STATEMENT OF POSITION
The United States is approaching herd immunity through a combination of natural and vaccine immunity. The COVID-19 pandemic is past us. However, the American media has spent the last month hyping reports of genetic mutations in the virus that causes COVID. These variants are said to be highly infectious and more deadly. Pathogen strains from the UK and South Africa, in particular, have been identified in multiple states since December 2020 and continue to grab breathless headlines despite little or no evidence of their additional lethality.
The purpose of this Issue Brief is to describe the two leading SARS-CoV-2 variants in greater detail using the available scientific data and propose evidence-based mitigation strategies based on clinical knowledge and patient experience. As always, America's Frontline Doctors (AFLDS) recommends following the facts as the most effective antidote to media credulity.
FEAR OF THE UNKNOWN
Pathogenic mutation is normal. Viruses mutate all the time, frequently into a state of greater benignity. For instance, the seasonal flu millions of Americans live with every winter was once the fatal Spanish influenza that killed 675,000 fellow citizens in two years. New COVID-19 strains are no different. Any virologist will tell you that viruses change to make a leap from one host to the next while avoiding an immunity or antiviral response. It's that simple.
As Dr. Paolo Zanotto, an expert on the molecular evolution of emerging viruses, has written: "When the amount of susceptible people decreases a lot, the natural selection changes its optimality criteria, and the viruses that are able to be better transmitted are the ones that spread better in a situation of scarcity of susceptible people."
Scientists have detected seven major viral variants in the United States since testing began. With this background in mind, let's take a closer look at the two major international strains, the UK's B.1.1.7 and South Africa's B.1.351:
- B.1.1.7 - Identified in London and South East, UK in December. This variant has been observed to spread more quickly between hosts, but British researchers can only state that the virus is "likely" to be linked to a higher number of hospitalizations and deaths, owing to the small sample size of their population study.
- The variant is believed to be in dozens of countries, including the US, and reportedly spreads 35 and 45 percent more easily.
- However, the Centers for Disease Control and Prevention (CDC) doesn't know if the disease caused by the viral variant differs substantively from its US cousin. As for the effectiveness of available vaccine platforms, the CDC says, "studies suggest that antibodies generated through vaccination with currently authorized vaccines recognize these variants," but that "more studies are underway."
- B.1.351 - Identified in South Africa in October 2020, this genetic mutation appears to be better at evading antibodies, although, as with the British strain, researchers stress more study is needed.
- Researchers believe that the variant could have arisen in patients with weakened immune systems, allowing the virus to reproduce longer.
- A study by Rockefeller University in New York and the California Institute of Technology in Pasadena using blood from patients who had been administered either the Pfizer or Moderna vaccines showed that three major mutations in the South African virus reduced the ability of antibodies to neutralize the virus by a "small but significant margin."
- This variant alone is believed to have at least 20 mutations.
CONCLUSION AND RECOMMENDATIONS
Although the media and certain public health experts are quick to assign new deaths to viral variants present in the US, it's far from clear what is responsible for those fatalities. The most effective approach to combating COVID-19 remains isolating and caring for the frail elderly and those with compromised immune systems while expanding early treatment options for Americans at risk of developing mild to moderate symptoms in order to reduce potential hospitalization. This straight-forward mitigation strategy allows patients to make their own healthcare decisions based on their own circumstances, in consultation with a physician.
It's natural to fear the unknown. But fear should not be a paralyzing feature of modern life. AFLDS believes that current viral variants do not pose an outsized risk to patients and that, given additional study, these mutations will be largely neutralized within the population. Planning, prevention, and attention to personal liberties ought to guide this process.