COVID-19: the race against the variants and their migrating mutations

2020 was a challenging year globally. However, the start of 2021 has welcomed the rapid roll out of the breakthrough COVID-19 vaccines in the UK, a ray of hope for a way out of the pandemic. Over 20 million people in the UK have already been given vaccine doses, with the hope that the majority of the UK adult population will be vaccinated by the end of 2021.

Nevertheless the emergence of multiple variants of COVID-19 is still causing increasing concern globally. Viruses constantly change through mutation and many variants of the virus that causes COVID-19 have already emerged, with the following of the most concern in the UK:

• 1.1.7 (UK variant also known as the Kent variant)
• South African variant (also known as B.1.351)
• Brazilian variant (also known as P.1)
  
  

B.1.1.7 is the dominant variant in the UK and was first recorded in September 2020 and has led to a sharp increase in cases. The South African and Brazilian variants are now also present in the UK (although not as widespread) and share some of the same mutations as the B.1.1.7 variant.

All three variants share some of the same mutations as each other. Recent findings by scientists have found that B.1.1.7 has a higher ‘viral load’, making it more likely for the variant to transmit to other people and that the Brazil variant (recently labelled a ‘variant of concern’) may evade immunity provided by past infection and may also spread more quickly.          

Severity

Public health officials are studying the variants quickly to determine whether they cause milder or more severe disease in people. The UK’s New and Emerging Respiratory Virus Threats Advisory Group (NERVTAG) have recently considered data from Public Health England and three universities which have compared death rates between people infected with B.1.1.7 and the older form of COVID-19.

NERVTAG concluded that there was a ‘realistic possibility’ that the virus had become more deadly. All of the studies had found an increase in mortality and it was reported that those infected with B.1.1.7 are 30-40% more likely to die than someone with a different variant. However, this is still being investigated and more studies are needed to confirm this finding.

Symptoms

Recent analysis of symptom data from King’s College London shows no significant differences in COVID-19 symptom types. Furthermore, It has been suggested by research that the new variants of coronavirus share the same key symptoms with the initial strain, which include a high temperature, continuous cough and a loss of sense of taste or smell.

However, the Office for National Statistics (ONS) has recently reported that those infected with B.1.1.7 are more likely to have a cough, sore throat, fatigue and myalgia that those infected with other variants. The data also shows that people with this new variant are less likely to experience a loss of sense of smell or taste. The ONS findings have prompted a review of the COVID-19 symptom list to be potentially expanded, something which has not happened since May 2020.

Long-term effects

The newness and unpredictability of COVID-19 makes it difficult to predict what some of the long-term effects of the new variants will be.

Research in Wuhan found that after six months of the initial COVID-19 acute infection, COVID-19 survivors were mainly troubled with fatigue, muscle weakness, sleep difficulties and anxiety or depression. Furthermore, a study published by neurologists in July 2020 found that a rare brain inflammation called ADEM, triggered by viral infections, appeared to be increasing in prevalence due to COVID-19.

While we are unaware of whether this is likely to occur with the new variants of COVID-19, given that the new variants share similar symptoms to the original strain, there is potential for a similar dormant pattern to occur.

Vaccine variant fast-track

Today (4 March 2021) the UK's medical regulator, the MHRA, has announced new guidance alongside Australia, Canada, Singapore and Switzerland to fast-track the approval of vaccines to combat new COVID-19 variants. This coalition of regulators, known as the ACCESS Consortium, have advised that authorised COVID-19 vaccines that are modified in response to new variants will not need a brand new approval or “lengthy” clinical studies.  This approach is based on the tried and tested regulatory process used for seasonal flu vaccines. MHRA Chief Scientific Officer Dr Christian Schneider stated that: “should any modifications to authorised COVID-19 vaccines be necessary, this regulatory approach should help to do just that".

Comment

Further research still needs to be carried out to establish whether there are any new or increased long-term effects of the variants. There is still a large overlap in symptoms between the original strain and the UK variant, however there are some slight differences in how it might manifest.

On a positive note, early results suggest that the Moderna, Pfizer and Oxford AstraZeneca vaccines can all offer protection against the new variants, although they may be potentially slightly less effective in some cases. Moderna are already beginning to develop a booster shot specific to the new variants.

There is the possibility that more variants will emerge throughout the year, however, the good news is that the COVID-19 vaccines can be tweaked to work against them, which is already happening. However, to avoid any potential product liability risks and implications, such tweaks must be with the relevant regulators’ blessings, that is, authorised by them with reference to any necessary updated safety and efficacy data, which could take time.

For the immediate future, the race will be between the speed at which we can vaccinate against COVID-19 globally and the speed at which the emerging variants can become resistant to the COVID-19 vaccines. To help the vaccination program, it will be essential for these emerging variants to be monitored and for their mutation sequencing to be shared globally in a timely manner.

In spite of the potential risks of these COVID-19 variants and their migrating mutations, the UK Prime Minister’s recent roadmap to cautiously ease the lockdown brings reasons for hope and optimism in the months ahead.

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• COVID-19: vaccine development – UK leading the way with controversial Human Challenge Trials
• Global distribution of a COVID-19 vaccine: aviation’s mission of the century?
• COVID-19 vaccines – bringing hope to many, but presenting challenges to forwarders