Feb. 8, 2021 -- The coronavirus variant first detected in the United Kingdom is rapidly becoming the dominant strain in several countries and is doubling every 10 days in the United States, according to new data.

The findings by Nicole L. Washington, PhD, associate director of research at the genomics company Helix, and colleagues were posted Sunday on the preprint server medRxiv. The paper hasn't been peer-reviewed in a scientific journal.

The researchers also found that the transmission rate in the United States of the variant, labeled B.1.1.7, is 30% to 40% higher than that of more common lineages.

The findings lend credence to modelling predictions the CDC released in January. The agency said at the time that the new strain could cause more than half of new infections in this country by March, even as the U.S. races to deploy vaccines.

In the new study, while clinical outcomes initially were thought to be similar to those of other coronavirus variants, early reports suggest that infection with the B.1.1.7 variant may increase death risk by about 30%.

A coauthor of the current work, Kristian Andersen, told The New York Times, "Nothing in this paper is surprising, but people need to see it."

Andersen, a virologist at the Scripps Research Institute in La Jolla, CA, said, “We should probably prepare for this being the predominant lineage in most places in the United States by March."

COVID-19 Mutations Demand Immediate ActionWebMD's Chief Medical Officer, John Whyte, MD, speaks with Ashish K. Jha, MD, Dean, School of Public Health, Brown University, about immediate actions needed to confront the COVID-19 mutations. 667

[MUSIC PLAYING]

DR. JOHN WHYTE: Welcome,

everyone.

Thanks for tuning in.

I'm Dr. John Whyte, Chief

Medical Officer at WebMD.

And you're watching Coronavirus

in Context.

A lot of folks have questions

about these mutations,

these strands.

Should we be worried about it?



And how are people rating

the distribution plan

of the vaccine?

Is it a success?

And does it depend on where you

live?



So 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.



DR. ASHISH JHA: Thank you

for having me here.



DR. JOHN WHYTE: Let's get right

to it.

People want to know

about these mutations, even

the words--

mutations strains.

How concerned should people be?



DR. ASHISH JHA: Yeah.

So 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, every once

in a while,

one of these mutations

becomes functionally important.

It becomes either more

contagious or 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

that 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 LA,

though we're still sorting that

out.

I've been hearing about strains

all through 2020.

And most of the times

I looked at the data

and shrugged my shoulders

and said, eh, there's not

much to see here.



DR. JOHN WHYTE: Does strain mean

it's a new virus?

Some people are saying,

is it new?

Is it different?

Does it matter?

Same



DR. ASHISH JHA: Virus.

Same virus.

Works in the same way, but just

a bit more contagious, or a lot

more contagious.

And here's what's going on.

On a molecular level, basically

the spike protein, those little

spikes on the virus--

that's what is really

important for attaching

to human cells

and infecting people.

There have been these mutations

on the spike protein that just

makes it attach more efficiently

and infect cells more

efficiently.

And that's bad, of course.



And so 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 a serious--

this is an important issue.



DR. JOHN WHYTE: So when it's

serious, what does that mean

for listeners?

Does that mean we definitely

need to try to speed up vaccine

distribution?

Serious sounds serious.

So what should people do?



DR. ASHISH JHA: And I don't say

serious lightly.

It is serious because what we

are going to see

is we're going to see

this variant take off

across the country.

We're going to see it cause

large spikes in infections

and hospitalizations and deaths.

And we got to do everything

we can to prevent it.



So what do we need to do?

We absolutely need to be

vaccinating many, 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 our masks

and the masks

that we're wearing.

I think the standard cloth masks

we've worn through 2020--

probably not good enough

for this variant.

We need better quality masks.



DR. JOHN WHYTE: Do we need

a double mask?



DR. ASHISH 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 OK.

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 KN95s or KF94s--

these are all

available on Amazon

and other retail stores.

Those 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.



DR. JOHN WHYTE: What about

the multi-layer cloth masks

that maybe you put a filter in,

a coffee filter?



DR. ASHISH JHA: Yeah.

I think a multi-layer cloth mask

with a filter can be quite good.

It really depends there on fit,

if you have a really good fit,

a good seal.

Again, you got to cover

your nose.

It's got to come

below your chin.

I think that can also be quite

effective.



DR. JOHN WHYTE: You're a dean,

so you're used to giving grades.

So 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?



DR. ASHISH 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.



DR. JOHN WHYTE: Was there even

a plan, Dr. Jha?

Some people are saying,

there wasn't actually even

a plan.

It was just, let the states do

it.

And here they did a great job

in terms of 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?



DR. ASHISH JHA: Yeah.

So it has been a debacle.

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

vaccinations and how it works.

They just said, well, we'll let

states figure it out.

Everybody will go to their CVS

and get it.

Didn't think through the details

and certainly didn't have

any sense of urgency

and then made a whole bunch

of predictions like 20 million

will be vaccinated by December,

50 by January, that clearly was

never going to come true.



So a lot of disappointment

and frustration.

But I think 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.



DR. JOHN WHYTE: When do we need

to turn it around?

Do we have several week leeway?

There are several states where

people are having

the second shot appointment

canceled.

And 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.



So 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 it

or can't get their second shot.

So it becomes, why bother?



DR. ASHISH JHA: Yeah.

Yeah.

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.



And 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

wain 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 we

can do it, but there is going

to be a lot of work.



DR. JOHN WHYTE:

And the President has talked

about 100 million shots in 100

days.

So that's a million shots a day.

We're at about 800,000-900,000.

But some experts, as you may

know, Dr. Jha, have been

arguing, 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--

we need to be at more

than a million

because we need to make up

in terms of what's going on.

And then we need people

to actually sign up.

And that's where the frustration

is.



DR. ASHISH JHA: Yeah.

So I'm pretty confident.

We're going to get there.

Here's why.

Look, the first couple of weeks

of the administration

is going to be tough.

They're going to be picking up

the mantle.

They're going to be trying to do

a lot of stuff.

And 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.



There are a couple of things

that give me optimism.

Right now we have Moderna

and Pfizer.

I'm hoping we'll have Johnson

& Johnson online soon.

We may have Novavax.

We may have AstraZeneca.

So these are, again--

we don't know.

We don't know.

And I don't want to count

on those.



DR. JOHN WHYTE: Those are

expected not to have

good manufacturing capabilities

until April.

So even if they apply for EUA

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.



DR. ASHISH JHA: Absolutely.

Absolutely.

And I don't think any of them

are going to make a material

difference, as you said,

until April.

We may see some impact, maybe

of J&J, by March.

But again, not a lot of doses.

So right now, 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.



And that's why I do think

within 100-day target--

we're going to hit that.

But the question is, how much

of that can we do front loaded?

And that's where 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.



DR. JOHN WHYTE: And finally, I

want to ask you

about public health.

Here 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 is

changed because of COVID?

And has it changed

for the better?

Because in some ways,

people may be saying,

you know what?

Hasn't worked out so well.



DR. ASHISH JHA: Yes.

I think a majority of Americans

are pretty-- well, first of all,

I should actually start off

by saying, I think most people

didn't even know what

public health was.

I think people now know what

public health is.



DR. JOHN WHYTE: They think it's

the water supply.



DR. ASHISH JHA: Right.

Right.

So people now know what

public health is.

You don't have to explain it

to folks.

I think the second is, most

people have seen

the public health community

as part of the solution,

that they've been helpful.

And we haven't gotten everything

right.

There have been missteps.

But in general, I think people

have relatively favorable views

of public health.



I'll tell you.

At our school,

we've seen a greater than 100%

increase in our applications.



DR. JOHN WHYTE: Wow.



DR. ASHISH JHA: There is so much

interest in public health

right now, just

excitement about people

who want to come and learn

public health

and study public health

and do public health.

And 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 just

to stir it on.

But if that's one

of the silver linings, that's

OK, I guess.



DR. JOHN WHYTE: Well, we'll

leave it at that.

Dr. Jha, I want to thank you

for taking the time today

and sharing your insights.



DR. ASHISH JHA: Dr. Whyte,

thank you for having me on.

I really appreciate it.



[MUSIC PLAYING]



John Whyte, MD, MPH, Chief Medical Officer, WebMD.<br>Ashish K. Jha, MD, Dean, School of Public Health, Brown University./delivery/aws/dd/ed/dded31f6-75cc-3955-83df-b2ec27f5f199/Jha_012121_v3_,4500k,2500k,1000k,750k,400k,.mp401/25/2021 12:00:0018001200Jha_012121_1800x1200/webmd/consumer_assets/site_images/article_thumbnails/video/covid19-images/Jha_012121_1800x1200.jpg091e9c5e820ece89

"Our study shows that the US is on a similar trajectory as other countries where B.1.1.7 rapidly became the dominant SARS-CoV-2 variant, requiring immediate and decisive action to minimize COVID-19 morbidity and mortality," the researchers write.

The authors point out that the B.1.1.7 variant became the dominant SARS-CoV-2 strain in the United Kingdom within a couple of months of its detection.

"Since then, the variant has been increasingly observed across many European countries, including Portugal and Ireland, which, like the UK, observed devastating waves of COVID-19 after B.1.1.7 became dominant," the authors write.

The B.1.1.7 variant has likely been spreading between US states since at least December 2020, they write.

As of Sunday, there were 690 confirmed cases of the B.1.1.7 variant in the US in 33 states, according to the CDC. But, the true number of cases is certainly higher. Normal coronavirus tests do not detect if an infection comes from one of the variants. Only genomic sequencing can do that, and the U.S. has only recently begun to ramp up that type of testing.

Washington and colleagues examined more than 500,000 coronavirus test samples from cases across the United States that were tested at San Mateo, CA-based Helix facilities since July 2020.

In the study, they findings of the variant varied across states. By the last week in January, the researchers estimated the proportion of B.1.1.7 in the U.S. population to be about 2.1% of all COVID-19 cases, though they found it made up about 2% of all COVID-19 cases in California and about 4.5% of cases in Florida. The authors acknowledge that their data is less robust outside of those two states.

While those percentages are still low, "our estimates show that its growth rate is at least 35-45% increased and doubling every week and a half," the authors write.

"Because laboratories in the US are only sequencing a small subset of SARS-CoV-2 samples, the true sequence diversity of SARS-CoV-2 in this country is still unknown," they note.

Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, said the U.S. is facing a "Category 5" storm with the spread of the B.1.1.7 variant as well as the variants first identified in South Africa and Brazil.

"We are going to see something like we have not seen yet in this country," Osterholm said recently on NBC's Meet the Press.