New COVID variants: how much should you worry?
Should you be concerned about the new COVID-19 variants? Yes.
But how much should you panic? What can you do?
“New variants of [COVID-19] are detected every week,” says Stuart Ray, M.D. at John Hopkins Medicine. The problem isn’t that variants are emerging. Rather, the issue is that some of these variants are spreading more rapidly than others.
Tip: Here is a cute illustrated guide from NPR that shows how variants work.
There is good and bad news.
The bad news is that these variants will likely increase the number of cases and deaths in our communities because they have been shown to be much more transmissible. The good news is that currently emergency-authorized vaccines still work. Vaccines’ fundamental mechanism of protecting us by exposing our immune system to a “fake” version of the virus still work. That’s because the variants are not entirely different strains — they are slightly different from the original virus, but still recognizable to the immune system that received the vaccine (or in someone that was previously exposed to COVID-19).
There are currently 3 variants that are most concerning to public health officials: B.1.1.7, B.1.351, and P.1.
B.1.1.7 (first identified in the United Kingdom)
Public Health: Increased transmissibility (twice as contagious compared to the original COVID-19)
Vaccination Efficacy: No known meaningful impact on vaccine efficacy
B.1.351 (first identified in South Africa)
Public Health: No impact on disease severity
Vaccination Efficacy: May reduce efficacy of vaccine
P.1 (first identified in travelers from Brazil)
Public Health: Increased transmissibility
Vaccination Efficacy: May reduce efficacy of vaccines
A note on efficacy
Reduced efficacy is not the same as no efficacy.
Currently available vaccines, such as Moderna’s and Pfizer/BioNTech, have a published efficacy of ~95%. That is very effective. Johnson & Johnson’s one-dose vaccine recently published their efficacy at 72% efficacy and that sent public health officials around the world on a happy dance. For context, the annual flu shot has an efficacy between 40–60%, depending on the year.
If you are still not convinced, we can play a quick and dirty game of math to illustrate why reduced efficacy is still an effective vaccine.
Dirty (“back of the napkin”) Math
You are in a restaurant with 100 patrons. One waiter is unknowingly spreading the disease:
Percentages obtained from here.
Scenario A: If the vaccine is 0% effective or no one is vaccinated
- 100 people are exposed to the virus. No one is protected and all are infected. 20 will be asymptomatic, 81 will develop mild disease, 14 will report severe symptoms.
- 2 will die (could be you and/or the person you went to dinner with)
Scenario B: If the vaccine is 70% effective and everyone receives the vaccine:
- 100 people are exposed to the virus. 70% are protected by the vaccine, the other 30% are infected with the virus.
- Among the 30 that are infected, 6 will be asymptomatic, 24 will develop mild symptoms, 4 will report severe symptoms, but no one dies.
Scenario C: If the vaccine is 90% effective and everyone receives the vaccine:
- 100 people are exposed to the virus. 90% are protected by the vaccine, the other 10% are infected.
- Among the 10 that develop symptoms, 2 will be asymptomatic, 8 will report mild symptoms, 1 will report severe symptoms, but no one dies.
The actual math is far more complicated, and you can learn more here and here.
What is our tolerance for “reduced efficacy”?
Months before Moderna and Pfizer/BioNTech’s data was published, the FDA announced that it will approve vaccines that demonstrate at least 50% efficacy. In April 2020, the World Health Organization also published their minimum metric of 50% efficacy for 6 months of immunity, but a desired target of 70% for 1 year of immunity.
While it is not ideal that the variants will reduce the efficacy of current vaccines, it is reassuring that current progress will not be obliterated.
With that said, both vaccine makers are already working to develop a booster shot to ensure efficacy rates remain high. So in this fast-changing environment, we’ll be having a conversation on whether or not to receive a booster shot in a month or two.
The variant’s impact on public health
These variants are most concerning to unvaccinated populations. As of writing this, 31.8 million (~9.4% of U.S population) have been vaccinated against COVID-19. The remaining 250 million in the United States remain vulnerable to these new variants.
As Anthony Fauci, M.D. noted in his press conference on January 21st, 2021, increased transmissibility will lead to increased number of deaths. We may be numb to hearing skyrocketing cases of COVID-19, but the threat is very real.
It has led to many states tightening their restriction measures. In my home state of Michigan, restrictions were tightened to limiting in-person gatherings. In my home country of Malaysia, the Movement Control Order (MCO) was reinstated to limit grocery runs to 2-persons and banning all other in-person gatherings.
These variants will continue to emerge as it finds larger pockets of unvaccinated and unprotected populations to infect and breed in. We should worried about its impact on public health, but significantly less worried about its impact on vaccine efficacy. In other words: we will not have to restart 2020 by developing the vaccines from scratch again.
I empathize that many of us, myself included, are exhausted. The number of cases being reported everyday have become so large and common that it numbs us.
It is normal that all the questions we are seeing today relate to the variant’s impact on vaccines, rather than on the unvaccinated, because we are so laser focused on returning to normalcy.
We are tired of hearing it, but masking, social distancing, and reducing in-person gatherings remain our best weapon against COVID-19 and its variants in lieu of a vaccine.
The virus cannot spread if it does not find an unvaccinated or susceptible host. So stay home and stay safe!