Q&A: What PCPs should know about new COVID-19 variants in US, abroad

A new variant of SARS-CoV-2 identified in New York — B.1.526 — has increased in prevalence since it was first observed in samples collected in November 2020, according to researchers.

In a preprint study published in medRxiv, researchers wrote that the variant was found in 3% of samples from New York City analyzed in January. That rose to 12.3% by mid-February.

The researchers searched publicly available databases and identified cases of the B.1.526 variant and closely related strains in samples that were taken predominately in the Northeastern United States.

“It's not just one cluster, which means the lineage is probably spreading widely through the region,” Anne-Catrin Uhlemann, MD, PhD, associate professor of medicine in the division of infectious diseases in the College of Physicians and Surgeons at Columbia University, said in a press release.

Meanwhile, other variants have continued to cause concern worldwide. In Italy, for instance, new restrictions were put in place to help stop the rise in cases caused by a variant from the U.K. and slow vaccine rollout in the country, according to the New York Times.

Healio Primary Care spoke with Monica Gandhi, MD, MPH, professor of medicine and associate chief in the division of HIV, infectious diseases and global medicine at the University of California, San Francisco, to learn more about COVID-19 variants in the U.S., and whether physicians should be concerned about these variants.

Healio: What should U.S. physicians know about the COVID-19 variant identified in New York?

Gandhi: The variant in New York seems to be dominating the new cases in the city and state. However, it is not yet known whether the strain is more transmissible or not and there is no evidence that the strain is more virulent, in terms of hospitalizations per case.

Healio: Should they be more concerned about the New York variant than other variants circulating in the U.S.?

Gandhi: No, there should not be undue concern about this variant. The virus has evolved mutations, but we do have safe and effective vaccines now that are being rolled out more quickly in the U.S. than before. We want to try to roll out vaccines in a “race” against these variants; by providing immunity to the population, the virus — no matter its mutations — will slow down and stop infecting our population. So, we have the solution; we now need to apply it quickly.

Healio: What other variants circulating in the U.S. should physicians be aware of?

Gandhi: The B.1.1.7, B.1.351, P.1, B.1.427, and B.1.429 variants have been identified as “variants of concern” in the United States by the CDC.

Healio: Italy is in lockdown again, partially due to the spread of the U.K. variant in the country. Should this raise concerns about this variant in the U.S.?

Gandhi: No, we should not be concerned about this variant in the U.S. hospitalizations from COVID-19 are decreasing in the U.S. steadily. In the states with the highest prevalence of B.1.1.7 — Florida, where 50% of the strains are B.1.1.7; California, Michigan and Colorado — hospitalizations and cases are decreasing as well. In Israel, with the real-world rollout of the Pfizer vaccine, cases and hospitalizations decreased quickly with rapid dissemination, despite 80% of the circulating strains being the B.1.1.7 variant. Similarly, in the U.K., despite a high prevalence of this variant, hospitalizations and cases have also decreased quickly with rapid vaccine rollout, with 36% of the population now vaccinated. Italy has had a very slow rollout of COVID-19 vaccination, exacerbated recently by its decision to halt AztraZeneca distribution due to concern of a low rate of clots among some vaccinated individuals that did not exceed rates in the general population. Therefore, without vaccination, the U.K. variant is likely to take hold in that it is more transmissible and likely more virulent. It is therefore important to rollout vaccinations quickly to combat this and other variant strains.

Healio: What should physicians tell patients who are concerned that the spread of COVID-19 variants could delay the return to normal in the U.S.?

Gandhi: I tell patients that I do not think the variants will impede our progress if we vaccinate quickly, which we are starting to do in the U.S. The variants will remain susceptible to our current vaccines, especially when it comes to T-cell immunity, so I am hopeful our escalating rate of vaccine distribution will allow us to get back to normal life by fall of 2021.

References:

• Annavajhala MK, et al. medRxiv. 2021;doi:10.1101/2021.02.23.21252259v1.
• CDC. SARS-CoV-2 Variants. https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/variant-surveillance/variant-info.html. Accessed March 18, 2021.
• CDC. Variant Cases in the U.S. https://www.cdc.gov/coronavirus/2019-ncov/transmission/variant-cases.html. Accessed March 18, 2021.
• New York Times. Italians start a widespread lockdown. https://www.nytimes.com/2021/03/14/world/italy-covid-lockdown.html. Accessed March 18, 2021.
• Newswise. New ‘Home-Grown’ Coronavirus Variant Found in New York City Region. https://www.newswise.com/coronavirus/new-home-grown-coronavirus-variant-found-in-new-york-city-region/?article_id=746815&sc=mwhr&xy=10024062. Accessed March 18, 2021.
• Pfizer. Real-World Evidence Confirms High Effectiveness of Pfizer-BioNTech COVID-19 Vaccine and Profound Public Health Impact of Vaccination One Year After Pandemic Declared. https://www.pfizer.com/news/press-release/press-release-detail/real-world-evidence-confirms-high-effectiveness-pfizer. Accessed March 18, 2021.
• Statista. Daily number of hospitalizations due to coronavirus (COVID-19) in the United Kingdom (UK). https://www.statista.com/statistics/1190335/covid-19-daily-hospitalizations-in-the-uk/. Accessed March 18, 2021.
• Tarke A, et al. bioRxiv. 2021;doi:10.1101/2021.02.27.433180.