A user guide for coronavirus variants in California

It looked like everything was getting better – and then the mutants arrived.

Yes, the horror story that is our lives a year after the start of the coronavirus pandemic has already challenged us with many “when you let your guard down” twists and turns. And here we are, with case and death rates plummeting, companies reopening and millions of people being vaccinated in every corner of the country. Things are looking up. But now health officials and infectious disease specialists are eyeing something that threatens all this progress: the COVID-19 mutations.

You have probably heard of these variants: the United Kingdom, South Africa and Brazilian varieties. There is even a version of California and New York appearing now.

What are they? Will vaccines protect us from them? And how big of a threat are they to our recovery?

These are the main questions as scientists and medical service providers rush to prevent their spread and end the pandemic.

Like other viruses, the coronavirus mutated over time. Its crown-shaped tips may change as it spreads. This is not uncommon and is not always a cause for alarm – in fact, tracking mutations helps scientists track the spread of the virus from one place to another. But several variants are causing concern in the U.S.

In general, “they spread faster, are highly transmissible, can cause more disease and can prevent the immune response,” said Melanie Ott, director of the Gladstone Institute of Virology in San Francisco.

This is not necessarily true for all variants, and scientists themselves disagree about whether some of the new strains, such as one first detected in South Africa, make people sicker than the original.

“We don’t know yet,” said Benjamin Pinsky, medical director at the Stanford Clinical Virology Laboratory.

Even the nomenclature of the variants themselves is controversial and incredibly complicated. Different researchers are using different names for the same virus. Some are based on the date when a variant was first identified, while others have to do with which specific part of the virus was changed. All of this led people to identify variants geographically. This, in turn, raised concerns about the residents of these places being unduly stigmatized, but so far there is no clear and standardized alternative.

Here is a quick summary of the concern variants in the US:

The strain of the United Kingdom

Also known in the scientific community as B.1.1.7, this variant was identified in the UK last fall. It appears to be about 50% more infectious than the original virus, say the scientists. In January, experts in the UK said it also looked more deadly than the original strain. It was first detected in the United States in December 2020 and is now spreading around here. According to the Centers for Disease Control and Prevention, there have been more than 2,600 cases reported in at least 47 states and Puerto Rico. California has registered more than 200 cases. The CDC said it could become the dominant variant in the United States this spring.

The good news: researchers like Pinsky are less concerned about the UK variant than others because vaccines appear to be very effective in preventing people exposed to this variant from becoming ill.

The South African strain

Also called B.1.351, this variant was identified in South Africa in October and arrived in the United States in January. It appears to be better for avoiding antibodies produced by the body’s immune system, raising some concerns about whether this variant reduces the effectiveness of available coronavirus vaccines. For example, clinical trials abroad with vaccines from Novavax and AstraZeneca PLC have shown that they have been less effective in South Africa than elsewhere.

The USA has recorded more than 68 cases of the South African variant in 17 states, including several cases in California. The CDC says there is no evidence to suggest that the variant has any impact on the severity of the disease, but South Africa’s health minister said it seemed to affect young people more than previous versions of the coronavirus. (This observation also coincided with a large number of graduation parties where young people gathered.)

The Brazilian strain

Known as P.1, this variant was identified in January, when Brazilian travelers arrived in Japan. Like the South Africa variant, scientists are concerned that the Brazilian strain may be better at eliciting antibodies, which means that vaccines may be less effective.

There is also evidence that people who have already recovered from COVID-19 can be reinfected by the Brazilian strain. This seems to be happening in the Brazilian city of Manaus, which was hit so hard last spring by a different variant that some scientists speculated that the city could have achieved herd immunity, where a large percentage of the population has become immune and the virus begins have trouble spreading. But then P.1 appeared earlier this year, infecting people who were already sick.

So far, at least 13 cases have been reported in at least seven U.S. states. Stanford scientists found another Brazilian variant, known as P.2, in the bay area, and Los Angeles County Public Health Director Barbara Ferrer said on Wednesday that authorities had also identified a case there. It is different from the P.1 variant that is of great concern, but has not yet been identified in California, according to the CDC.

California and New York

There is also another variant of concern in California, which appears to be an internally developed variant, known as B.1.427 and B.1.429. This variant is now spreading widely in California, and UCSF research suggests that it can make people sicker and may be more contagious than the previous coronavirus.

On Wednesday, Governor Gavin Newsom said a variant spreading across New York and the East Coast – B.1.526, which also appears to be able to escape some of the body’s defenses – has been identified in Southern California.

Most COVID-19 tests only determine whether someone is infected or not, so it can be difficult to say exactly which patients have which variant. But Pinsky said that doing more sophisticated laboratory tests to find out which variants are spreading in any community is useful because doctors can adjust treatment plans. For example, people infected with certain variants respond well to treatments with monoclonal antibodies. But for other variants, such as the California variant, an antibody combination treatment may make more sense.

In recent weeks, researchers like Charles Chiu, an infectious disease specialist at UCSF, have been tracking the California variant in the bay area, focusing on San Francisco’s Mission district, where COVID-19 hit a large Latinx community hard. As with other variants, experts are monitoring how they respond to what are known as neutralizing antibodies – checking whether the virus resists – and studying transmissibility, observing how quickly the virus spreads, within individual families and beyond.

The understanding of health experts is changing daily, sometimes hourly. But they know that while vaccines may be slightly less effective against certain variants, all three approved in the U.S. – Pfizer, Moderna and Johnson & Johnson – have been shown to be 100% effective in preventing coronavirus-related deaths and hospitalizations, regardless of variant.

In other words, “even if you are infected and vaccinated, you will not die and you will not go to the hospital,” said Ott.

As far as medicine is concerned, this is a small miracle.

And the pharmaceutical companies that make the vaccines are already looking at ways to make them more effective in preventing variants, potentially through booster injections.