Impact on vaccines and monoclonals remains unknown
By Daniel R. Lucey M.D., MPH, FIDSA
Today at least 10 European nations announced some new travel restrictions with regard to the United Kingdom due to a SARS-CoV-2 mutated variant that UK officials announced could be 70% more transmissible. See details below in two publications posted today including one by the European Centre for Disease Control and Prevention (the ECDC). Any impact of this variant virus on vaccination, monoclonal antibody treatment, or lateral flow diagnostic tests is still unknown.
This virus was first detected Sep. 20-21 in the UK, but expanding more recently in London, in Kent and elsewhere. Within the past ~48 hours UK Prime Minister Boris Johnson has called for the highest level “Tier 4” restrictions in affected areas of London and the region. On Monday he will convene an emergency “COBRA” meeting (the acronym stands for “Cabinet Office Briefing Room A” and is a forum to bring ministers of departments across the government together).
Today ECDC posted a 13-page “THREAT ASSESSMENT BRIEF” titled “Rapid increase of a SARS-CoV-2 variant with multiple spike protein mutations observed in the United Kingdom.“ This virus variant with multiple mutations in the Spike (“S”) protein, including the critical “Receptor Binding Domain (RBD)” is named “SARS-CoV-2 VUI 202012/01 (Variant Under Investigation, year 2020, month 12, variant 01).”
The multiple key recommendations (with my bolded words) include:
- “Public health authorities and laboratories are urged to analyse and sequence virus isolates in a timely manner to identify cases of the new variant. People with an epidemiological link to cases with the new variant or travel history to areas known to be affected should be identified immediately to test, isolate and follow up their contacts in order to stop the spread of the new variant.
- Laboratories should review the PCR performance and drop-out of the S-gene. PCR could be used as an indicator for cases with the new variant for further sequencing and investigation.
- Suspected cases of COVID-19 reinfection should be followed up, closely accompanied by sequencing respective virus isolates from these cases. Similarly, cases with treatment failures using convalescent plasma or monoclonal antibodies should be further studied.
- With the implementation of vaccination, close monitoring of COVID-19-vaccinated individuals needs to be ensured to identify possible vaccination failure and breakthrough infections. Virus isolates from these cases should be sequenced and characterised genetically and antigenically.”
Also today, the following report on the same virus variant (here named: “B.1.1.7”) was posted by Andrew Rambaut from University of Edinburgh and seven more members of the UK “COVID-19 Genomics Consortium UK (CoG-UK)” titled: “Preliminary genomic characterisation of an emergent SARS-CoV-2 lineage in the UK defined by a novel set of spike mutations.” The conclusion of these UK scientists is:
“We report a rapidly growing lineage in the UK associated with an unexpectedly large number of genetic changes including in the receptor-binding domain and associated with the furin cleavage site. Given (i) the experimentally-predicted and plausible phenotypic consequences of some of these mutations, (ii) their unknown effects when present in combination, and (iii) the high growth rate of B.1.1.7 in the UK, this novel lineage requires urgent laboratory characterisation and enhanced genomic surveillance worldwide.”
My best guess is that by Dec. 26-28 a public announcement from the UK will be made on laboratory updates regarding any impact of this virus variant on vaccinations, monoclonal antibody tests, and accuracy of diagnostic tests.
In my opinion, it would be reasonable and prudent to sequence all SARS-CoV-2 isolates from all UK COVID-19 vaccine studies from September 2020 through February 2021 to compare rates of this variant virus in both the placebo and the vaccinated groups.
Daniel Lucey, M.D. MPH, FIDSA, FACP, is a Clinical Professor of Medicine (Teaching) at Dartmouth Geisel School of Medicine, adjunct Professor at Georgetown Medical Center, senior scholar at Georgetown Law, Anthropology Research Associate at the Smithsonian Museum of Natural History and a member of the Infectious Diseases Society of America Global Health Committee. He served as a volunteer to outbreaks overseas including patient care in Sierra Leone and Liberia (MSF) during Ebola 2014, SARS 2003, MERS 2013, Plague 2017 as well as H5N1, Zika, and Yellow Fever. Since Jan. 6 he has contributed more than 50 posts to Science Speaks on COVID-19 and traveled to China Feb. 11. With career experiences, he proposed and helped design the 2018-2022 Smithsonian Exhibition on Epidemics.