What About the B.1.1.529 Variant?

I’ve been watching news about this new variant since news of it began to emerge a couple of days ago. We still have a lot to learn about it, but I’m aware that sudden reinstatement of travel bans, quarantine for travelers from certain countries, and today’s headlines are alarming. For you and me, this variant is not a surprise.

Background

We have been expecting a variant along these lines. We know that as a species, we have allowed SARS-CoV-2 to continue circulating without enough hindrance. To keep this variant from happening, the entire world would have needed to respond to the emergence of the pandemic like New Zealand, Singapore, Vietnam, and a few other countries. That means stringent restrictions (a zero-COVID strategy), then blanket vaccination with restrictions loosened but not removed, so the virus would have a very hard time making the leap from person to person.

Instead, many countries clamped down too little too late, mostly didn’t vaccinate enough of the population if they could have and didn’t make sure other countries could do so, and lifted restrictions too much too soon. In many of the better-off countries, after avoiding collapse of the health care system, short term status of the economy took top priority.

The price of that choice? More deaths, more people impaired by Long COVID, and more opportunities for the virus to develop new variants. Each case of COVID, symptomatic or asymptomatic, is a Petri dish for the virus to explore mutations. Each case that turns into chronic COVID instead of resolving in the usual length of time becomes practically a whole laboratory for the virus.

Scientists believe the new variant developed in someone with chronic COVID. This is not a new concept. They believe the Alpha variant developed in one patient in Kent who became one of the early cases in whom active virus lingered for a long time.

The Delta variant spreads more efficiently than the original virus. It is nowhere near the limits of possibility. I’ve seen scientific estimates that SARS-CoV-2 could evolve to spread as much as three times more efficiently than Delta. We can also anticipate mutations for better evasion of our immune systems and our vaccines.

That doesn’t mean every mutation is a threat. Some variants have looked significant, yet failed to compete well with Delta and fizzled out. Maybe this is the one that will push Delta aside, just as Delta pushed Alpha aside. If so, you and I have been expecting it to happen eventually. It doesn’t rattle us.

Now What?

How should we respond in the event that this is indeed the next step beyond Delta?

Some countries are imposing bans on direct travel from specific countries where B.1.1.529 may be circulating. Even the UK, where I live, is doing that. The UK is notorious in this pandemic for often shutting the barn door after the horse is out, so this quick action is a positive surprise. If this variant truly is more efficient at spreading, we probably can’t corral it. We can delay its spread. In the northern hemisphere, delay can allow us to get through more of the winter before we have to contend with it locally. The ideal would be to postpone its arrival on our doorstep until the seasons turn so that we can meet each other more readily outdoors with distance.

However, we may not delay the spread that long. For example, direct flights will be allowed into the UK again after arrangements are in place to quarantine arriving travelers from affected countries. This is better than I expected. It will not prevent the variant from hopping in. First, indirect travel from the listed countries remains open. Second, the planned quarantine will not be long enough for full blockage and the final test before travelers are released will leave a couple of days for disease to develop undetected before they are released. We aim to throttle how much of it gets into the country when it first arrives. We aren’t trying to block it.

I’ll get to our long term response in a moment. Before that, what can you and I do at a personal and household and group level in the short to medium term?

Well, we all have a lot of relatively recent practice at that, and we know a lot more than we did in early 2020 about the nature of this virus. So…

• We’ll make sure we are as vaccinated as we can be.

• If we are well situated to safely visit with a few family and friends, we’ll do that now. It involves careful consideration of levels of vaccine-induced or post-infection immunity, exposure levels and vulnerability (because breakthrough infections can still be miserable and hazardous). When in doubt, we err on the side of caution. Where we can still reasonably do our visiting outdoors with distance, we will opt for that. (Walks are a great British pasttime anyway, even in the cold and wet.)

• We will make sure we have enough food and household supplies on hand in case lockdown is imposed. (We should already have decent stock levels anyway because when COVID gets into a household, it takes a while to make its way through everyone, so the entire household is in quarantine until the last person is either long enough post-illness or safely through quarantine after the second-last person’s case finished.)

• We never stopped wearing face masks when we go into shops and other indoor venues. Now we prefer N95/FFP2 or better masks. If we may have to get too close to other people outdoors, such as walking to a shop in town, we wear face masks there too so we won’t have to fumble to put a mask on at the last second.

• We will work from home where we can and use precautions such as face masks at work where we can’t work from home. Tradespeople who need to come in must wear a face mask.

• When the new variant arrives in our country, without waiting for official guidelines, we will clamp down. This includes getting groceries by delivery or curbside pickup (click and collect in the UK), using Zoom or WhatsApp etc video meetings more again, and so on.

Can We Ever Get Out of This Pandemic?

Do we have to live with this as an endemic virus? Will we have wave after wave of this? I believe it’s too soon to be sure, and I see a way we can get out of it.

As interim steps, we have vaccines. Now we also have reasonably effective treatments such as monoclonal antibodies, and soon new pills from Merck and Pfizer which both companies have decided to allow to be manufactured by others so that poor countries can have access to them. These mitigate the incidence of COVID and the severity of its effects, but won’t stop the pandemic. Remember, each infected person provides the virus with opportunities to develop new mutations. To really stop the pandemic, we need to do what we did to eradicate smallpox and block transmission.

Did you notice the recent announcement of why some people get exposed to the virus over and over, yet never get even an asymptomatic case of COVID? That’s our potential exit.

Current vaccines are based on recognizing portions of the exterior of the virus, especially the spike that it uses to invade our cells. Vaccines stimulate production of antibodies against the virus, a first line of defense, and some vaccines also teach a type of T cell in the immune system to recognize the virus. Those are sweeping generalizations, but enough to work with for the moment.

Antibody levels start to fade after a few months, weakening our immunity. That’s why wealthy countries are administering booster vaccinations, plumping up antibody levels again as winter sets in for the heavily populated northern hemisphere. Changes in the portions of the virus that our vaccines recognize help the virus sneak through, and it turns out that the virus is adept at making changes there.

The immune systems of naturally resistant people have T cells which recognize a portion of the interior of the virus. Their immune systems could have learned this by fighting one of the other coronaviruses that have circulated among humans. In addition to SARS and MERS, a handful of coronaviruses are known to cause symptoms like a common cold in people. Even though T cells are not the very first line of defense, they kick in so well in the highly resistant people that they never get infected with COVID (or to be more specific, when they get exposed, infection of their cells is snuffed out so quickly and thoroughly that they don’t develop even an asymptomatic case of the disease).

This means the portion of the virus they are recognizing is the same in multiple strains of coronaviruses. It doesn’t change frequently like the exterior pieces we’ve used for our vaccines up to now. Even better, the T cells that respond to it do a particularly fast, complete job of blocking infection. Not weakening the infection, not reducing severity, but blocking it.

I’ve heard a scientist say he believes we can make a vaccine to teach our T cells to do what they are doing in naturally resistant people.

It will take time, but this coronavirus spurred us to apply one or two decades worth of research to devise vaccines far more quickly than we have been able to before, without foolish shortcuts on safety. We can do it again, this time shifting the target to that interior piece of the virus. Once again, we have a parallel within living memory. The first vaccine developed against polio was a game changer, but not ideal. (It used attenuated live virus and caused a few cases of non-paralytic polio from every batch.) The second vaccine was more bothersome to administer, but more effective and with less risk of adverse side effects. Polio isn’t quite eradicated, but nearly so. (Before this pandemic, WHO was considering a campaign to finish wiping it out.)

With new vaccines based on the interior target and a campaign like what we did against smallpox, I see a path out of these waves of COVID.

It’s true that this virus crosses species barriers readily, so reservoirs of it could remain active in animals. It could try to cross over into humans again, but the future vaccine can block it. We have a path out. Let’s walk it.