Experts who predicted the Covid-19 spread in the U.S. over the past year are now considering scenarios for the spread of new, more contagious strains of the coronavirus.
At the same time, the US is still on the lookout for coronavirus variants, despite being one of the most developed genomic sequencing infrastructures in the world.
The warnings come because the U.S. appears to have experienced a devastating winter wave of infections, suffering more than 300,000 new infections and 4,000 deaths a day. Although daily infections have more than halved from the peak, the mortality rate will soon drop, but the threat of the more contagious variants now has the possibility of a new upsurge.
“Unfortunately, this is a bleak projection,” said Ali Mokdad, a professor at the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, one of Covid-19’s leading academic predictors. “I am concerned about an increase in the new variant and the relaxation of social distance,” he said. “People are tired. People are very tired. ”
Forecasters still do not consider this to be the most likely scenario, but also not the worst-case scenario, but the addition of the model is a recognition of how dangerous new variants can be, even in an environment where hospitalization and mortality rates will drop. .
The IHME ‘rapid distribution’ model predicts that total deaths will increase by 26,000 in the most likely scenario by May. Such a prediction would result in a total of more than 620,000 Covid-19 deaths by that time.
The most accurate are often ‘ensemble’ predictions, which attract many individual projections. The ensemble forecast published by the CDC only makes a forecast until February 27, when it estimates that up to 534,000 deaths could occur. IHME also estimates that universal masking can save 31,000 lives.
The best-known variant of concern is the B117 strain, which was first detected in the United Kingdom. B117 is thought to be as much as 50% more transmissible and is now distributed in the US, where 541 cases have been found in 33 states, according to the Centers for Disease Control and Prevention (CDC).
There are still studies being done on how B117 can affect the effectiveness of the two vaccines currently allowed in the US, from Moderna and Pfizer. Another variant from South Africa, called B1351 and recently found in South Carolina, appears to reduce the effectiveness of the vaccine. New strains may also affect the effectiveness of some of the only treatments for Covid-19 patients, including monoclonal antibodies.
“If the new variant makes the vaccines less effective and new variants emerge, we could have a boom in the summer,” Mokdad said.
Variations in how a virus repeats genetic materials are expected, and a feature of how viruses develop over time. This can be especially true for viruses such as the coronavirus, from which the genetic material of ribonucleic acid (RNA) is made, because these viruses do not have a “proofreading” mechanism that reduces mutations. Most changes are benign – like a typo in an article – and do not change the functionality of the virus.
But unbridled, widespread global transmission has given the coronavirus millions upon millions of opportunities to replicate and change as it happens. Among the random, insignificant typing errors are rare changes that change how the virus behaves.
For example, B117 is believed to be more contagious. A more contagious virus is a more successful virus, and through thousands of new infections, natural selection will benefit the successful virus and eventually replace the previous, first dominant strains.
“A small percentage of a large number is still a large number,” said Emily Bruce, a virologist and researcher at the Center for Immunology and Infectious Disease at Larner College of Medicine at the University of Vermont. Variations are a function of the number of people and the number of infections and replications that the virus undergoes’.
Scientists can detect these changes using next-generation sequencing technology. This technology was used in the spring of 2020 to indicate that the origins of a majority of the Covid-19 cases in New York were actually from Europe, not from China as the Trump administration insisted.
While some laboratories have pursued specific projects using this technology, a national, systematic oversight program has never been established. Only in November did the CDC start receiving regular samples of Covid-19 patients from state laboratories. It now processes about 750 samples per week. The US is currently 43rd in the world for Covid-19 genomic sequencing, despite having a well-developed genomic sequencing infrastructure.
“There are people who have done spectacular work here, but it has not been funded and strategized in a national way like the leaders in the field have done,” Bruce said.
The cost of genomic sequencing has cost $ 100 million since the early 2000s, when ambitions to map the human genome, according to the National Research Institute. The succession of one human genome today costs about $ 1,000.
Doctors were hoping to start using this advanced technology, called next-generation sequencing, to tailor treatment to specific patients. This field is presented as ‘precision medicine’, a way in which doctors can tailor treatments to specific patients.
But as in many other aspects of American life, the coronavirus pandemic has revealed weaknesses in the system. Experts said that the lack of a national surveillance program for coronavirus variants largely amounts to a lack of funding.
“It costs a certain amount of money to arrange each tribe, and I’m a brand new researcher. I do not have the money to pay for it,” Bruce said. “And people’s insurance does not pay for it because it is important information, but it will not change the care of an individual patient.”
The sequencing of an RNA virus is less expensive than sequencing an entire human genome because it is much less complex organisms, but it is still much more expensive than a typical coronavirus test that costs hundreds of dollars. This is because skilled labor is needed to interpret the results – including molecular biologists and virologists like Bruce.
“This virus is here to stay,” Mokdad said. ‘We are not going to achieve herd immunity, we are simply not going to achieve that. “It’s going to be seasonal, and it’s going to be like the flu, and we have to be ready for that,” he said.
This leads to another potential need for vaccine manufacturers – vaccine updates to improve immunity to new variants. Moderna and Pfizer are already working on ‘booster shots’ for Covid-19 variants. Experts now recommend double masking to protect against the virus, along with more vigilance at the social level.
These developments have compiled Mokdad from one outcome: ‘I am 100% sure in the winter [2021-22] we will have a boom – but it will slow down our decline. But I am convinced that will happen. ”