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Rochelle Walensky, MD, MPH, director of the Centers for Disease Control and Prevention (CDC), on Wednesday presented a multi-agency attack plan to contain the spread of three variants of COVID-19.
Dr. Rochelle Walensky. AP
As part of Journal of the American Medical Association’s (JAMA’s) Series of questions and answers with JAMA Editor-in-chief Howard Bauchner, Walensky made reference to the project that she co-authored with Anthony Fauci, MD, the country’s leading infectious disease specialist, and Henry T. Walke, MD, MPH, of the CDC, which was published in wednesday in JAMA Network.
In the point of view article, they explain that the Department of Health and Human Services established the SARS-CoV-2 Interagency Group to improve coordination between the CDC, the National Institutes of Health, the US Food and Drug Administration (FDA), the Biomedical Advanced Research and Development Authority, US Department of Agriculture and US Department of Defense.
Walensky said the first objective is to reinforce vigilance in relation to public health mitigation strategies to decrease the amount of virus that is circulating.
As part of that strategy, she said, the CDC strongly recommends against non-essential travel.
In addition, public health leaders are working on a surveillance system to better understand SARS-CoV-2 variants. This will require increasing the genome sequencing of the SARS-CoV-2 virus and ensuring that sampling is geographically representative.
She said the CDC is partnering with state health laboratories to obtain about 750 samples per week and is teaming up with commercial laboratories and academic centers to achieve a provisional target of 6,000 samples per week.
She acknowledged that the United States “is not where we need to be” when it comes to sequencing, but it has come a long way since January. At that time, they were sequencing 250 samples a week; they are sequencing thousands every week.
Data analysis is another concern: “We need to be able to understand at the level of basic science what information means,” said Walensky.
The researchers are not sure how the variants can affect the use of convalescent plasma or treatments with monoclonal antibodies. 5% of people vaccinated against COVID-19 are expected to contract the disease. Sequencing will help answer whether those people who have been vaccinated and who subsequently contracted the virus are among the 5% or if they have been infected with a variant that evades the vaccine.
Accelerating vaccine administration globally and in the United States is essential, said Walensky.
As of Wednesday, 56 million doses have been administered in the United States.
Three main threats
It updated the numbers of the three major variant threats.
Regarding B.1.1.7, which originated in the United Kingdom, she said: “So far, we have had over 1200 cases in 41 states.” She noted that this variant is probably about 50% more transmissible and 30% to 50% more virulent.
“So far, it appears that this strain has had no real decrease in susceptibility to our vaccines,” she said.
The South African strain (B.1.351) was found in 19 cases in the United States.
P.1. The variant, originating in Brazil, was identified in two cases in two states.
Outlook for March and April
Bauchner asked Walensky what she expects for March and April. He noted that public optimism is high in light of the continuing reductions in the number of COVID-19 cases, hospitalizations and deaths and the fact that warmer weather is coming and more vaccines are on the horizon.
“Although I’m really hopeful of what can happen in March and April,” said Walensky, “I really know it can go wrong so quickly. We saw it in November. We saw it in December.”
CDC models projected that, by March, the most transmissible B.1.1.7 strain is likely to be the dominant strain, she reiterated.
“I am afraid it is spring and we are all fed up,” said Walensky. She noted that some states are already relaxing the mandates of the masks.
“At that time, life will look and be a little better, and the motivation for those who may be hesitant about the vaccine may be reduced,” she said.
Bauchner also asked her to consider whether a third vaccine, from Johnson & Johnson (J&J), could soon obtain emergency use authorization from the FDA – and whether its lower expected rate of effectiveness could result in a layered vaccination system. , with high-risk populations receiving the most effective vaccines.
Walensky said more data is needed before this question can be answered.
“It may very well be that the data points us to the best populations to use this vaccine,” she said.
In Phase 3 data, the J&J vaccine was shown to be 72% effective in the United States for moderate to severe illness.
Walensky said it is important to remember that the effectiveness designed for this vaccine is greater than for the flu vaccine, as well as many other vaccines currently in use for other illnesses.
She said it also has several advantages.
The vaccine has less stringent storage requirements, requires only one dose and protects against hospitalization and death, although it is less effective in protecting against the disease.
“I think a lot of people would choose to get this if they could get it earlier,” she said.
Marcia Frellick is a freelance journalist based in Chicago. She has written for the Chicago Tribune and Nurse.com and was an editor for the Chicago Sun-Times, the Cincinnati Enquirer and the St. Cloud (Minnesota) Times. Follow her on Twitter at @mfrellick.
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