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By Hannah Critchfield
Even as the numbers of cases, hospitalizations and deaths from the novel coronavirus are dropping in North Carolina, there is a potential dark cloud on the horizon. That’s because, as of last week, both the South African and Great Britain variants of SARS CoV2, the virus also known as COVID-19, have been identified in North Carolina.
The South African variant, known as B.1.351, appears to render current vaccines less effective, and the British mutation is significantly more contagious than earlier strains of the virus that have emerged over the past year.
Due to the limited ability to test and identify variants, the number of people infected with these strains may be higher.
“There are almost certainly more cases than have been identified,” said Dr. Whitney Robinson, professor of epidemiology at the University of North Carolina School of Public Health. ”There could really be a sudden burst of more infections, and we need to be ready for that.”
The first B.1.351 variant in North Carolina, which was identified on Feb. 18, was found in an adult “in the central part of the state who had not recently traveled,” meaning they likely caught it from another person nearby. The B.1.1.7, which originated in the United Kingdom, was first identified in North Carolina in late January.
Variants are mutations of the original strain of the novel coronavirus, known as SARS-COV-2.
“When you’re typing on a keyboard, and you’re typing really fast, there’s going to be some errors that naturally happen,” said Dr. Ravina Kullar, an infectious diseases specialist and epidemiologist whose family lives in North Carolina. “Viruses are constantly replicating, so the same thing is going to happen — there’s going to be some errors, some words that are not spelled right because you’re typing so quickly. That’s how variants come about.”
Many of these variants lack any discernible difference from the original COVID-19 strain, and don’t make a difference in how sick a person gets from the virus. Sometimes, however, a mutation in the virus’s genomic coding leads it to be more infectious or makes it more difficult for a person to recover from the disease.
The UK variant, for example, appears to have several mutations on its spike protein, the area that the virus uses to attach to cells. It’s believed to be 50 percent more transmissible than the virus first identified in China last year, and 35 percent more deadly.
The U.S. Centers for Disease Control and Prevention predicts the UK strain will become the dominant strain in the U.S. by the end of March.
The more the coronavirus is able to spread, the more likely it is that variants will occur.
“Viruses can’t mutate if they don’t have hosts to copy themselves and make mistakes,” said Dr. Becky Smith, infectious disease specialist and professor at Duke University School of Medicine. “The more people that have coronavirus, the more opportunity there is for mutations to happen, which is natural — it always happens with viruses.”
‘I would be even more cautious’
While vaccines are slightly less effective on one of the variants, at this point, they appear to still be successful in preventing severe disease from the virus.
Still, future mutations could lead to variants that render existing vaccines less effective.
Reducing spread while allowing states time to get everyone vaccinated – a process that has been slowed by everything from bureaucracy to limited vaccine supply to natural disasters such as last week’s cold weather – is critical to curbing the virus’s ability to further evolve.
“Basically I’m just doubling down on everything I was doing before,” said Robinson. “I’ve been consistent about wearing masks, for example, if I’ve ever in an indoor setting. But I’ve started wearing better quality masks, or wearing a surgical mask with a cloth mask on top of it, to make it fit my face even tighter.”
Because the Great Britain variant is more contagious, everyone now has a greater chance of becoming infected with COVID-19.
“I would be thinking that everyone has that strain, everyone has that variant, so what can you do to protect yourself even more?” Kullar said. “I would be even more cautious about physically distancing when you’re out and about, at the grocery store, et cetera.”
Masks are one area where the public can easily ramp up their prevention efforts, experts said.
The CDC now recommends the public engage in a practice known as “double-masking” – which, if done properly, involves wearing a cloth mask over a medical-surgical mask.
Wearing two masks can both reduce your risk of getting infected and lower your chance of spreading the virus to others.
Limited activity still recommended
In North Carolina, the number of COVID-19 cases is down to pre-Thanksgiving levels, mirroring the drop in infections seen throughout the nation.
As local officials push to reopen indoor dining at restaurants across the country, experts say these venues remain some of the highest-risk settings for transmission of the virus.
“Anything where you’re inside for an extended period of time, meaning greater than 15 minutes, around others whose COVID practices you don’t know, that is of highest risk,” said Kullar. “I don’t think indoor dining is safe yet, especially with these variants circulating around.”
Even if tables are kept six feet apart, studies have shown droplets can travel long distances indoors, particularly if aided by ventilation systems. And by nature, dining requires consumers to take off their masks for extended periods of time.
“Indoor dining was something I wouldn’t do even before the spread of new variants,” said Robinson. “I would advise people if they have been doing it and it seems like it’s been okay, now’s the time to reconsider that — because everything that you do is just a little bit more dangerous now, and unpredictably so.”
Robinson noted that she’s limiting social activities of any kind, dining or otherwise, to outdoor settings.
For employees of these businesses, who are considered frontline essential workers but must wait until March 10 to become eligible for the vaccine, practicing this guidance may be impossible.
“I say do as much protection as you can in that setting, and then really minimize other sources of risk, especially to keep people safe in those settings that you can’t avoid,” said Robinson. “It might be work for some people, or school for others.”
Experts said that in the long term, ordering takeout and trying to reduce the number of indoor customers in these settings is better for both workers and restaurants, which need to shut down each time an outbreak occurs.
Still better than no vaccine
Current research shows the vaccine is less effective on the South Africa variant. This has led some to question whether to even get the vaccine.
The short answer, experts said, is to absolutely get the vaccine.
Vaccines fight against the novel coronavirus by instructing cells to make a harmless piece of the “spike protein” — not by injecting live virus into a person’s body. In response to this spike protein, our immune systems begin building up antibodies. The process teaches our bodies how to protect against future COVID-19 infection.
Existing vaccines appear to be less effective against the South Africa variant because, like the UK variant, it’s undergone changes to its spike protein.
“Enough mutations happened in the coding for that spike protein,” said Smith. “Your antibodies aren’t as specific for it, so they don’t attack it as well.”
The presence of this variant is cause for caution, experts said, but not dismay.
South Africa paused its rollout of the Oxford-AstraZeneca vaccine earlier this month, after finding it substantially reduced protection from mild to moderate COVID-19 illness in people infected with the strain. Yet preliminary data suggests other vaccines are more effective against the South African strain. The African nation has shifted to the Johnson & Johnson vaccine, for example, which is thought to be 57 percent effective in its residents, and 72 percent effective in the United States.
Even among those studied who did contract COVID-19, getting a jab appears to lessen the danger of the virus — not a single person was hospitalized or died.
Moderna and Pfizer vaccines, the only vaccines that have been approved in the United States, appear to prompt the body to release significantly fewer antibodies against the South African strain than other versions of the virus, according to studies released last week. However, while the effectiveness of both U.S.-authorized vaccines against the variant needs further study, they seem to still release enough antibodies to neutralize the virus, companies said.
“We still highly recommend vaccination,” said Smith. “It will still have a very good chance of protecting you – even for the South African variant, we’re seeing that it reduces your chance of getting severe disease.”
Getting vaccinated when it’s your turn is the best way to help curb further spread of existing COVID-19 strains and prevent even more resistant mutations from developing, epidemiologists said.
“Even if it’s not a 97 percent reduction in your probability of infection, but it’s say, a 70 percent reduction, it’s still huge – wouldn’t you want that much reduction in your risk of getting sick?” said Robinson. “And there’s some new, evolving data that vaccines likely lower your risk of transmitting it to others as well.”
This is particularly important when it comes to the South African variant, which may be more likely to reinfect people who have already had COVID-19, increasing the potential reach of its spread.
“We really want to do our best to not have that one become the endemic variety in our country,” said Smith. “Viruses can’t mutate further if they don’t have a host to do it in.
“People should get vaccinated. Having some protection is better than zero protection.”
Smith added that even with reduced efficacy, current COVID-19 vaccines are more effective at preventing infection than annual flu shots offered each year – which tend to be about 40 – 60 percent effective at preventing illness entirely and reduce the risk of an ICU visit by 82 percent.