COVID Transmissions for 6-7-2021
Important and worrying update on the B.1.617.2 variant
Greetings from an undisclosed location in my apartment. Welcome to COVID Transmissions.
It has been 568 days since the first documented human case of COVID-19. In 568, the Byzantine Empire began to seriously contract, losing Lombardy and Tuscany in invasions. It would never again reach the extent that it had achieved in 555.
COVID-19 is also contracting in the US:
This is a special evening edition of COVID Transmissions due to my weekend having been happily taken over by the lovely experience of a couple of good friends getting married (see Pandemic Life).
In hopes that happy occasions like this will be allowed to continue, I provide today some urgent information about the B.1.617.2 variant, the first emerging lineage of SARS-CoV-2 that genuinely worries me as a candidate to compromise vaccine efficacy. While the news is not good, I am hoping that by sharing it, I will induce everyone to be safe and take the right actions to protect yourselves and those around you. Details follow in the headlines section.
Look, we can do this! We need to keep vaccinating, though, and get the population really protected, but we CAN do this. The data show it to be true.
Bolded terms are linked to the running newsletter glossary.
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Now, let’s talk COVID.
B.1.617.2 variant update: this one I’m worried about
Last week, I shared information about this variant becoming dominant in the UK after first appearing in India. I also shared concerning preliminary findings that this variant is more likely to send patients to the hospital and also potentially more transmissible than other serious variant lineages.
On Friday, I was very concerned to see news that the B.1.617.2 variant also seems to substantially evade the immune response generated by common vaccinations. The report on this, from Public Health England (PHE), indicates that the effectiveness of the vaccines is weakened comparably to previously-observed weakening seen with the B.1.351 variant, which originated in South Africa.
This effect is reportedly most pronounced with a single dose of the vaccine, as described here:
This assessment is supported by some published and preprint work that assesses the ability of the vaccines to produce meaningful immune responses to different variants.
First, there is a preprint reporting vaccine effectiveness with the mRNA vaccines and with the AstraZeneca vaccine, looking at the B.1.1.7 lineage and the B.1.617.2 lineage, and also looking at effectiveness in patients who received 1 dose of these vaccines vs 2 doses.
Against B.1.1.7, all vaccines were around 50% effective after 1 dose and then had performance similar to in their clinical trials after 2 doses. Against B.1.617.2, after 1 dose, performance of all of the vaccines was very poor, hovering in the 30% range for all 3 options. After 2 doses, the mRNA vaccines achieved effectiveness against this lineage that was 80% or better, and the AstraZeneca vaccine came in around 60%, which is also acceptable. However, based on this preliminary report it would appear that the vaccines are somewhat compromised in effectiveness against this variant, but particularly the AstraZeneca vaccine is impacted. Also apparent is that 1 dose simply does not offer close to sufficient protection for this particular lineage. I do not have data on the Johnson and Johnson vaccine from this report, however. I really can’t say if it is impacted—I cannot be 100% certain of the reliability of these results anyway—but if this is a solid result, then I don’t know why that vaccine wouldn’t also be impacted.
You can read the preprint I am talking about here: https://www.medrxiv.org/content/10.1101/2021.05.22.21257658v1
That report is based on real-world experience with epidemiology, but there is also a report from The Lancet (Here: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01290-3/fulltext) that looked at the ability of immune sera from patients vaccinated with the Pfizer vaccine to neutralize different variant viruses. Here’s a key figure from that:
Looking at this, we see that 2 doses of the Pfizer vaccine are much better than 1 when it comes to the B.1.617.2 lineage. There is also a lot of other interesting information we can glean from this, such as the clear demonstration of an overall weakening effect with this lineage, but I wouldn’t make too much of that observation. We know that the vaccine is still effective from the epidemiological data examined earlier; this weakening effect in antibody neutralization is noticeable in the lab, but apparently antibodies are still largely effective despite the drop. What’s clear to me, though, is that there is an explanation for why one dose isn’t enough for B.1.617.2: many patients don’t make a sufficient antibody response to combat this lineage after just one dose. That’s worrisome.
My take home message from all this is that everyone needs to complete their vaccination course as soon as possible, or take very serious measures to avoid exposure to this variant. It has become the dominant variant in the UK and is already present in the US. I expect that it will become dominant everywhere eventually, unless some other variant emerges before that happens. This is the first one I’m quite genuinely concerned about. B.1.351 worried me, but it didn’t seem to be great at disseminating itself. This new option seems to have similar immune evasion to B.1.351 but with the added feature that it transmits at least as well as, if not better than, other lineages.
This is not great news and I urge you to take it seriously. Also please tell your friends, loved ones, and even most distant acquaintances that they ought to take it seriously too. This is important.
What am I doing to cope with the pandemic? This:
Attending a wedding
I had the pleasure of attending the modestly-sized, fully-vaccinated wedding of a couple of my friends yesterday.
2020 was a tough time for anyone hoping to get married, or really for anyone planning any sort of large life cycle event that normally would attract a crowd. Many of the social supports that we rely on were simply not available, even at the most important times.
So, it is really a huge relief to see that vaccination has made it possible for a full event to take place, safely and securely, to celebrate such a joyous occasion.
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No corrections since last issue.
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Always,
JS