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What’s up with variants?

-by Dr. Alan Laird, Chief Medical Officer

-by Dr. Alan Laird, Chief Medical Officer

Unfortunately, Covid-19 continues to be a newsmaker.  While it seems to be fairly quiet in Sioux county (at least at the time of writing this column) other areas of the country are not so fortunate.  So why does it continue to be problematic? We are far from having all the answers, but let us cover a few points.

What are variants? Viruses are constantly changing as they move from person to person and from one population group to another.   As they do so, some of their characteristics change.  That true for us humans as well.  Looking at my high school graduation picture, it is easy to see I have changed.  Different hairline, body shape, facial lines – time has changed me (along with not enough exercise and a few too many calories). Hopefully you can still tell it is me.  It is the same with the virus, but the change is on a smaller level and happening more rapidly.  When there is enough change, the virus can start behaving differently.  Again, not dis-similar to myself. I no longer go on spinning amusement rides and getting up from the floor has become a bit of a task. Fortunately, those changes took years for me, rather than months or weeks as they do in the virus.

What are variants of concern? Most changes in the virus do not affect how it behaves.  My change in hairline may make me look different or part my hair differently, but it did not affect my ability to get up off the floor. My change in muscle strength did that. When a change happens that makes the virus easier to pass to others, or cause more severe illness, then it is a variant of concern. These changes can cause the new version of the virus to become the primary virus causing infection in a particular area.  With our mobile society, it is not long until the new variant spreads to other areas, other cities, other counties, other continents. The CDC is monitoring over 200 variants, most of which are a small minority of the infections in the United States.  That is a big job and requires the combined efforts of the CDC, Public Health Laboratories and private industry to try to monitor the virus.  Rapid sequencing allows us to “see” changes in the virus. This technology became available early in this century.  But at that time, the technology was slow and expensive. Improvements now allow us to monitor these changes more rapidly and with much lower cost.  Hence, we can have fairly rapid information on how the virus is changing.  Unfortunately, we cannot predict how the virus will change.  So even though we get faster information, we are still behind what the virus is doing today. Since at least April, the alpha variant of the virus has been causing the majority of disease in the US.  In early July this changed.  The delta variant is now the leading cause of Covid infections that have been tested for a variant.  This leads us to believe it is becoming the dominant strain.

What is the difference between a variant and a strain?  The key is if the virus behaves differently.  All strains are variants; meaning they all have changes or mutations that make them different from the previous types of virus we have seen.  A virus is labeled a new strain when we see it behave differently; more or less contagious, infects different cells, cause more severe illness.

Have any of the new strains been more resistant to the vaccines?  In general, not as far as we know.  That is always a concern and one of the reasons we previously had a hard time developing vaccines against viruses that could change rapidly. Often by the time we could understand the virus and produce a vaccine, the virus had changed enough that the vaccine was poorly or not effective.  With the new technology, previous work that had been put in, and the use of emergency authorization, a vaccine was brought forward this time that has been extremely effective. Should you get Covid despite having had the vaccine, it appears that you are far less likely to need hospitalization or die from the virus.  Since the virus is always continuing to change, we could see a drop in the vaccine effectiveness.  Thankfully, so far, this does not appear to be the case.

So what about the uptick in cases we are hearing about in the news?  What is the reason for that? We do not know all the answers.  It may be the new variant (delta) is causing more problems. It appears that most of the new cases are in unvaccinated people.  So perhaps the virus is still finding its way to vulnerable populations it had not yet passed through.  As we open up the country with travel and commerce, there is more opportunity for the virus to tag along and find new places to infect. Perhaps we are still filling the area under the curve we flattened by closing things down.

What does this all mean? I certainly do not claim to have all the answers.  I think it has become clear that that the vaccine works and works well.  There are side effects to the vaccine; most of them are annoying and short lived.  Those that are more severe and concerning are rare.  Moreover, if the vaccine can give you the side effects, it is very likely the disease would cause you far more problems and severity.  So, I would consider carefully getting vaccinated, and personally I would encourage you to do.  However, I understand others feel differently.  Short of being vaccinated, the only way to avoid contracting Covid is to not encounter it.  That would mean staying home, avoiding anyone who might have it and significantly limiting your social contacts.  Masking would also be appropriate.  Still, the good news remains that for most who do get the illness it will be an annoying cold.  That does not mean it won’t be severe in some of us.  Will the virus increase in severity and become commonplace?  Stay tuned, it does not appear we are done with this yet.

Alan Laird