SARS-CoV-2 Variants of Concern in the United States—Challenges and Opportunities
JAMA, 17th February, 2021
https://jamanetwork.com/journals/jama/fullarticle/2776739?utm_source=jamalive&utm_medium=social_jama&utm_campaign=product_marketing&utm_term=walensky0217&utm_content=manual_mb
Rochelle P. Walensky, MD, MPH1; Henry T. Walke, MD, MPH1; Anthony S. Fauci, MD2
January 10, 2020, the first genomic sequence isolated in Wuhan
As of February 3, 2021, 468,000 sequences uploaded to public domain
3 specific viral lineages reflecting VOCs, B.1.1.7, B.1.351, and P.1.
B.1.1.7 lineage
September 2020, first detected, UK, December 2020
In at least 80 countries
In at least 33 US states
B.1.1.7, potential, reverse the present downward trend in new infections
Highlighted the risk of domestic and international travel
February 3, 2021, B.1.1.7 variant in the US is now approaching 1%, with prevalence in some states exceeding 2%
B.1.351 lineage
October 2020, South Africa, December 2020
In at least 41 countries
South Carolina and Maryland
Demonstrated reduced response to previous ‘wild type’ antibodies
Lymphocyte response may well be the same
P.1 lineage
December 2020, travellers from Brazil
Minnesota
Zambia
B.1.351 variant
Early December to 22 of 23 samples (96%) sequenced
December 2020 to early January 2021
16-fold increase in COVID-19 incidence
The possibility of a similar experience in the US is a real threat
First
Level of community transmission must be aggressively decreased
consistent use of face masks,
physical distancing,
restrictions on high-risk and high-capacity settings,
frequent hand washing,
delaying travel,
widespread diagnostic testing and screening to swiftly identify and isolate infectious individuals,
particularly those who are asymptomatic, and quarantine contacts
Second
Increased genome sequence surveillance
Third
CDC’s 750 samples per week, to more than 6000
Fourth
Accelerate SARS-CoV-2 vaccination nationally and globally
CDC is leading a comprehensive suite of studies to assess the actual effectiveness of these vaccines
Looking out for breakthrough infections
Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine
https://www.nejm.org/doi/full/10.1056/NEJMoa2034577
NEJM, (December 31st)
A two-dose regimen of BNT162b2 conferred 94.8% protection against Covid-19 in persons 16 years of age or older
After 1 dose, efficacy = 52.4%
NEJM, (17th February)
But if you take data after 2 weeks ….
https://www.nejm.org/doi/pdf/10.1056/NEJMc2036242?articleTools=true
One Pfizer dose, vaccine efficacy of 92.6% (based on FDA data)
One Moderna dose, vaccine efficacy of 92.1% (based on FDA data)
Uncertainty about duration of protection with a single dose
Administration of a second dose within 1 month, little added benefit in the short term
Leaving high risk groups completely unprotected
Postponement of the second dose is a matter of national security that,
if ignored, will certainly result in thousands of Covid-19–related hospitalizations and deaths this winter in the United States
hospitalizations and deaths that would have been prevented with a first dose of vaccine.
Source