COVID-19 Mutations Demand Immediate Action

John Whyte, MD, MPH; Ashish K. Jha, MD, MPH

Disclosures

January 25, 2021

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  • The functional mutations of SARS-CoV-2 make the virus more efficient in attaching to and infecting cells. The UK mutation appears to be more contagious and is likely to storm across the United States, causing an increase in infections, hospitalizations, and deaths.

  • The single most powerful tool to fight COVID-19 is vaccination of as many people as possible, as fast as possible.

  • Americans need to upgrade their masks beyond the standard cloth masks. Consider using a surgical mask, N95 or KF94. Wearing two cloth masks or one cloth mask with a filter may also offer good protection, but the masks need to have a good seal on the face, cover the nose, and go below the chin.

  • Vaccine distribution has been a "debacle," with virtually no federal plan, leaving it up to each state to figure it out on its own.

  • Everyone must get the second shot. One shot provides inadequate protection that will wane over time.

  • One to three more companies may have vaccines ready for distribution by April to add to the two available now.

This transcript has been edited for clarity.

John Whyte, MD, MPH: Welcome, everyone. Thanks for tuning in. I'm Dr John Whyte, chief medical officer at WebMD. You're watching Coronavirus in Context.

Many folks have questions about COVID mutations and strands. Should we be worried about it?

And how are people rating the distribution plan of the vaccine? Is it a success? Does it depend on where you live?

To help provide some insights, I've asked one of the leading experts on COVID-19, Dr Ashish Jha. He is the dean of Brown University School of Public Health. Dr Jha, thanks for joining me.

Ashish K. Jha, MD, MPH: Thank you for having me here.

Whyte: Let's get right to it. People want to know about these mutations and strains. How concerned should people be?

Jha: Let's just talk a little bit about the words. Mutations are pretty common. Basically, every time the virus replicates, there are a few mutations here and there; 99.999% of them have no meaning. They don't have any clinical significance. They're no "big whoop," as they say.

The problem is, occasionally one of these mutations becomes functionally important. It becomes either more contagious, more lethal, or in some other ways important. And that's what's happened. Now we have a few different mutations that have acquired these functional differences, which means that they really are different strains. I think we've heard about them — the UK variant, the South Africa one, one from Brazil, maybe one from Los Angeles — though we're still sorting that out. I was hearing about strains all through 2020. And most of the time, I looked at the data and shrugged my shoulders and said, "There's not much to see here."

Whyte: Does "strain" mean it's a new virus? Some people are asking, "Is it new? Is it different?" Does it matter?

Jha: Same virus. Works in the same way, but just a bit or a lot more contagious. On a molecular level, the spike protein — those little spikes on the virus — is what's really important for attaching to human cells and infecting people. There have been these mutations on the spike protein that make it attach and infect cells more efficiently. And that's bad, of course.

The UK variant really does look like it is more contagious. As opposed to all the mutations of 2020 that I felt like we could blow off, this one is not one we can blow off. This is serious; this is an important issue.

Whyte: "Serious" sounds serious. What does that mean for listeners? Does that mean we definitely need to try to speed up vaccine distribution? What should people do?

Jha: I don't say "serious" lightly. It is serious because we're going to see this variant take off across the country. We're going to see it cause large spikes in infections, hospitalizations, and deaths. We've got to do everything we can to prevent it. So, what do we need to do?

We absolutely need to be vaccinating many more people as quickly as possible, probably our single most powerful tool in the short run. Probably all of us need to be upgrading the masks that we're wearing. I think the standard cloth masks we've worn through 2020 are probably not good enough for this variant. We need better-quality masks.

Whyte: Do we need a double mask?

Jha: A double mask can be pretty reasonable under certain high-risk circumstances. So, if you're out for a walk with your dog, you probably don't need a double mask. Even a simple cloth mask is maybe okay. But if you're going to go into a room with a bunch of other people, I think double masks, certainly high-quality masks like N95s or KF94s — these are all available on Amazon and other retail stores — are generally higher-quality masks. A good surgical mask is also quite useful. But again, in high-risk situations, a double mask may be the thing that's needed.

Whyte: What about the multilayer cloth masks that maybe you put a filter in?

Jha: I think a multilayer cloth mask with a filter can be quite good. It really depends on fit, if you have a really good fit, a good seal. Again, you've got to cover your nose. It's got to come below your chin. I think that can also be quite effective.

Whyte: You're a dean, so you're used to giving grades. I want you to grade the distribution of COVID-19's vaccine. Would you give it a gentleman's C? Would you give it an F? Is it a D? What grade is it?

Jha: Well, it's certainly not an A or a B. So I would probably say it's somewhere like a C minus, D plus.

Whyte: Was there even a plan, Dr Jha? Some people are saying that there actually wasn't. It was just, "Let the states do it." They did a great job in the development of vaccines, and then when it comes time to get it out, some people could argue it's worse than the testing debacles that we've had. Why so wrong? How do we fix this?

Jha: I think "debacle" is a good word for it. Basically, there was not much of a federal plan. The people who put this together on part of the federal government fundamentally just misunderstood vaccination and how it works. They just said, "Well, we'll let states figure it out. Everybody will go to their CVS and get it." They didn't think through the details and certainly didn't have any sense of urgency, and then they made a whole bunch of predictions — like 20 million will be vaccinated by December, 50 million by January — that clearly were never going to come true.

So, a lot of disappointment and frustration. If we look forward, the way I see it is states are starting to figure this out. The new federal government has been very clear that they're going to work with states to augment state capability. I do think we can turn this around, but it's going to take a lot of work and a lot of resources.

Whyte: When do we need to turn it around? Do we have a several-week leeway? There are several states where people are having the second shot appointment canceled. My concern is that some people are just going to say, "Well, I got one. That's better than none." And that's not necessarily true.

How much leeway do we have? And does all of this decrease confidence in vaccination? We're making some progress in terms of people willing to take the vaccine, and now people can't even get the first or their second shot. So it becomes, why bother?

Jha: So, a couple of things. First, when do we need to turn this around? Yesterday would be a good day to have turned this around, meaning that we don't have time to lose on his. The second point is, absolutely everybody needs a second vaccine. If you've gotten one shot and you're wondering, "Do I need a second?" Yes, you do. You need that second shot because that's what's going to give you a durable protection. One shot will give you inadequate protection that will wane over time. So in my mind, it's a no-brainer. Everybody needs to get a second shot.

Look, the new team has a lot of work to do. They just got into office. They've got to sort out the details. I think we've got to give them at least a few days to come up with a plan. The plan they have so far looks good, but it's going to be the reality on the ground of, how many vaccines do we have? What are the capabilities of the states and how do we augment it?

If people have had their second doses canceled, they need to get rescheduled more or less right away. And we've got to get the vaccines out to individuals. So, there's a lot of work to do. I remain pretty optimistic that we can do it, but there is going to be a lot of work.

Whyte: President Biden has talked about 100 million shots in 100 days. That's a million shots a day. We're at about 800,000 to 900,000. Some experts have been arguing that we need to be at 1.4 million if we want to vaccinate everyone by the end of summer. How optimistic are you that we're going to be able to get to [that point]? We need to be at more than a million per day to make up in terms of what's going on. And then we need people to actually sign up. That's where the frustration is.

Jha: I'm pretty confident that we're going to get there. Here's why: The first couple of weeks of the administration is going to be tough. They're going to be picking up the mantle and trying to do a lot of stuff. I wouldn't be surprised if they can't quite hit a million a day. But I think over time you are going to see more vaccines There are a couple of things that give me optimism. Right now, we have Moderna and Pfizer vaccines. I'm hoping we'll have Johnson & Johnson (J&J) online soon. We may have Novavax and AstraZeneca. We don't know, and I don't want to count on those.

Whyte: Those are expected not to have good manufacturing capabilities until April. So even if they apply for emergency use authorization in February, that's a couple of months away. To your point, if we have this variant that's more transmissible, we need to be getting shots in the arm now.

Jha: Absolutely. I don't think any of them are going to make a material difference until April. We may see some impact (maybe from J&J) by March. But again, not a lot of doses. Between now and March, it's largely a Moderna and Pfizer game. But once we get into April, we could have help from several other vaccines.

That's why I do think within the 100-day target we're going to hit that. But the question is, how much of that can we do front-loaded? That's what the game of trying to outpace the variant is all about — 100 days is too late for the variant. We've got to move in the next 30 to 60 days.

Whyte: Finally, I want to ask you about public health. You're at one of the most prestigious schools. You're working with students who are excited about being involved in public health. Do you think the way the public perceives public health has changed because of COVID-19? Has it changed for the better? Because some people may be saying, "You know what, it hasn't worked out so well."

Jha: First of all, I should start off by saying that I think most people didn't even know what public health was. I think people now know what public health is.

Whyte: They think it's the water supply.

Jha: Right. People now know what public health is; you don't have to explain it to folks. Second, most people have seen the public health community as part of the solution, that they've been helpful. We haven't gotten everything right; there have been missteps. But in general, I think people have relatively favorable views of public health.

At our school, we've seen a greater than 100% increase in our applications. There is so much interest in public health right now, just excitement about people who want to come and learn, study, and do public health. I think that's great, and we've got to turn that excitement into education and learning and action.

So, I'm pretty optimistic about the future of public health. I wish it didn't take a horrible crisis like this to stir it on. But if that's one of the silver linings, I guess that's okay.

Whyte: Well, we'll leave it at that. Dr Jha, I want to thank you for taking the time today and sharing your insights.

Jha: Dr Whyte, thank you for having me on. I really appreciate it.

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