A strategy for the new variant of Covid: stay calm and continue to vaccinate

At least we’re learning. Remember when the first reaction to the outbreak of a deadly virus in Wuhan was to discourage people from changing their travel plans?

The South African government has not been content with information about a disturbing new variant of SARS-CoV-2, which the World Health Organization has now dubbed omicron. This did not minimize it. Rather, the authorities shared detailed slides for countries to develop their responses.

It is now up to governments and local authorities to adapt to a rapidly evolving viral image, which remains blurry in places.

Genomic sequencing of infections in South Africa revealed that the B.1.1.529 variant contained many more mutations than the dominant delta variant. More worryingly, some of the mutations occur in the area of ​​the spike protein that is targeted by the antibodies. This could mean that existing vaccines will be less effective, which we should know with more certainty in the coming weeks.

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On Friday night, the WHO dubbed the omicron variant (not “naked,” which seemed to be the Twitter consensus; and, in some conversations, a previous mutation referred to as “mu”). It has also been called a ‘variant of concern’, which means that it contains genetic changes known to affect transmissibility, disease severity, or evade vaccines and therapies.

Certainly, the transmissibility of omicron appears to be extremely high. WHO was alerted on November 24 and said the variant was identified from a sample taken on November 9. It is already evident in most provinces of South Africa, as well as in Botswana, and cases have been found in Hong Kong, Israel and Belgium. On Saturday, the British government said two cases of omicron had been discovered in Britain. It is highly likely that it has spread elsewhere as well.

Although South African officials are unhappy with it, travel restrictions are the obvious first answer. The British government announced on Thursday evening a temporary travel ban in several countries. However, when a flight from Gauteng – the South African province that includes Johannesburg – arrived in London on Friday, some 300 passengers were released back into the wild with only a warning message to self-isolate and pass. some tests. (For a government that has complained a lot about the laxity of French border controls, this counts as an objective against its camp.)

Meanwhile, Israel has implemented new travel restrictions, quarantines and PCR testing at the border. The EU has recommended an “emergency brake” on travel from South Africa. These restrictions only save a little time to plan the next steps. If scientists confirm that omicron can indeed evade the defenses of current vaccines, then the race is on to develop a better defensive weapon.

Pfizer Inc. says it can deliver a vaccine that would counter the new variant within 100 days of sequencing. It’s fast. Regulators like the U.S. Food and Drug Administration are likely to speed up approval processes for vaccines that are only tweaked for new variants. Pfizer estimates it could produce 4 billion doses in the first 12 months. 8 billion additional doses of Moderna Inc. and AstraZeneca Plc vaccines are expected to be available within a similar time frame.

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Even so, testing will need to be done on the updated vaccine. Getting it into enough arms will take many months, even with delivery systems primed by the current vaccine rollout.

Other lines of defense will also be important. It is debated whether the new variant may alter the effectiveness of treatments with monoclonal antibodies, proteins that bind to a specific target in the virus spike protein and may be a key tool in the treatment of early infection and even as a prophylaxis in people vulnerable to serious illness.

Maybe we’ll be lucky. The authors of a study published in the journal Nature in September found the presence of “abundant” neutralizing antibody targets on the spike protein of the SARS-Co-V-2 virus; it apparently takes a lot of mutations to escape vaccines or natural infection. Again, omicron has about 50 mutations and over 30 in the spike protein, many more than the delta variant. Ten of the mutations are found in what is called the receptor binding domain (RBD), which is the part of the virus that first comes into contact with cells; this is compared to two with delta.

Omicron was a statistical probability long before it actually appeared. With a vaccination rate of 24%, it’s no surprise that it first appeared in South Africa. The Hong Kong case involved a vaccinated traveler; the Belgian in an unvaccinated one. The longer it takes to vaccinate entire populations, the faster we will go through the Greek alphabet with new variants; the only way to avoid this is to vaccinate more people faster.

Wherever omicron is seeded, it’s likely we’ll need the now-familiar array of detection and mitigation measures – mask warrants in public places, more frequent testing, and advice for working from home. Although these measures are already back in much of Europe, it would be an unfortunate regression for the United Kingdom, where the wearing of masks is increasingly rare.

South Africa’s transparency and swift response suggest that we are learning at least the first lesson in managing a pandemic: that ‘wait and see’ is a losing strategy.

With the help of Sam Fazeli.

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