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The rise of coronavirus variants will define the next phase of the pandemic in the United States



The bottom line on all three remains positive. In laboratory studies, vaccines are as effective against the variant identified in the United Kingdom as they are against the original virus strain. And there is only a modest drop-off in their effectiveness against two others.

“These variants arose because we continued to give the virus a greater chance of spreading,” said David D. Ho, whose laboratory at Columbia University is leading the research on the P. 1 variant, which was first discovered in Brazil. “The sooner we vaccinate everyone, the sooner we will contain the virus spread and reduce the chance of new variants emerging.”

But the overall picture hides problems in some places. One or more of the variants – which also cause more serious disease than the original version of the virus – run through the Northeast and Midwest. It has prompted officials in some communities to ask for more vaccine than they would receive under the government’s population-based formula. Officials in the Northwest are seeing a major outbreak of the P. 1 variant in British Columbia.

“We need more vaccine here on the Cape, now,” said Bruce G. Murphy, health director for the city of Yarmouth, Mass., On Cape Cod, which has 82 active cases among the population of just over 23,000.

Mass vaccination centers in the Boston area are of little help to Yarmouth residents, especially the elderly who cannot travel, Murphy said.

“If we look at 13 [cases], it could just be the tip of the iceberg coming in, ”he said.

Michigan has also asked for more vaccine to control an astonishing wave, with its average daily coronavirus caseload rising from 1,503 on March 7 to 7,020 on Wednesday, according to CDC data analyzed by The Washington Post.

Asked whether the administration will ever change its strategy, Andy Slavitt, senior adviser to the White House coronavirus response team, said Wednesday that the government is already able to move vaccine supplies from other parts of a state to hardest-hit areas.

“We get the amount of vaccines that we think are needed by the population because they are basic,” Slavitt said. “And then we work in very tactical areas. . . how to maximize that vaccine distribution so we get the things we want: efficiency, health balance, and the other goals we have. ”

In addition to these three variants, the CDC considers two in California as “variants of concern” and follows them closely. It also monitors a variant found in New York City.

With most of the rest of the world far behind with immunizations, the virus will continue to spread and mutate, each copy with the potential to trigger a variation that current vaccines are unable to control. The odds of that remain low, experts say, but they are not zero.

“I’m afraid there’s going to be a terrible variant that comes out and takes us back to the front row,” Ho said.

But experts said vaccines could be boosted, and new ones developed, to address any variants that arise.

As of April 6, there were 16,275 cases of B.1.1.7, 386 of B. 1,351 first detected in South Africa and 356 of P. 1 in the United States. Experts believe that the actual numbers are much larger, but because of the United States’ efforts to sequence the virus genes of the genome, it is difficult to know how widespread the variants really are.

“The landscape is this big explosion in the UK, the worrying recovery in p. 1 and then others stems as well,” said Daniel Jones, vice president of the Division of Molecular Pathology at Ohio State University Wexner Medical Center. Within a few weeks, he said, there will be enough infections in the United States to collect better data on the immune response from humans rather than through tests in a laboratory.

Lab tests usually involve looking at one mutation at a time; the variants that circulate can have many, said Stephen Kissler, an immunology expert at the Harvard TH Chan School of Public Health.

And “the human immune system is much more complex than we can imitate in a petri dish, so we can only get partial information,” he said.

Found in more than 24 countries and 25 U.S. states, P. 1 is thought to be up to 2.2 times more contagious and 61 percent more contagious than the original form of the virus. In other words, it produces a greater viral load, which is likely to make people sicker.

Some experts have wondered whether competing variants have slowed the spread. Northern California, for example, is dominated by B.1.427 / B.1.429 cases, while Southern California has a higher proportion of B.1.1.7.

“We see different variants in different parts of the country competing to take over the populations,” said Benjamin Pinsky, medical director of the Stanford Clinical Virology Lab.

For now, B.1.1.7 seems to be dominant. According to the latest data from Helix, a company that works with the CDC to track variants, B.1.1.7 makes up about 50 percent of all case-sequenced cases in the United States.

“My feeling is that if you went in a boxing ring with all the variants, the British variant would win in terms of transferability,” said Peter Chin-Hong, an infectious disease expert at the University of California at San Francisco.

The immune response to the P. 1 type “will be better than the South African variant, but probably not as good as the British variant,” Ho said.

The varieties discovered in California appear to be potentially more benign than the others. Several states with B.1.1.7 increases have reported unusual outbreaks among school children spreading to their communities, but this has not been the case for California variants.

“We have dropped hospital admissions really low” in areas where B.1.427 / B.1.429 is becoming dominant, Chin-Hong said. “You expect to see more cases among children and spring breakers, but we have not seen that. It suggests that it does not mark its territories by making younger people sicker. ”

In Canada, public health officials have struggled with the largest increase in P. 1 variant outside of Brazil. There were more than 787 cases in British Columbia as of Tuesday and a small but growing number in the adjacent province of Alberta. It has sick young skiers at the Whistler Blackcomb resort and workers in an energy company. 21 players and four employees of the Vancouver Canucks hockey team have been infected with a variant of the virus, although the team has not decided which one.

Deena Hinshaw, chief medical officer of Alberta, tweeted on Monday that her team was investigating a P. 1 outbreak linked to “a major employer” that began with a traveler returning from a trip out of the province. She said there was a separate labor outbreak in another part of the state.

Hinshaw said the province had identified 887 new cases during the previous day and that 39 percent of the active cases are now variants.

In Connecticut, the variant first discovered in the United Kingdom has helped 20- to 29-year-olds with the highest rate for any age group in the state. Whether it reflects the characteristics of the variant, relaxed precautions among young people or vaccinations that protect the elderly – or a combination of the three – is not clear.

Another variant, originally discovered in India, has made headlines in California this week as a “double mutant” because it contains properties from the variants first discovered in California and Brazil / South Africa.

Described by Indian researchers on March 24, it was first identified in the United States on March 25 in a patient in the San Francisco Bay Area.

Pinsky said “it is too early to tell how this variant will work. We know how these individual mutations alter the virus, but we have not been able to see how they behave in combination. ”

Brazil, now fully in control of the P. 1 variant, shows how quickly it can take control when not taken seriously. In the Amazon rainforest, it quickly destroyed the city that spawned it, then stormed south. It was soon widespread across the country – and its attack on Brazil, now in the midst of a nationwide medical failure, has been merciless ever since.

Nearly 67,000 Brazilians died of covid-19 – the disease caused by the virus – in March, more than double that of any other month during the pandemic. The highest number of deaths – 4,195 – was recorded on Tuesday. Researchers have not proven that the variant is more lethal. But doctors and health officials in Brazil say it has signaled a darker and more deadly phase of the pandemic.

The degree of vaccination in Brazil lags far behind the rate in the United States.

Patients arrive much sicker – and much younger.

“The nationwide P. 1 variant is clearly contributing to the increase,” Sylvain Aldighieri, a senior official in the Pan American Health Organization, told reporters last week. “We also receive signals and reports in various states that young adults are hospitalized in higher numbers.”




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