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New coronavirus variant: What do we know?

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The rapid spread of a new variant of coronavirus has been blamed for the introduction of strict tier four mixing rules for millions of people, harsher restrictions on mixing at Christmas in England, Scotland and Wales, and other countries placing the UK on a travel ban.

[This content was originally published by the BBC on the 20th December.]

So how has it gone from being non-existent to the most common form of the virus in parts of England in a matter of months?

The government’s advisers on new infections have “moderate” confidence that it is more able to transmit than other variants

All the work is at an early stage, contains huge uncertainties and a long list of unanswered questions. 

As I’ve written before, viruses mutate all the time and it’s vital to keep a laser focus on whether the virus’ behaviour is changing. 

Why is this variant causing concern?

Three things are coming together that mean it is attracting attention:

  • It is rapidly replacing other versions of the virus
  • It has mutations that affect part of the virus likely to be important 
  • Some of those mutations have already been shown in the lab to increase the ability of the virus to infect cells

All of these come together to build a case for a virus that can spread more easily. 

However, we do not have absolute certainty. New strains can become more common simply by being in the right place at the right time - such as London, which had only tier two restrictions until recently. 

But already the justification for tier four restrictions is in part to reduce the spread of the variant.

“Laboratory experiments are required, but do you want to wait weeks or months [to see the results and take action to limit the spread]? Probably not in these circumstances,” Prof Nick Loman, from the Covid-19 Genomics UK Consortium, told me.

How much faster is it spreading? 

It was first detected in September. In November around a quarter of cases in London were the new variant. This reached nearly two-thirds of cases in mid-December. 

Mathematicians have been running the numbers on the spread of different variants in an attempt to calculate how much of an edge this one might have. 

But teasing apart what is due to people’s behaviour and what is due to the virus is hard.

The figure mentioned by Prime Minister Boris Johnson was that the variant may be up to 70% more transmissible. He said this may be increasing the R number - which indicates if an epidemic is growing or shrinking - by 0.4. 

During the talk he said: “It is really too early to tell… but from what we see so far it is growing very quickly, it is growing faster than [a previous variant] ever grew, but it is important to keep an eye on this.

There is no “nailed on” figure for how much more infectious the variant may be. Scientists, whose work is not yet public, have told me figures both much higher and much lower than 70%. 

But there remain questions about whether it is any more infectious at all. 

“The amount of evidence in the public domain is woefully inadequate to draw strong or firm opinions on whether the virus has truly increased transmission,” Prof Jonathan Ball, a virologist at the University of Nottingham. 

How far has it spread?

It is thought the variant either emerged in a patient in the UK or has been imported from a country with a lower ability to monitor coronavirus mutations.

The variant can be found across the UK, except Northern Ireland, but it is heavily concentrated in London, the South East and eastern England. Cases elsewhere in the country do not seem to have taken off. 

Data from Nextstrain, which has been monitoring the genetic codes of the viral samples around the world, suggest cases in Denmark and Australia have come from the UK. The Netherlands has also reported cases.

A similar variant that has emerged in South Africa shares some of the same mutations, but appears to be unrelated to this one.

Has this happened before?

Yes.

The virus that was first detected in Wuhan, China, is not the same one you will find in most corners of the world. 

The D614G mutation emerged in Europe in February and became the globally dominant form of the virus. 

Another, called A222V, spread across Europe and was linked to people’s summer holidays in Spain.

What do we know about the new mutations?

An initial analysis of the new variant has been published and identifies 17 potentially important alterations

There have been changes to the spike protein - this is the key the virus uses to unlock the doorway to our body’s cells. 

One mutation called N501Y alters the most important part of the spike, known as the “receptor-binding domain”.

This is where the spike makes first contact with the surface of our body’s cells. Any changes that make it easier for the virus to get inside are likely to give it an edge. 

The other mutation - a H69/V70 deletion, in which a small part of the spike is removed - has emerged several times before, including famously in infected mink.

Work by Prof Ravi Gupta at the University of Cambridge has suggested this mutation increases infectivity two-fold in lab experiments. 

Studies by the same group suggest the deletion makes antibodies from the blood of survivors less effective at attacking the virus. We have already been supporting members of Vala who have previously been sick with Covid-19, who have contracted the new variant and have become sick again.

Where has it come from?

The variant is unusually highly mutated.

The most likely explanation is the variant has emerged in a patient with a weakened immune system that was unable to beat the virus.

Instead their body became a breeding ground for the virus to mutate. 

Does it make the infection more deadly?

There is no evidence to suggest that it does, although this will need to be monitored.

However, just increasing transmission would be enough to cause problems for hospitals. 

If the new variant means more people are infected more quickly, that would in turn lead to more people needing hospital treatment.

Will the vaccines work against the new variant?

Almost certainly yes, or at least for now. 

All three leading vaccines develop an immune response against the existing spike, which is why the question comes up.

Vaccines train the immune system to attack several different parts of the virus, so even though part of the spike has mutated, the vaccines should still work.

“But if we let it add more mutations, then you start worrying,” said Prof Gupta.

“This virus is potentially on a pathway for vaccine escape, it has taken the first couple of steps towards that.”

Vaccine escape happens when the virus changes so it dodges the full effect of the vaccine and continues to infect people.

This may be the most concerning element of what is happening with the virus.

This variant is just the latest to show the virus is continuing to adapt as it infects more and more of us. 

A presentation by Prof David Robertson, from the University of Glasgow on Friday, concluded: “The virus will probably be able to generate vaccine escape mutants.”

That would put us in a position similar to flu, where the vaccines need to be regularly updated. Fortunately the vaccines we have are very easy to tweak.

Stay safe, use Vala

The new restrictions will have altered Christmas plans for millions of people in the U.K. However we would encourage people to try and enjoy some fun and love with the people they are still allowed to see over the festive period. It’s been a tough year for people, and trying to take some well-needed rest is good for our health and wellbeing.

However, it is now more important than ever to try and follow the health and safety guidance. Remember when you head into your chosen locations for Christmas to always;

  • Try to stay at least 2 metres (3 steps) away from anyone you do not live with (or anyone not in your support bubble)
  • Wash your hands with soap and water often – do this for at least 20 seconds
  • Cover your mouth and nose with a tissue or your sleeve (not your hands) when you cough or sneeze
  • Put used tissues in the bin immediately and wash your hands afterwards

If you are worried about the new strain of the virus, and would like practical help and advice to support yourself, and your entire family, then book an appointment to speak to one of our team. We can also help you manage the symptoms of coronavirus. We will also be able to help you get tested for the disease.

Further Reading

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What are the current coronavirus rules about Christmas in the UK?

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The importance of sleep and how to get it

Why prevention is better than cure when it comes to your health

The Top 10 Most Googled Health Questions That Aren't About Coronavirus

Best therapy apps for managing your mental health at home

COVID-19 will probably become endemic – here’s what that means

Online doctor calls for other healthcare companies to join in Facebook advertising boycott

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