Illustration of the spike protein (red) from the new variant B117 of the SARS-CoV-2 coronavirus, the ... [+]
Evidence continues to grow that that the U.K. variant, otherwise known as B.1.1.7, is likely more lethal, and leads to more hospitalizations and cases compared to wild-type strains of the virus, based on data released on a British government website.
The new research complied data and studies from multiple institutions and found “increased severity” of Covid-19 cases compared to non-variants. The study noted that B.1.1.7 cases were 30-70% more lethal in comparison to the original wild-type strains.
Concerns about increased lethality of B.1.1.7 first surfaced in January when the British government’s New and Emerging Respiratory Threats Advisory Group (NERVTAG) revealed data suggesting the increased lethality compared with wild-type strains.
Initial data evaluated by the researchers, based on linked community testing and mortality data, were all predicated on the same datasets, and therefore the same biases. However, more recent analysis of newer data has allowed investigators to control for “additional confounders increasing confidence in the association of the [variant of concern] with increased disease severity," the authors write.
Multiple other studies looked at the effect of the B.1.1.7 variant on hospitalizations. In particular, Public Health Scotland used the S-gene target failure as a marker to identify variant Covid-19 cases. Researchers noted the risk of hospitalization was higher among S-gene target failure cases compared with S-gene positive cases. In addition, data from Intensive Care National Audit and Research Centre (ICNARC) and QRESEARCH also discovered a higher risk of ICU admission for variant versus non-variant cases.
But the researchers did not all agree that the variant predisposed to more serious disease and increase risk of death. Data from COVID-19 Clinical Information Network (CO-CIN), which found no evidence suggesting variants are linked with higher in-hospital case fatality rates. An analysis from Office for National Statistics (ONS) noted that while the hazard ratio suggested higher risk of all-cause mortality, "the number of deaths are too low for reliable inference."
"There are potential limitations in all datasets used but together these analyses indicate that it is likely that B.1.1.7 is associated with an increased risk of hospitalization and death compared to infection with non-B.1.1.7 viruses," the authors concluded.
“It has not been definitely established that the 1.1.7 variant is more lethal but even the hint of this being the case should redouble the efforts to accelerate vaccinations to keep pace with the more transmissible variant’s spread,” said Amesh Adalja, MD, an Infectious Disease physician, and Adjunct Assistant Professor, Center for Global Health, Johns Hopkins Center for Health Security.
As the U.S. continues its efforts to increase the pace of vaccinations, with over 2 million vaccinations administered for 2 days consecutively (February 5th and 6th), Peter Hotez, MD, PhD, Professor and Dean of the National School of Tropical Medicine at Baylor College of Medicine, and co-director of the Texas Children’s Hospital Center for Vaccine Development cautioned in a Washington Post Op-Ed last month that we need to pick up the pace significantly—with a goal of vaccinating 3 million people daily in order to reach herd immunity by mid summer. The Biden administration’s goal of 100 million vaccinations in 100 days now stands at over 52 million doses administered as of today, showcasing the pace of efforts currently underway. In the past week, an average of 1.64 million doses per day were administered according to the CDC’s Covid-19 Vaccine Tracker.
But another expert, Dr. Angela Rasmussen, a virologist with the Center for Global Health and Security at Georgetown University offered that the B.1.1.7 variant may have minimal effect on vaccine effectiveness. “Fortunately, there shouldn’t be much of an impact on vaccines, since B.1.1.7 doesn’t seem very capable of even partially evading immunity elicited by the vaccine. This to me underscores the importance of getting vaccinated ASAP, staying home when possible and being diligent about exposure reduction when you can’t.”
Rasmussen also points out that “some B.1.1.7 strains have acquired the E484K mutation [first seen in the south African (B.1.3.5.1 variant)] which is bad news, but we have no data yet. Since we are still learning how vaccines might protect against different variants, it’s important to take every precaution to avoid exposure and get transmission down,” said Rasmussen.
“This, along with getting vaccinated as soon as you can, will reduce the risk of more transmissible and possibly more virulent variants gaining traction,” she added.
There is, however, growing concern regarding the South African variant’s (B1.3.5.1) ability to escape immunity provided by mRNA vaccines manufactured by Pfizer and Moderna as well as the AstraZeneca-Oxford and Novavax. Data thus far suggests that the vaccines work against the variant, but have a reduced effectiveness. Novavax, a Maryland-based biotech company, said that “data suggest that prior infection with Covid-19 may not completely protect against subsequent infection by the South Africa escape variant,” but its vaccine “provided significant protection.” based on reporting by the Washington Post.
So far, the B.1.3.5.1 variant has been identified in 17 patients is 8 states according to the CDC. Additionally, a recent report of the first known patient reinfected with the South African variant in France has raised even further concern as the patient remains critically ill in the ICU.
The case, reported in the journal Clinical Infectious Diseases, represents the first recorded case of reinfection involving the B.1.3.5.1. variant. Authors of the article explained that while such cases of reinfection are rare they are likely underestimated. As a result, they recommend doing future studies that look at cross-immunity between variants and how well vaccines perform against them (vaccine effectiveness).
The WHO on Friday also said that it had received reports from South Africa regarding reports about people being reinfected with a new variant of the virus, not mentioning the case in France. WHO Chief Scientist Soumya Swaminathan said the review of reinfections in currently an active area of investigation.
Meanwhile, researchers in France detailed that the man who is currently critically ill in the ICU had a fever and shortness of breath the initial time he was infected with Covid-19 in September. After he recovered he tested negative 2 times in December. It’s not clear at this time, based on their report, which variant he was initially infected with.
