We are barely a week into 2021 and already there are urgent warnings about a novel pandemic virus strain spreading surreptitiously and exponentially across the world.
This seems like déjà vu. But in a sense that’s a good thing: This is not just another chapter in the exhausting saga of SARS-CoV-2, the virus that causes Covid-19, which newly available vaccines will slowly bring under control.
Humanity wasn’t remotely prepared for our struggle with SARS-Cov-2 when it emerged late in 2019. So we lost to it.
But we are better prepared for this new enemy, called B.1.1.7, or B-117 for short.
We already understand how this new virus spreads, which public health strategies can help contain it, and how to effectively treat people infected with it. We’re already performing millions of diagnostic tests each day that can sensitively detect the new pathogen and distinguish it from our old foe.
Anyone who has already had Covid-19 is highly resistant to B-117, a variant of SARS-CoV-2. So in one respect the old virus is helping us against the new one. Most important, the new vaccines that have been developed against SARS-CoV-2 and that are being rolled out in the U.S. and several other countries around the world are likely to protect us against B-117, meaning vaccination campaigns could defeat both viruses.
Yet B-117 has two critical advantages. One is that we’re justifiably exhausted from fighting Covid-19. People may struggle to muster the energy to respond to a new viral threat, especially when the rise of the new virus is hidden in the larger sea of SARS-CoV-2 cases. The other is that cases of B-117 can rise far faster than those of our 2020 foe. In the United Kingdom, where B-117 appears to have evolved, most districts that imposed Tier 4 stay-at-home conditions kept SARS-CoV-2 cases flat only to see B-117 increase 10-fold every three weeks or so. The same pattern of exponential growth seems to have begun in Denmark.
What might this mean for the at least 32 countries outside of the U.K. with confirmed cases of B-117?
Assume that your community is using masks and distancing to maintain flat SARS-CoV-2 transmission levels, but it has detected a single case of B-117 (plus 1,000 cases of SARS-CoV-2). In three weeks, your community may have ten daily B-117 cases (plus 1,000 SARS-CoV-2 cases). In six weeks, there could be 100 cases of the novel variant (plus 1,000 SARS-CoV-2). In nine weeks, half of all cases may be B-117, and the number will continue to increase even once the spread of both viruses slows due to infection and vaccination building up immunity in the population. These estimates are meant to illustrate what can happen, but are consistent with what we know about the comparative spread of B-117 and other strains of SARS-CoV-2.
Because B-117 can grow exponentially even in communities that are keeping SARS-CoV-2 under control, the situation is extremely urgent. If we want vaccination to win this new race, we have to slow down the new virus while it’s still rare.
Step one is to find the enemy. Each week, Thermo Fisher makes 20 million TaqPath test kits capable of detecting B-117, which exhibits a pattern of “S-gene dropout” that distinguishes it from SARS-CoV-2. These kits, an equivalent of the PCR tests used to detect SARS-CoV-2 infection, and/or genetic sequencing can be used on samples that already tested positive for SARS-CoV-2 to see which of them were actually B-117. No emergency use authorization is required to further analyze positive samples.
Step two is to redirect resources to the new and faster-spreading threat. Testing and contact tracing can slow the spread of rare pathogens such as B-117, but become comparatively ineffectual when there are too many cases. Multiple models (including one developed by one of us, K.E.) show that tracing bidirectionally to find both the sources of infection as well as those exposed to it can prevent more than twice as many cases as standard methods.
This suggests that as soon as the first person is diagnosed with B-117 in a community, local contact tracers should drop everything else in order to map the complete chain of transmission of the new strain using every resource available. Veteran tracers can visit the homes of contacts to provide medical advice, take samples to be mailed to labs to be tested for B-117 with next-day results, and offer supplies to people who need to self-quarantine.
Widely publicized guarantees of legal exoneration for anything revealed in the course of contact tracing could help combat mistrust. Governments should also offer financial compensation and job preservation to exposed individuals self-quarantining at home and B-117-positive people isolating, if necessary, in publicly provided hotel rooms or other accommodations. Because this new threat remains rare in most of the world, we have a second chance to apply the testing and tracing countermeasures that helped contain the initial spread in some locations, and that faltered in many others because SARS-CoV-2 had already become too widespread.
Step three is to consider diverting doses of Covid-19 vaccines to any region with large clusters of cases for whole-community vaccination. To be clear, we have very limited data showing how well the current vaccines prevent infection or transmission of B117. Yet the data we do have suggest the effect could be substantial, as it is for virtually all other viral vaccines.
Given the tremendous importance of blocking B-117’s exponential growth early, it seems worth swiftly trying this approach, monitoring the results, and adapting as we learn how well it is working. We didn’t have this potential silver bullet last time. Now it could turn the tide.
Two other steps are needed. In the immediate term, diagnostics must be developed that can detect other SARS-CoV-2 variants of concern, such as the 501.V2 strain that has appeared in South Africa but is not yet known to have spread to the U.S. or to many other countries harboring B-117. This variant does not yet appear to be as transmissible as B-117, but questions about how vulnerable it is to the Covid-19 vaccines have not yet been resolved.
Starting now, over the next few years we must build a genomic monitoring system to detect evolutionary changes in viral, bacterial, and other pathogens that could require new measures to protect public health, and that could detect new pandemic pathogens of any provenance early enough to intervene. The need is global, so as the US upgrades domestic systems, we should be learning from the experience of countries that have been more agile in spotting new variants, such as the U.K. and South Africa, and helping others to set up their own systems.
Genomic monitoring will be a central pillar of the larger project to massively upgrade the public health information systems that failed at many stages of the current Covid-19 pandemic.
Those who are fatigued and impatient for the pandemic drama to end — a category that includes both of us — can take comfort in the fact that the light at the end of the tunnel is still getting brighter, even though the emergence of B-117 adds an extra measure of urgency. Biologically, the new virus is an evolved variant of SARS-CoV-2. Epidemiologically, it appears to be a distinct and more formidable enemy, but one for which we are far better prepared.
It’s 2021, and a different race has begun. Let’s win this one.
Kevin Esvelt is an assistant professor at the Massachusetts Institute of Technology’s Media Lab, where he directs the Sculpting Evolution Group. Marc Lipsitch is a professor in the Departments of Epidemiology and Immunology and Infectious Diseases at the Harvard T.H. Chan School of Public Health, where he also directs the Center for Communicable Disease Dynamics.
This article is making is sound like B-117 is akin to Ebola, and it is going to destroy us. It appears to be more infectious than covid, but it is not more virulent. And most people with covid have no symptoms or mild ones. Only about 5% go to ICU and mortality is about 1-2% depending on whose stats you look at, some are as low as ).5%. And yes, it can cause problems long term and affect other systems in the body, but the bottom line is that most people are fine. So stop trying to whip everyone up into a frenzy. Almost half of all deaths in the US are in nursing homes, so we know who the most vulnerable people are. Methods of reducing transmission need to be geared towards the most vulnerable while allowing others to get back to work and to their life–for many, the consequences of lockdown are far worse than the virus and there has to be a balance. Articles like this don’t help. As someone mentioned in one of the comments, the authors or editors don’t read the comments so I wonder why I bother. STAT publishes good stuff, but occasionally garbage like this.
So… at the US Capitol riots… were you one of the terrorists with a Confederate flag or with an Auschwitz tshirt? Or did you just cheer them on at home while spinning conspiracy theories on Parler? Because you’re not fooling anybody.
The steps for delaying peak B-117 are clear. What is also clear is none of these steps will be taken. To execute this would require swift, decisive, and intelligent decision-making on incomplete information. The US health agencies best equipped to make these decisions just don’t have the incentive, direction, funding, or flexibility to make the required decisions in time to do much of anything.
The title is partly correct that we have lost the battle. The rest makes no sense. “Find the enemy” is really our lack of a national plan. That has been the “enemy.” Focusing on testing and contract tracing has failed. We need one strategy: High Throughput Covid-19 Vaccinations ASAP. So far we 50 different approaches that are not working.
the united states is well below the average covid deathrates.
lower than canada, uk, france, italy, sweden etc. people do some actual research.
Not B117!
It is called B 1.1.7!
Last I heard the vaccine works against it!
STOP TRYING TO PANICING PEOPLE!
I’m not sure what the point is in commenting here, since I doubt either of the authors, or any other person with any power to affect pandemic response, ever looks at these comments. But they’re otherwise completely insulated from feedback, so here’s a shot.
Look, there is no “we” here. There never has been. There’s well-off, economically stable professionals like yourselves who can count on support and continued career and a life. And then there’s a bunch of us who have no stability, no support, and absolutely nothing to look forward to in the years to come. Even when this pandemic ends (if it ends, which it sounds like it never will), we have no reason to expect that our lives will get any better or that we’ll ever make up what we lost.
And just speaking for the people I know here, even with all that, we did everything you told us to do! A lot of us are still doing it! We do all the masking and social distancing and handwashing we can. We try not to get sick at work, or we try to get by with *no* work. We try to keep our loved ones safe, which I guess *is* a lot easier when we have no prospect of seeing them again for years and years, if ever. We’ve taken our lives and dutifully put them aside to try and fight the pandemic. And our reward has been half the country siding with murderous conspiracy theories that ensure this pandemic will never be gone. Meanwhile the people with power and influence – you – tell us over and over to “hunker down,” and chide us for any weakness we show, any failing, anything less than 100% personal sacrifice.
And many of us are still going to keep making that sacrifice to try and save lives. I don’t really know why, anymore, but I’ll keep doing it.
All I ask is that you just stop talking about “we” and “us,” and stop talking about a light at the end of the tunnel. There is no light at the end of the tunnel for me. This pandemic has turned the last decade of my life into a waste, and the next decade into an black hole. And of course there’s the runaway pandemic + new variants + crippled vaccination program, which together mean that the vaccines will certainly be rendered useless before I even have a chance to get one.
Just be honest, that’s all.
I completely agree with Leo though I am in a different situation. As a biomedical scientist, I understand that these viruses could be the end of us. We are promised vaccines, we find new variants we don’t fully understand, the vaccines are not being distributed effectively and the people who are devoted to spreading the virus are also trying to overturn our government. I have no optimistic advice for Leo but only sadness for him and for myself.
Thanks for sharing your thoughts Leo. There are countless people whose lives have been utterly ruined. This is why this article is so insulting. If you except that humanity failed then naturally there is no reason to ask questions about who is responsible and why. Enough time has now elapsed that we can look at the public information available and see how and when other nations responded. There is stark difference between countries that managed it well and those which did not. The parts of the world that did mobilize very quickly and succeeded in breaking the chains of transmission are now reaping the rewards and huge parts of there society and economy have come roaring back. By putting it in the context of humanity failing, there is no need to ask why our institutions completely failed us. Its designed to absolve these very institutions, to not ask questions and reflect but to only look forward. On the other hand I have also noticed a steady stream of narratives designed to mitigate the righteous anger by scapegoating foreigners or to direct that despair and anger at a singular political figures or a political party. The harm done runs deep and these farcical attempts to manipulate public opinion will not work on most of us.
“Humanity wasn’t remotely prepared for our struggle with SARS-Cov-2 when it emerged late in 2019. So we lost to it.”
I guess the 1.4 BILLION people in China who did control it aren’t part of the humanity the good professor is referring to. Or the people in Vietnam, Thailand, New Zealand, etc.
“We already understand how this new virus spreads, which public health strategies can help contain it,….”
Got it, so we failed back then because we didn’t know how viruses spread, its certainly not like we have been dealing with viruses since “humanity” learned of them a century ago. The Chinese and the others nations who mobilized immediately, with countries like Vietnam providing masks for the population in the country side by mid February must have been acting on some special psychic information.
Do you really trust any info coming out of ‘Nam? It’s a third world country. They could have people dying in the streets for all we know. China is also not credible.
Taiwan and NZ are good examples. And South Korea and Japan.
Yes, yes i can.
There are countless Americans and other westerners living in a place like China . It’s abundantly clear they have it under control. They intermittently have small outbreaks and they have a robust system to contain it. They are current trying to contain an outbreak outside of Beijing. They are yet again going through extreme measures to contain it. Did you not see the videos of massive new years celebrations. Do you think those were fake as well? In the early months of the pandemic i can understand the skepticism. However at this point no-one serious is questioning the success of countries like China and Vietnam.
Yes, we should be embarrassed that Vietnam with its near 100 million citizens and despite sharing a border with China has only lost less than 100 people to covid. Why? It took it seriously in early January. And mobilized its national resources immediately. Again, at this point no one serious thinks they are somehow deceiving the world. That is incredibly juvenile. Do you have any idea how many American and other western corporations do business in both China and Vietnam? i assure they are back up and running and making bank.
When you have a vaccine (As we have already seen with the Mereks vaccine, given to huge numbers of chickens) that allows asymptomatic transmission, then as with the MEREKS vaccine, you can promote the development of more virulent mutations.
If the new version is transmissible in grocery stores, or can remain on grocery products, then no lock down that does not involve starving large portions of the population will work. And I think at that point, the risk/benefit ratio strongly points to the need to focus on treatments .It is a pity we have not had the funding, or the will, to get definitive answers on easy possible interventions like vitamin D supplementation, or on what treatments work best in the early stages of COVID. Eternal lockdown for each new virus that mutates is a never ending and non sustainable solution.
Everyone with a brain takes vitamin D.
Step 3 is ill-advised. The LAST thing you want to do is to send all your vaccine doses to a hotbed of infection. All you’re doing is setting up a genetic screen selecting FOR escape mutants.
1. Wow.
2. The steps described above to contain B-117 are so far from what the U.S. can/will do that I do not have a word for it. The closest I can come is gut punch.
Yeah, I’m a bit freaked about this too. The good news is that we will be starting a new administration in just 11 days. There are still the anti-maskers and anti-vaxxers to worry about, but at least we will be under a stronger leadership who, hopefully, will follow through on the aggressive plans to take on the virus. My family and I will be bunkering down again like early last year until B-117 is under control.