South Africa’s scientists say the 501Y.V2 variant moves more easily and faster, but it’s not more deadly
South Africa already has a clearer picture of the Covid-19 variant 501Y.V2 just a month after it was first detected and described to the public. While it may travel more easily and much faster, it is not more deadly, according to the eight scientists leading its study. The question of reinfection and the impact of vaccines needs more research.
On 18 January 2021, eight scientists leading the research studies in South Africa on this variant explained that 501Y.V2 seems to spread more easily and much faster than previous variants.
However, it is not causing more severe illness. It remains to be seen whether or not antibodies from the country’s first wave can recognise and kill this new variant, but data so far indicate that the reactions are mixed and reinfections remain at a stable level.
All scientists agreed that at this stage in what we know, current vaccines should be administered as they may well be able to tackle this variant too.
The co-chair of the ministerial advisory committee on Covid-19, Prof Salim Abdool Karim, led the discussion and emphasised that “we’ve learnt a lot more in the month since the variant was first described to South Africa”. The scientific research on this variant continues, but he felt it necessary to provide an update in order to challenge disinformation at this time.
Is the 501Y.V2 variant spreading more easily and much faster?
This variant is spreading more easily, and therefore more quickly than other variants, says Karim. He said this is evident in studies of the variant’s biological structure and in the data on new cases in the Western Cape, Eastern Cape and KwaZulu-Natal.
What concerned Karim when he first learnt of the variant was that its structure had changed in a way that made its affinity to the human cell stronger and made it easier for it to bind to human cells. This made transmission easier.
The researchers could see the impact of this in the drastic increase in new Covid-19 cases in the second wave in the Western Cape, Eastern Cape and KwaZulu-Natal. This is where this variant is known to be the dominant form of the disease.
This new variant emerged in the latter part of October and November – just before the second wave began. As Karim said, the second wave reached “completely new heights”. “We are now seeing today more cases and more deaths than we ever on any day saw during the first wave. This rapid rise in cases was accompanied by more hospitalisations and deaths,” he explained.
Firstly, the proportion of tests which come back positive has increased across the country. The positivity rate at the peak of the second wave was 32% higher than that of the first wave. “This drastic change that we are seeing is being driven by a virus that certainly biologically looks like it can attach to human cells more efficiently,” he explained. This dramatic increase is evident in all provinces and we are “still in the throes of the second wave”.
The number of cases has increased substantially. The Western Cape’s second wave peak is almost double that of the first wave and it lasted longer. Daily admissions have been more than double any level of first wave. The same can be seen in the data for the Eastern Cape and KwaZulu-Natal.
“The second wave has put enormous pressure on our healthcare system,” says Karim. Nowhere is this more evident than in KwaZulu-Natal — its first wave looks like Mount Kilimanjaro compared to the Mount Everest of a second wave, he compared.
Not only does this variant spread more easily, shown by just how many more people have contracted it, but also much more quickly.
This variant is 50% more transmissible than the previous variants we had in South Africa, according to Karim. A study used mathematical modelling to extrapolate what we should have seen in the second wave if we had the same variants and what the difference was.
In the Western Cape, it took 107 days to reach 100,000 cases in the first wave. It took just 54 days in the second wave, meaning the second wave was 50% faster than the first.
In KwaZulu-Natal, it was 39% faster. The first wave saw 100,000 cases in 54 days. In the second wave, it took just 33 days. Abdool Karim emphasised that this is the result of a number of factors, such as behaviour and testing, but the variant is certainly one of them.
Does it cause more severe illness?
This variant does not cause more severe illness or increase the risk of dying, according to studies presented at the webinar.
They showed that the two waves had a similar proportion of cases admitted to hospital. In addition, the profiles of those admitted to hospital and those who died remained the same, according to research done by Prof Mary-Ann Davies, a public health specialist responsible for epidemiology and surveillance in the Western Cape Department of Health.
However, current data indicates the variant is putting increased pressure on hospitals, said Karim. “We may see in due course an increase in deaths because of a lack of beds and the pressure in the healthcare system.”
What about reinfection?
Reinfection has happened, but it is not yet known what role this new variant plays in it. For now, reinfection levels have remained stable. According to two studies, antibodies created in reaction to illness during the first wave show little reaction to this new variant.
The part of the virus which binds to the human cell has changed in a way which makes it binding affinity for human cells stronger. This means this variant can escape antibodies – in other words, it can evade existing immunity. This has been shown in two studies presented during the discussion.
The mutations changed the parts of the virus which have acted as flags to the immune system to attack, explained Prof Penny Moore, an National Research Fund research chair of Virus-Dynamics at the University of the Witwatersrand and the National Institute of Communicable Diseases. In her study, they tested the blood of 50 people who had Covid-19 during the first wave. In 48% of them, the antibodies in the blood did not recognise the new variant. In the 52%, there was some recognition in people who had a strong immune response.
She pointed out that more research needs to be done on how antibodies produced by vaccines, and not naturally by the body, might react to this new variant. This can be found out by looking at clinical data to understand how serious the problem of immune evasion is.
The study of virologist Prof Alex Sigal echoed the findings of Moore’s. Sigal is a virologist at the Africa Health Research Institute. He emphasised that the body will still launch an immune response to this variant, but that it might be different to that triggered by other variants. He explained that although the current vaccines are designed for other variants, this does not mean it will not work. He said there is reason for concern, but that much more research needs to be done to know for sure what the answer is.
Reinfection is defined as a person becoming ill with Covid-19 after 90 days of being disease-free after recovering from having Covid-19 previously, says Prof Koleka Mlisana, the executive manager of academic affairs, research and quality assurance at the National Laboratory Services. Reinfection occurs because the body’s initial immune response was weak, but now we have to consider if it is caused by the new variant.
Her study analysed testing data and found that by 6 January 2021, more than 4,000 people were re-infected out of 6.7 million tested.“What we don’t know is who is getting reinfected and what is driving this.”
However, the data shows that the risk of reinfection has remained constant, meaning that we have not seen a marked increase… so far, we are able to say there is no evidence that suggests that the risk of reinfection is increasing as a result of the new variant. But bear in mind we are only talking a month after initial infection,” she explained.
What does this mean for vaccine efficacy and testing?
There is not yet any new evidence on this, but scientists around the world are working on it, said Karim. “We don’t yet have an answer, but we’re expecting an answer pretty soon… we want to see the actual data. It’s not yet available.”
Karim is adamant that the country’s vaccine strategy should not change at this stage with the evidence available.
He explains, “The vaccines are amongst the most effective vaccines we have for any disease. They achieve a critical goal – they reduce illness and hospitalisation. There are many unknowns which will take us a long time to resolve fully…. However, this is not any reason for us to hesitate to use a vaccine that saves lives. But I have to say that the vaccine rollout is not going to be easy or quick. It is a mammoth task that is going to need all hands on deck to vaccinate at least healthcare workers, the elderly and those with comorbidities as soon as we can. That is our challenge – to make a difference and the evidence I’m presenting to you today on the new variant doesn’t change that.”
Leading TB and vaccines expert Prof Willem Hanekom said it seems like our current testing and diagnostic methods for Covid-19 are working on this variant. He leads the Africa Health Research Institute. He voiced optimism that the vaccines will still work, “Our immune systems are extraordinarily clever. Although there may be small changes in the virus and therefore the antibodies may not be binding as well, there may be compensation through other arms of the immune system that allow vaccines to still work.”
Hanekom argues that we should “absolutely not” hold off on administering these vaccines until we know more about this variant. “If I could get the vaccine today, I would take it today… getting vaccines in people’s arms might be even more important than answering all these research questions.”
South Africa’s research effort
Karim commended the scientists on the speed and quality of their work, as did Minister of Health Dr Zweli Mkhize who opened the session.
The discovery of the variant was a cause of alarm for all the scientists. However, Prof Tulio De Oliveira pointed out that “you need to know your enemy so you can fight it well. He is a bioinformatician who directs KRISP at the University of KwaZulu-Natal.
“It’s very important to know it, even if our enemy is a much more transmissible virus. A positive of the discovery is that South Africa is leading the world on this genomic surveillance. This discovery was done in South Africa faster than anywhere else in the world because scientists worked with clinicians and government.”
The scientists working on this research have not had an easy time. “I promise it was not easy when the health minister, Abdool Karim, Lessels and myself had to present this to the president,” recalls De Oliveira. “How do you say to your president that now you have discovered a much faster variant that is completely going to overwhelm your health system within weeks? That was not easy.”
In addition, he said researchers felt they had to defend against attacks from global media and governments which said we have the worst variant in the world. He urged everyone to call this variant by its name – 501Y.V2 and not “the South African variant” in order to shrug off this misleading stigma.
Abdool Karim had started the session by making a similar appeal. “There are variants across the world and even if they are found in one country we do not know if that’s where they originated from and they will rapidly spread to other countries. The B117 variant is already in 50 countries and the 501Y.V2 is in more than 10 countries.”
He ended his presentation by pointing out that the emergence of this variant and others shows once again that no one is safe until everyone is safe.
He shared a quote from an article written by Pope Francis to highlight that no one is safe from this virus until everyone is safe. It reads:
“The pandemic has exposed the paradox that while we are more connected, we are also more divided… To come out of this crisis better, we have to. recover the knowledge that, as a people we have a shared destination. The pandemic has reminded us that no one is saved alone. What ties us to one another is what we commonly call solidarity. Solidarity is more than acts of generosity, important as they are; it is the call to embrace the reality that we are bound by bonds of reciprocity. On this solid foundation, we can build a better, different, human future.” DM/MC
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