The United Kingdom's recent announcement of the discovery of a new variant of coronavirus has once again caused panic world over, with several people questioning the transmissibility and virulence of the new strain and if the vaccines in work would still be effective enough. Here is what we know so far.

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On January 30 this year, a third year medical student from Wuhan University, China, tested positive for coronavirus after she returned to her home in Kerala. She was the first COVID-19 patient in India. She recovered fully after nearly three weeks. Shortly, more people were found infected. As on December 24, 2020, 7:58 AM there were 10,123,544 cases and 1,46,778 deaths in India.

Ever since COVID-19 spread far and wide, thousands of researchers in different disciplines worldwide started studies to unravel the behaviour of the virus, its infection potential and related aspects to develop vaccines for prevention and effective drugs for therapy. Now we know a lot about the virus and COVID-19- the disease it causes.

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What is the latest news?

Unfortunately, it seems to be bad news! However, there is no need to panic if we strictly follow recommendations on masking hand hygiene and physical distancing. On 14 December this year, the UK’s health minister informed the British parliament that researchers had identified in south-east England a new variant of the coronavirus associated with faster spread. This led to widespread concern; newspaper headlines highlighted the arrival of “super COVID” and “mutant COVID”. We have yet to find answers to many questions associated with the variant.

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What is so worrying about the new variant?

It is not the first new variant of the pandemic. But it is reportedly 70% more transmissible than the previously dominant strain, in cases in the UK. Reuters reports that this strain dominates in cases of COVID-19 in parts of southern England. Scientists have linked it to an increase in hospitalisation rates especially in London and in the adjacent county of Kent.

However, specialists universally believe that we need not worry excessively if we scrupulously follow the three basic recommendations: Universal masking, frequent washing of hands with soap and water and maintaining adequate physical distance among people. When these measures are in place we have no reason to worry. In any case, we cannot relax these precautions. Though vaccines are available, vaccination against the COVID-19 virus may take time.

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The present status in UK

A press release from the UK Prime Minister’s office announced that many areas notified as tier 3 will now be moved to tier 4. In tier 4 the ‘stay at home’ message will be put in law. As previously done, some exemptions including travelling for work or education, for childcare purposes, and for exercise will continue.

“People should not enter or leave tier 4 areas, and tier 4 residents must not stay overnight away from home. Where people cannot work from home, they should still travel to work, for example in the construction and manufacturing sectors.

Non-essential retail, indoor leisure [such as swimming pools and gyms], indoor entertainment [such as cinemas, bowling alleys and casinos], and personal care sectors such as nail bars, barbers and hairdressers] must all close.

Tighter social contact restrictions will also be introduced, meaning one person can meet with one other person in an outside public space. Rules on support bubbles and childcare bubbles will remain as currently, and communal worship can continue to take place,” the press release clarified. The government decided to review the new restrictions on December 31, 2020.

“The rapid spread of a new variant of coronavirus has been blamed for the introduction of strict tier 4 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," the Health and science correspondent, BBC reported.

According to the BBC, the UK is engaged in urgent talks to unblock its international isolation after more than 40 countries suspended travel links, alarmed by a new coronavirus variant in the UK. Almost all the 27 EU member states are now blocking travellers from the UK. Reports on the birth, behaviour and possible impact of the virus variant occupied virtually all the pages of journals such as the New Scientist and the BMJ and the news agencies such as the BBC news.

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How was the variant detected?

This is a typical instance in which an official agency in the UK is doing its job and also doing it well. The COVID-19 Genomics UK (COG-UK) consortium, which undertakes random genetic sequencing of positive COVID-19 samples around the UK picked up the variant. The consortium is a partnership of the UK’s four public health agencies, the Wellcome Sanger Institute and 12 academic institutions. Apparently, any agency who does any specialised job in related disciplines is in the consortium!

The consortium uses the data to track outbreaks, identify variant viruses, and publish a weekly report. No wonder they have been doing a magnificent job. Such variants identified in the UK may be born in other countries as well.

The BBC quoted Prof. Tom Connor, who was involved in setting up COVID sequencing in Wales, saying that he believes it is "probable" that similar variants are emerging around the world, but they may not have been detected yet.

Relying on statements from various researchers and from other sources, the BBC correspondent reported that other countries such as South Africa, Denmark and Netherlands which have strong genomic sequencing and surveillance systems also identified the variant.

According to the BBC report, Professor Tom Connor revealed that the UK is sequencing at a disproportionate rate; he insisted that the UK has a better surveillance system than other countries. “In order to know how far the variant has travelled or where it came from, you would need to compare notes with other countries - but comparable data very often does not exist," Prof. Connor stated.

Prof. Sharon Peacock, head of Cog-UK, asserted that the UK's high level of genomic surveillance meant "if you're going to find something anywhere, you're going to find it probably here first."

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How common is the variant?

According to the British Medical Journal as of 13 December, researchers identified 1108 cases with this variant in the UK in nearly 60 different local authorities, although the true number will be much higher. These cases were predominantly in the south east of England, but there have been recent reports from further afield, including Wales and Scotland.

The BMJ quoted Nick Loman, professor of microbial genomics and bio-information at the University of Birmingham, telling in a briefing held at the Science Media Centre on 15 December that the variant was first spotted in late September and now accounts for 20% of viruses sequenced in Norfolk, 10% in Essex, and 3% in Suffolk. “There are no data to suggest it had been imported from abroad, so it is likely to have evolved in the UK,” he asserted.

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Does this variant spread more quickly?

In a briefing at the House of Commons on 14 December, the UK Health Secretary revealed that the initial analysis showed that the new variant “may be associated” with the recent rise in cases in southeast England. However, this is not the same as saying that it is causing the rise. Professor Loman accepted that there is striking growth in this variant, which is why we are worried; he asserted that it needs urgent follow-up and investigation.

Based on preliminary modelling data, the New and Emerging Respiratory Virus Threats Advisory Group (NERVTAG) now consider that the new strain can spread significantly more quickly. The government promised that the responsible agencies would continue to analyze the new and existing data as they learn more about the variant.

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Is the new variant more dangerous?

The British Medical Journal (The BMJ) summarised the response to this crucial question thus:

“We don’t know yet. Mutations that make viruses more infectious don’t necessarily make them more dangerous. A number of variants have already been detected in the UK. For example, the D614G variant is believed to have increased the ability of the virus to be transmitted and is now the most common type circulating in the UK, although it doesn’t seem to result in more severe disease.”

The BMJ revealed that Public Health England’s laboratory at Porton Down is currently working to find any evidence that the new variant increases or decreases the severity of disease. The Journal quoted Susan Hopkins, joint medical adviser for NHS Test and Trace and Public Health England, as saying that there is currently no evidence that this strain causes more severe illness, although it is being detected in a wide geography, especially where there are increased cases being detected.

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Will the vaccines and drugs still work?

Finally, the most worrying question is the impact of the mutations on the effectiveness of the vaccines which have been developed now at breath-neck speed and the drugs.

The BMJ stated that the new variant has mutations to the spike protein that the three leading vaccines are targeting. However, vaccines produce antibodies against many regions in the spike protein, so it’s unlikely that a single change would make the vaccine less effective.

However over time, as more mutations occur, the vaccine may need to be altered. This is nothing new; it happens with seasonal flu, which mutates every year, and the vaccine is adjusted accordingly.

The BMJ concluded:

"At this moment there is no evidence to suggest this vaccine will not work against the new variant," European Medicines Agency (EMA) chief Emer Cooke told a press conference as she announced approval of the jab. She was talking about the Pfizer-BioNTech COVID-19 vaccine at a press conference on 21 December 2020.

“The SARS-CoV-2 virus doesn’t mutate as quickly as the flu virus, and the vaccines that have so far proved effective in trials are types that can easily be tweaked if necessary.”

Sharon Peacock, director of COG-UK revealed that with this variant there is no evidence that it will evade the vaccination or a human immune response. “But if there is an instance of vaccine failure or re-infection then that case should be treated as high priority for genetic sequencing.” she suggested.

Speaking on Tuesday, 22 December 2020, the BioNtech chief executive said: "We don’t know at the moment if our vaccine is also able to provide protection against this new variant," ITV news reported. But he added, because the proteins on the variant are 99% the same as the existing strain of the virus, BioNtech has "scientific confidence" in the vaccine.

Prof. Saad Shakir, Director, Drug Safety Research Unit said that reduction in the efficacy of medicines used to treat COVID-19, such as dexamethasone and remdesivir, is unlikely. However, the effects of the new variant on products that use antibodies or monoclonal antibodies need to be evaluated.

“When it comes to the efficacy of the vaccines, assertions have been made by the Chief Medical and Scientific Officers in the UK that the changes in the spike protein of the new variant are unlikely to reduce the protective effect of COVID-19 vaccines. Since the three vaccine forerunners target the spike protein, how the variant responds to the vaccines and the protection that the vaccine will offer does still need to be examined in detail and scientists are working round the clock to answer these questions.” he revealed.

Scientists at the research facility in Porton Down in the UK are growing the variant virus and will examine the interaction between the vaccines and the virus. Studies (cluster clinical trials or epidemiological studies) to examine this question in vaccinees will take much longer.

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Conclusions

Prof Julian Hiscox, Chair in Infection and Global Health, University of Liverpool, said:

“Coronaviruses mutate all the time so it is not unexpected that new variants of SARS-CoV-2 are emerging, we see this all the time in other human and animal coronaviruses. We have great systems in place in the UK to identify these variants to inform a public health response. The most important thing is to investigate whether this variant has any new properties that impact on human health, diagnostics and vaccines. We need robust mechanisms in place to do this.

Prof Mark Harris, Professor of Virology, University of Leeds stated that it is important to point out that it is still the same virus, causing the same disease. He concluded:

“The mechanism by which it is transmitted is also the same, but the genetic changes in this variant appear to enable it to transmit more efficiently, although the biological explanation for this increased rate of transmission remains to be determined. So the key messages to prevent transmission are the same – limit the number and size of gatherings, maintain social distancing, wear masks in public areas, wash hands frequently etc. The virus can only mutate into new variants when it infects people, so reducing the number of infections will also decrease the potential for variation."

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Disclaimer- The views and opinions expressed in this article are those of the author's and do not necessarily reflect the official policy or position of M3 India.

Dr. K S Parthasarathy is a former Secretary of the Atomic Energy Regulatory Board and a former Raja Ramanna Fellow, Department of Atomic Energy. A Ph.D from University of Leeds, UK, he is a medical physicist with specialization in radiation safety and regulatory matters. He was a Research Associate in the University of Virginia Medical Centre, Charlottesville, USA. He served the International Atomic Energy Agency as an expert and member in its Technical and Advisory Committees.