundreds of thousands of coronavirus genomes, the United States has been an enigma. Despite having world-leading genome sequencing infrastructure and experiencing more COVID infections than any other country, the United States has until recently lagged far behind in sequencing coronavirus genomes and spotting worrisome variants.

‘But in recent weeks, US researchers have identified a host of new variants, including in California, New York State, Louisiana and elsewhere. And they are continuing to ramp up SARS-CoV-2 sequencing efforts.

‘That has brought another challenge: making sense of the variants that are discovered. They carry potentially worrying mutations and might be becoming more common, but a dearth of data on how the variants are spreading means the threat they pose is unclear.’

Read here (Nature, Mar 6, 2021)

Finding an ultimate vaccine to fight the mutating “emperor” virus

‘We are commenting on the shocking CNN website report (March 2), headlined “All our recent progress with COVID-19 could be wiped out by variants, CDC director says”. The first two paragraphs (below) are enough to sum up the CNN report: “The US is at risk of losing all its recent gains in the battle against COVID-19 as highly contagious variants take advantage of Americans getting lax with safety measures... “Please hear me clearly: At this level of cases with variants spreading, we stand to completely lose the hard-earned ground we have gained,” said Dr Rochelle Walensky, director of the US centers for Disease Control and Prevention (CDC).”...

‘With new variants, serious doubts are suggested by the CNN report on whether this “vaccine” [mRNA], the first in the global market, would work, even if safety factor is put aside. Nevertheless, there are safe and workable vaccines, using tried and tested technologies like using inactivated or attenuated virus from nature to stimulate the body to produce anti-body response. Even the adenovirus viral vector technology, tried and tested for Ebola, appears to be safer than mRNA.

‘There are also safe and good alternatives, like the anti-viral “broad spectrum” drug Ivermectin, which can destroy the new variants. In the meantime, it is vital that we improve our body immunity against COVID-19 by taking Vitamin C with zinc, Vitamin D, minerals and trace elements needed, explore proven traditional and complimentary medicines, and maintain established standard operating procedures (SOPs) of physical distancing, wearing surgical masks and personal hygiene in public places.’

Read here (Focus Malaysia, Mar 4, 2021)

Why has P1 appeared? Heads it wins, tails we lose?

‘You may already know that viruses mutate, that this is normal and these small changes to the virus’s genetic code are to be expected. Well, that’s true, but that doesn’t mean they’re always harmless. Many mutations will be irrelevant, and some will make a virus weaker and will die out. But others will make it fitter, giving it an advantage over other variants and allowing it to out-compete them.

‘As people socially distance, observe stricter personal hygiene and wear masks, it becomes an advantage for the virus to be more transmissible. Similarly, as more people around the world gain immunity through being infected or vaccinated, another advantage would be for the virus to change so that antibodies can no longer attach to it and prevent it from infecting cells.

‘It’s therefore not surprising to see variants with mutations that provide these advantages now out-competing other forms of the coronavirus. Control measures and rising immunity are pressuring the coronavirus to evolve.’

Read here (The Conversation, Mar 3, 2021)

Covid-19 infections falling worldwide but WHO warns against apathy

‘Reported daily coronavirus infections have been falling across the world for a month and on Tuesday (Feb 16) hit their lowest since mid-October, Reuters figures show, but health experts warned against apathy even as vaccines are being rolled out worldwide. Falls in infections and deaths coincide with lockdowns and severe curbs on gatherings and movement as governments weigh the need to stop successive waves of the pandemic with the need to get people back to work and children back to school.

‘But optimism over a way out of the crisis has been tempered by new variants of the virus, raising fears about the efficacy of vaccines. "Now is not the time to let your guard down," Maria Van Kerkhove, the World Health Organization's technical lead on COVID-19, told a briefing in Geneva.’

Read here (Channel News Asia, Feb 19, 2021) 

Protein behind corona’s slow Asia spread: Study

‘Deficiency in a particular human protein, which is more common in Europe and the United States than in Asia, could explain why coronavirus is not spreading as fast in Asian countries. A team of scientists from the National Institute of Biomedical Genomics in Kalyani, West Bengal, have found a biological reason for the slower spread of a mutant of coronavirus in Asia compared to the West. The team has explained how higher levels of a human protein — neutrophil elastase — helps the virus to enter the human cell, multiply and also spread faster from infected individuals... 

“However, some naturally-occurring mutations in the AAT-producing gene results in deficiency of the AAT protein. This deficiency is known to be much higher in the Caucasians of Europe and America than among Asians,” said Majumder. “While we used AAT deficiency data from East Asia, along with North America and Europe, for the study, considering the pace at which the coronavirus is spreading, the numbers are representative of other Asian regions too, including India.”... 

‘As per their data, AAT deficiency is the least in East Asian countries — 8 per 1,000 individuals in Malaysia, 5.4 per 1,000 in South Korea, 2.5 in Singapore. On the other hand, 67.3 in per 1,000 individuals in Spain are AAT deficient, 34.6 in the UK and 51.9 in France and in the US it is prevalent in 29 individuals among 1,000.’

Read here (Times of India, Feb 9, 2021)

Variants v Vaccines: The race between the tortoise and the hare -- Tomas Pueyo

‘The B117 variant will probably take over between February and March in most developed countries. That’s without taking into account the Brazilian and South African variants. Emerging countries are in an even worse position: Not only will they have the 3 variants. They will also receive vaccines much later. And in the Southern hemisphere, they’re now enjoying summer. Winter, with more variants and not enough vaccines, might be less forgiving.

‘So keep tight for a few more months. Don’t let your guard down. The end of the tunnel is near. Get a vaccine if you can. If not, wait till the summer. By September, we’ll likely be back to the new normal in developed countries. And in emerging ones, let’s hope more vaccines and a fast rollout avoids a repeat of 2020.’ 

Read here (substack.com, Feb 8, 2021)

Vaccine strategy needs rethink after resistant variants emerge, say scientists

‘Leading vaccine scientists are calling for a rethink of the goals of vaccination programmes, saying that herd immunity through vaccination is unlikely to be possible because of the emergence of variants like that in South Africa. The comments came as the University of Oxford and AstraZeneca acknowledged that their vaccine will not protect people against mild to moderate Covid illness caused by the South African variant. The Oxford vaccine is the mainstay of the UK’s immunisation programme and vitally important around the world because of its low cost and ease of use.

‘The findings came from a study involving more than 2,000 people in South Africa. They followed results from two vaccines, from Novavax and Janssen, which were trialled there in recent months and were found to have much reduced protection against the variant – at about 60%. Pfizer/BioNTech and Moderna have also said the variant affects the efficacy of their vaccines, although on the basis of lab studies only.

‘All the vaccines, however, have been found to protect against the most severe disease, hospitalisation and death.’

Read here (The Guardian, Feb 7, 2021)

How to redesign Covid vaccines so they protect against variants

‘Some aspiring vaccine makers have had their eye on the threat that escape variants might pose from the start. A team at Gritstone Oncology decided to focus on this potential problem by designing a vaccine that targets multiple sites on several viral proteins, in contrast to first-generation shots that target only the spike protein, says Andrew Allen, president of the company in Emeryville, California. The hope is that the vaccine, which should soon start clinical trials, will make it difficult for the virus to evade immunity because many genetic changes would be necessary for it to do so. “You can either play whack-a-mole and chase the variants, or you can try to get ahead of them,” Allen says.

‘Because updating the construction of existing vaccines is relatively simple, a new RNA vaccine could be designed and manufactured for clinical testing within six weeks, Weissman estimates. But that is only the beginning. “Mass-producing a vaccine is hard. To start all over again will be hard,” says Offit. Some researchers are expecting periodic updates to coronavirus vaccines, as with flu, to become a way of life. “This is not unusual,” says Stanley Plotkin, a consultant who advises companies on vaccines. But it could mean that worries over supply chains and logistics will continue for some time.’

Read here (Nature, Jan 29, 2021)