Mind the Mutations
MEDICAL AND MENTAL HEALTH UPDATE
Attack of the Mutant Virus would make a great movie title, but what to do when we’re living through the horror show?
As you probably know, coronavirus variants have been discovered in the UK and South Africa and are now being detected all around the US. While this news is concerning, it’s important to understand the facts and practical implications of the variants before we admit defeat and (re-)assume the fetal position.
What do the coronavirus variants mean, and how should their existence change your day-to-day behavior?
Let’s be clear: viruses mutate. That’s what they do. And as the genetic code of a virus shifts, every once in a while, a virus gets lucky by mutating in a way that helps it survive and reproduce. Any change that allows a virus to survive or replicate more readily inside the host (e.g. the human nostril) gives that virus a competitive advantage.
The novel coronavirus is no exception; it is thought to have mutated thousands of times already. This time, the mutations have enabled the spike protein on the surface of the virus to lock onto and infect human cells more efficiently.
The current coronavirus variants are not more lethal. Nor do they cause more severe illness. The problem is that they seem to spread more easily (by some estimates up to 50%). What is the mechanism for increased contagiousness? We don’t know for certain. Epidemiologic studies so far suggest that the variant viruses may more readily latch onto the inside of our noses when we breathe it in, thereby allowing it more readily to replicate, increase our “viral load,” and infect our friends when we breathe/sneeze/talk around them.
Meanwhile, there is no evidence that the coronavirus variants can fundamentally evade masks, social distancing, or other risk mitigation measures. Masks still work. Distancing still works. Being outdoors is still better than indoors. The new variants simply poke through any holes of risk mitigation more easily.
Upshot: if you got away with breaking the rules in the past, you may not be so lucky now. You are more likely to get infected, all else being equal. And as a result of increased contagiousness, the new strains can sicken and kill more people and more readily overwhelm our already fragile healthcare system.
It takes time for a virus to mutate. So it’s not surprising that these variants are being identified now, given the enormous amount of time the coronavirus has had to naturally select for more contagious versions of itself. We humans are giving the virus loads of time to shift and mutate. Remember the lockdowns in the spring? It’s not that I enjoyed eating baked beans from 2017 from my cupboard back in March, but the lockdowns weren’t long enough. Many cities still do not mandate masks and not everyone is doing a great job of distancing. Just look at the airports at the holidays!
According to the Institute for Health Metrics and Evaluation data, we’d crush this virus in 8-10 weeks if we adopted universal mask-wearing in the US. If we layered strict social distancing, we’d lick this virus even sooner.
We’re in a race against time, and right now the virus is winning.
The good news? WE CAN DO IT. We need to employ three strategies at once:
We need to tighten up and layer all risk mitigation elements (aka MOSHPIT). To reiterate, there is no evidence that the coronavirus variants can fundamentally evade masks, social distancing, or other risk mitigation measures; we simply need to be more strict about implementing them. The sooner we strictly adhere to these behaviors, the sooner the virus loses its opportunity to mutate.
We need widespread vaccination. Once we get the vaccine out of refrigerators and into people’s arms, the virus won’t be able to spread like wildfire, mutate further, and gain an even more competitive advantage. Today in DC Mayor Bowser announced that the vaccine will be rolled out according to plan: for District residents ages 65 and over starting this week through DC's online portal. And as of this morning, at least some Virginia residents in phase 1 (people ages 75 and above, frontline essential workers, and healthcare workers) are able to sign up to receive the vaccine on this site.
We need widespread, frequent COVID testing. The more we test people without symptoms and isolate asymptomatic carriers of the virus, the more we shut down community spread. Invisible spread by people who don’t know they’re infected continues to be the main driver of this catastrophe.
The other good news?
The Pfizer vaccine still works (for now). Moderna’s should, too. It makes sense biologically: the virus hasn’t had enough exposure to vaccinated individuals to develop a competitive advantage over the immune system of vaccinated people. At some point, however, the virus likely will evade the vaccine. When will that happen? We just don’t know yet. But if and when it happens, we’ll need to adjust the coronavirus vaccine to outsmart the virus—similar to the way we adjust the flu shot for new flu virus variants every year.
The mRNA vaccines (like Pfizer’s and Moderna’s) are much easier to adjust than other types of vaccines as the virus mutates. The technology is sophisticated enough that scientists can simply plug in the new genetic sequences we need to generate the appropriate immune response from the host.
What’s the upshot of the upshot?
Be afraid of COVID-19. Coronavirus’ more contagious variants are better able to slip through the cracks of our risk mitigation layers, so don’t let your guard down. HERE is a clip from my interview with NBC last week on the riskiest activities at the moment.
Know that we have the tools to fight COVID-19, and use them when you can. We have so much more control over the virus than we think!
Get tested. If you think there’s any chance you might have had a contact, get tested.
Get vaccinated when your turn comes. It could save your life and that of someone else.
Hope is alive despite a brutal start to the New Year. Instead of panicking, let’s stay alert, informed, and motivated to be safe. That way, we'll be in a much better place later this year.
I will check in later this week. Until then, be well.
P.S. Join me and Dr. Ackerly Facebook live TONIGHT at 8 pm. We will discuss these very issues. Bring your questions!