As of this writing, the Rochester region has detected none of the more-troubling coronavirus variants making COVID-19 potentially more contagious, more severe, more lethal, and/or more vaccine-resistant. But absence of lab confirmation does not mean the variants are not present among us, since only a very small portion of virus samples are sent for genetic sequencing.
This underscores the need to vaccinate as many people as possible as quickly as possible, and for all of us to maintain strict precautions including social distancing, wearing masks, hand hygiene, and limiting the size of gatherings.
The virus is mutating
The more viruses replicate—reproduce themselves—the more they mutate. The COVID-19 pandemic has given the SARS-CoV-2 coronavirus ample opportunity to mutate into an unknown number of variants.
The mutations of greatest concern are those that impact “viral fitness”—that help the virus survive and spread. At least four troubling variants have been detected in the United States so far: the UK (B.1.1.7); South Africa (B.1.351 or 501Y.V2); Brazil (P.1.); and California (L425R) viruses. The place names denote where the virus was first detected through genetic sequencing, not necessarily where it originated.
Detecting variants is a labor-intensive process, in which the United States has been lagging. Out of the approximately 7,500 COVID-19 tests conducted daily over a typical recent week in the Rochester region, less than 5 percent are sent for sequencing. Some of these go to a reference lab in Washington, D.C.; others are sent to the Wadsworth Center, the state Department of Health lab in Albany. Our sequencing capacity is limited.
Do we have laboratory confirmation that variants are here? No. Do we expect they might be here? Yes.
It’s possible but unlikely that Rochester has dodged the bullet on troubling mutations. The prevalence of COVID-19 in our community has been declining in recent weeks after a post-holiday surge. The Monroe County Health Department COVID-19 dashboard indicates that from a peak of 18.6 percent test positivity (seven-day average) on April 1, Monroe County was down to 2.7 percent on Feb. 8. However, we are still grappling with a high number of active cases—2,600 on Feb. 8, with a seven-day average of 197 new cases discovered daily.
As an epidemiologist, I am eager to learn what variants we have circulating here, because that information will impact our vaccine strategy, as well as our preventive and therapeutic strategies. I want to know how those variants behave. Are they more contagious? Are they more virulent?
Vaccination helps slow mutation
With variants emerging worldwide, it’s becoming even more critical to get as many people vaccinated as fast as possible. In doing so, you deprive the virus of an opportunity to mutate. Vaccination not only protects against COVID-19, it also can help reduce the severity of the disease for those who do contract it.
The Pfizer and Moderna vaccines currently approved for emergency use in the United States are 95 percent effective against the original strain of the virus, and are thought by the U.S. Centers for Disease Control to be still be effective, though somewhat less so, against the recent coronavirus variants. Moderna is working on a booster shot against the South Africa variant.
Regarding vaccines seeking approval, a one-shot Johnson & Johnson vaccine saw its efficacy rate drop from 72 percent in the United State to 57 percent in South Africa. The biotech company Novavax claims its two-dose vaccine is 89 percent effective, although one study indicates that effectiveness drops to 49 percent for the South Africa strain. The AstraZeneca vaccine was deemed safe and effective enough to gain conditional authorization in Europe, but the company is struggling to manufacture enough doses.
With vaccine scarcity a major stumbling block in the fight against COVID-19, more vaccine options means more power to fight the pandemic. To be approved by the U.S. Food and Drug Administration, a COVID-19 vaccine must prove safe and at least 50 percent effective.
The Rochester region rollout
The Rochester region has both strengths and vulnerabilities in the fight against COVID-19. ZIP codes matter, with areas of high-density housing at greater risk. An analysis of U.S. Centers for Disease Control data by the National Community Reinvestment Coalition last year found that the highest concentrations of COVID-19 in the Rochester area have been in historically redlined ZIP codes. The fight against COVID-19 in many ways coincides with a fight against structural racism.
To meet our COVID-19 challenges, the Rochester area can draw on strong local commitment and expertise, along with a robust health care, academic, research and commercial infrastructure. While the vaccine rollout has been slower than we wanted, the approved Moderna and Pfizer vaccines already have been provided to most frontline healthcare workers in the Finger Lakes region, as well as to nursing home residents and staff.
The main drawback to vaccinating more people has been lack of vaccine supply. That situation should improve over coming weeks and months as manufacturing ramps up, new vaccine brands gain approval, and the Biden administration directs resources toward distribution.
In addition to an adequate number of doses, our vaccine campaign requires a strong supporting infrastructure of vaccine storage capacity, community vaccination clinics, clinic staffing, and an educational campaign about the benefits and the risks of the vaccine, to reduce vaccine hesitancy. Our region’s health departments and health systems have been working diligently on all these fronts.
We also need the funding, infrastructure, and other enabling necessities to sequence more viral samples and discover any variants.
Even with all these measures moving ahead, it still might be months before everyone who wants a vaccine can get one. Meanwhile, the best advice to each person has not changed: Get vaccinated as soon as you can. Understand that vaccination does not mean you can’t still spread the disease; whether vaccine recipients transmit the virus remains unknown. So, wear a mask in public—perhaps even double-mask. Maintain social distance. Wash your hands. Limit the size of gatherings.
That’s how to protect yourself and others, and starve the virus of the opportunity to mutate.
Emil Patrick Lesho, DO, FACP, FIDSA, FSHEA, is a specialist in infectious disease and the health care epidemiologist at Rochester Regional Health.