My prognostication that Covid-19 infections would abate by early November was wrong. The prediction assumed that herd immunity required 40 to 60 percent of the population to be immune for the virus to find fewer hosts and trail off. The estimate assumed that some groups would be affected less than others due to self-quarantine and distancing, geography, and kindred reasons. The estimate was buttressed by research findings that 40 to 60 percent of persons displayed cross reactive T cell proteins that warded off infection.
However as recent data demonstrates, the prediction underestimated transmissibility due to persons ignoring self-quarantine and distancing, increased travel from infected to non-infected areas, increased interactions in closed spaces associated with return to schools, workplaces, commercial centers, restaurants, family gatherings, and arguably, more transmissible variants of Covid-19. Therefore, the United States contends with a “second” or “third” wave of the virus with infections and mortality that exceed than any other country in the world. The economy, small business, education, social and personal well-being have all been grievously affected.
The haphazard and variable response to Covid-19 by the US Federal government, states, and municipalities has not helped and, cynically, seems designed to promulgate the virus. Lockdowns in one state coupled with open interactions in another state sustain the virus, so that as a state reopens, the conserved virus may be reintroduced. Lacking national coordination, the virus finds a safe harbor.
The US government handling of Covid-19 contrasts with the Asian, New Zealand, Australian responses where the virus is effectively contained. Europe, absent England, falls in between. Countries that have contained the virus have done so by isolating infected persons and hotspots. When the virus is allowed circulation in one location or another, the “safe harbor” area operates like a petri dish where new variations of the virus evolve and are transmitted. The larger the petri dish, the more infected individuals, and the greater the likelihood of new mutations.
A December 2020 paper by Koyoma, Platt, and Parida, published in the Bulletin of the World Health Organization, summarized Covid-19 genetic sequences from large databases through May, 2020 and reported, “… 5775 distinct genome variants, including 2969 missense mutations, 1965 synonymous mutations, 484 mutations in the non-coding regions, 142 non-coding deletions, 100 in-frame deletions, 66 non-coding insertions, 36 stop-gained variants, 11 frameshift deletions and two in-frame insertions.”
Covid-19 evolves quickly and is a moving target. This fact has been brought to public awareness by the recently publicized Covid-19 variant VUI – 202012/01 widely distributed in England reputed to be 70% more infectious than the already highly infectious common forms. In late December 2020, the variant was found in Colorado and California.
The presence of this strain presents new challenges to US public health. The VUI – 202012/01 variant may be widely distributed in the US., and as recently reported, not just a matter of two or three people in Colorado and one in California. The US public does not know since no systematic government sampling or reporting occurs. The Centers for Disease Control and Prevention (CDC), the agency purportedly responsible for public health, has dropped the ball.
The major risk attendant to current US policy, or lack thereof, is “rotating petri dishes”, as one state or region opens, and others close. This policy virtually insures the continued evolution of new strains of the virus. Only confining petri dishes until the virus plays out and not allowing transfer to new locations will stifle the virus. As Koyoma, Platt, and Parida conclude “The number of people with confirmed COVID-19 has rapidly increased over the last five months with no sign of decline…. The fight against COVID-19 will be long, until vaccines and other effective therapies are developed.” This fight may be long because changes in the virus may negate earlier treatments or reduce effective vaccines. Yet the fight must not be resigned. The cost of this virus is not only morbidity and mortality, but a declining economy, failing businesses and education, social disharmony, and loss of global influence and prestige.
The optimum political and social solution to the pandemic is availability and widespread acceptance of an effective vaccine. A vaccine has the potential to quickly limit the pool of susceptible persons. The consequence is rapid decline and die-off of the virus.
Absent an effective vaccine, containment of the virus requires unpopular government actions. The actions hinge upon restriction or containment of citizen movement in affected areas until the virus is quelled. How this solution has been implemented has been all important to citizen acceptance and social harmony. Government measures, employed by countries around the world, vary in severity. At one extreme, police or army restrict travel within areas or districts. Moderate approaches include individual quarantine, curtailment of domestic airline passenger service; border and district checkpoints, and mandatory tests for work, school, or travel. The other extreme is hap-hazard, laissez-faire management evident in some states and municipalities.
Just as the writer was wrong about the virus declining in November 2020, the writer hopes he is wrong about the resiliency of Covid-19. Viruses usually evolve to less lethal forms, since only in this way can viruses survive. The vaccine may prove to be the magic bullet that puts the virus to rest and render Covid-19 a fading memory.
References
Abdullahi, I. N., Emeribe, A. U., Ajayi, O. A., Oderinde, B. S., Amadu, D. O., & Osuji, A. I. (2020). Implications of SARS-CoV-2 genetic diversity and mutations on pathogenicity of the COVID-19 and biomedical interventions. Journal of Taibah University Medical Sciences, 15(4), 258–264. https://doi.org/10.1016/j.jtumed.2020.06.005
Bal, A., Destras, G., Gaymard, A., Regue, H., Semanas, Q., d’Aubarede, C., Billaud, G., Laurent, F., Gonzalez, C., Valette, M., Bouscambert, M., Lina, B., Morfin, F., Josset, L., & Group, the C.-D. H. S. (2020). Two-step strategy for the identification of SARS-CoV-2 variants co-occurring with spike deletion H69-V70, Lyon, France, August to December 2020. MedRxiv, 2020.11.10.20228528. https://doi.org/10.1101/2020.11.10.20228528
Grubaugh, N. D., Hanage, W. P., & Rasmussen, A. L. (2020). Making Sense of Mutation: What D614G Means for the COVID-19 Pandemic Remains Unclear. Cell, 182(4), 794–795. https://doi.org/10.1016/j.cell.2020.06.040
Koyama, T., Platt, D., & Parida, L. (2020). Variant analysis of SARS-CoV-2 genomes. Bulletin of the World Health Organization, 98(7), 495–504. https://doi.org/10.2471/BLT.20.253591
Mahase, E. (2020). Covid-19: What have we learnt about the new variant in the UK? BMJ, 371, m4944. https://doi.org/10.1136/bmj.m4944