The Risks in Failing to Control Cases

No one is talking about the SARS-2 variant from New Zealand! Nor does the Taiwanese variant ever appear in the news! That is because the chances of a new and dangerous variant developing is directly proportional to the number of cases in a given area. Every time the virus replicates itself there is a really tiny, tiny chance of some random change in its generic material. Very rarely one of those changes will make the virus more dangerous to humanity. So far, the variants that worry the world health care community, also known as Variants of Concern (VOC), have been found in the UK, South Africa, and Brazil. All countries where there were very large COVID-19 outbreaks. More recently there have been variants identified in New York and California that may become VOCs. The take home message is that variants occur in places where large number of infections are going on.

Variants of Concern come in different flavors. The U.K. variant is much more easily transmitted from one person to another and it may also be slightly more lethal. But one really good piece of news is that existing vaccinations seems to be equally effective against the UK variant as they are against the “original” virus. There is some evidence that existing vaccine’s might be slightly less effective at protecting people from the South Africa and Brazil variant. In the trial of the J&J vaccine which was recently approved for emergency use in the United States, part of the trail was conducted in South Africa, and the effectiveness of the vaccine was shown to be slightly lower there than in the United States. Many have seen this as evidence that South Africa variant has an “escape mutation”, which means the changes allow it to at least partially evade the effect of our vaccination and perhaps even our natural immunity derived from having had a prior infection. Though the numbers remain relatively low, there have been an increased number of reported re-infections in the area where the Brazil variant in dominant. Perhaps indicating that people who have had the “original” virus are still susceptible to the Brazil variant.

Good Video of Viral Mutations by Dr Campbell who does a daily video of COVID-19 news.

If there were no VOCs, the fight against COVID would just be a matter of time. As the number of vaccinated people on the planet increase, the number of new COVID cases would go into decline. The handful of countries where vaccination rates are high, Israel, United Emirates, UK and even the United States, vaccinations are already reducing the number of deaths, and in some cases helping reduce the number of new cases as well.

Any place with a large number of cases, that are not brought under control runs the risk of creating new VOCs. Some of those VOCs might increasingly escape the protection provided by our current vaccines. This situation runs the risk of completely undermining our progress to date. State government’s should be using new cases, not new deaths to guide re-opening plans. My state of Massachusetts has recently reduced restrictions and cases have recently started to increase. Though Massachusetts cases declined tremendously since their peak in early January, daily cases were still 10 times higher now than they were last summer when the state had more restrictions in place.

Daily cases in Massachusetts from https://www.worldometers.info/coronavirus/usa/massachusetts/

In the United States, airlines have promoted cheap travel to Florida, while Florida hotels have offered cheap accommodations, actively promoting the type of activities, and social movement most likely to cause viral transmission. Making matters worse, Florida is where the greatest number of U.K. variant cases in the US have been detected. So vacationing students can get infected there with the U.K. variant and bring it home to their state, school and families. In the United Kingdom where the U.K. variant was the driving force behind the huge spike in cases, the UK instituted a “leisure travel ban” to prevent the kind of spread that will be resulting from the Spring break in Florida. While here in the US we lack the will and social cohesion to take the kind of actions necessary to prevent businesses from promoting the types of activities that are clearly at odds with public health interests.

A distressing form of self-interest seems to have taken hold in the United States. Airlines and Florida hotels place short term profits over containing new cases, the Governor of Florida promotes vacation travelers because its good for the Florida economy and students returning to other states possibility carrying the UK variant does not impact Florida. Each governor, concerned about their state’s economy wants open up as soon as possible. No Governor wants to the “last to open up” after things got better. For each state the chance that a really dangerous VOC will emerge on their turf is very small. The chance of a “Charlie Baker Variant” or a “Cuomo Variant” emerging in Massachusetts or New Your is very small. But collectively, 50 states not worrying about the level of new infections represents a real risk.

This self interest is visible on the individual level as well. From students deciding to go to Florida, to people refusing to wear masks or social distance, and people trying to game their state’s vaccine program to jump the line whenever possible. Individuals are choosing to prioritize what they see as their personal interests over the community interests expressed in public health recommendations.

On the international level we see the same things. Each country focuses on their own self interest, stock piling vaccines, threating export restrictions on vaccine production, and for the most part disregarding the need to address the virus on a global level rather than on a nation by nation basis. Even if everyone in the US is vaccinated, if a variant emerges in a far away land that totally escapes existing vaccines, the US, and the world will face the possibility of a whole new cycle of the pandemic.

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