The lack of national surveillance leaves Utah, other states ill-equipped to deal with the COVID-19 variants, says U. doctor.
(Rick Egan | The Salt Lake Tribune) Zeanne Timbol administers a test for COVID-19 at the Intermountain Salt Lake Clinic on Saturday, January 2, 2021. Two cases of the UK variant have been detected in Utah so far.
Health officials were at first unsure how to investigate Utah’s first known case of the most infectious variant of the “UK” coronavirus, according to emails sent by federal, state and local agencies.
But that initial uncertainty may reflect the deficits in a national disease surveillance system that relies heavily on state and private laboratories to detect changes in infectious diseases, said a Utah doctor last week.
“Our state of knowledge about the variants that appear in the United States and how they are spreading is, I hate to say, very irregular and irregular,” said Dr. Sankar Swaminathan, an infectious disease specialist at the University of Utah, at a news conference. Thursday press.
“We don’t really have a coordinated and integrated national system for proactively detecting high-level genetic variation. … For that reason, I would say that we really have a lot of knowledge, to be honest, inadequate. “
Summit County announced on Monday that a third Utahn – a woman between the ages of 20 and 44 – had contracted the variant. The second case, in Utah County, was announced by state officials last week.
Without a national genomic surveillance system, Swaminathan said, it is impossible to know how quickly the UK variant is spreading in Utah and other states since Utah’s first patient with the variant was confirmed in mid-January.
On January 14, county health officials received word that the man’s test sample was subjected to genetic sequencing by the Utah Public Health Laboratory as part of its surveillance for virus variants – and he had contracted the call “Variant of the United Kingdom. “
The man had already been identified as a possible contact by another person who had tested positive for the coronavirus in late December, the emails said. But it was two days after the man’s case was confirmed, on January 16, that a county epidemiologist wrote that she had interviewed the man and the patient who probably infected him.
Neither had traveled recently, she reported, and the source patient did not know where he was exposed to the virus.
In the meantime, health officials announced the case to the public the day after it was identified – but they seemed unsure how to proceed. County health officials were unsure whether it would be possible to know whether the patient who exposed the man also had the variant or whether contact tracking should be treated differently for patients with the variant.
“There is a specific type of investigation form that needs to be filled out for the variant case[s]? ”Wrote a county epidemiologist.
“Do we need to do a more thorough investigation?” wrote Dr. Dagmar Vitek, director of the medical division of the county health department. “Collect PCR [a genetic COVID-19 test] about him and contacts, sequence, see all your contacts? “
A scientist at the Utah Public Health Laboratory warned that the variant could be confirmed in the source patient only if he was still spreading the virus, more than two weeks after diagnosis; his original diagnosis was in an antigen test, with a sample that could not be used for genome sequencing.
“There was a previous discussion about how to handle variant cases to quickly identify any trip and identify a potential source,” wrote Nicholas Rupp, spokesman for the Salt Lake County Health Department, on Monday, when asked about the disclosed emails.
County officials decided that, for the COVID-19 variant cases, they would return to full contact tracking, where investigators would individually track each contact, Rupp said. For most COVID-19 cases, county investigators have switched to a “shared responsibility model”, where trackers ask patients themselves to alert some of the people they may have had contact with.
The US Centers for Disease Control and Prevention asked for details of the man’s case the day after the variant was identified, emails show. But the CDC did not ask the sample to conduct its own entire genomic sequencing until January 20.
It is unclear what information the CDC sequencing produces about sequencing the Utah Public Health Laboratory. State health officials could not be reached for comment.
The UK variant, dubbed B117, is substantially more contagious than the strain that previously dominated the United States – but it remains to be seen whether it is more likely to cause serious illness.
“There is still not much evidence for this, but there is this concern in some of the strains that have been less characterized. And we really don’t know how problematic this is, ”said Swamainathan.
On Thursday, the Utah Public Health Laboratory identified only two cases of the UK variant, epidemiologist Angela Dunn told a news conference. “But remember, we are sequencing just 10% of all of our positives,” said Dunn.
This is “a lot compared nationally with other states,” she said. “But we are still not able to sequence every person who becomes positive. So the fact that we find two means that he is here. It has already spread throughout the community. And that means that we have to be extremely cautious when it comes to taking preventive measures ”.
The more the virus spreads, the more likely it is to develop harmful mutations, Swamainathan said.
“It is not necessarily that these things come from outside,” he said. “With the transmission levels we have here, we will have our own in-house variants as well.”