The good news is that the vaccines available now provide reasonable protection against B.1.1.7, with minor declines in efficacy. But B.1.351 from South Africa and P.1 from Brazil, the so-called escape mutants, are proving to be more of a problem. The two SARS-CoV-2 variants each have another mutation in their genome: E484K. As if in some horror movie, American infectious disease specialists are now calling it the “eeek mutation.”
Experiments conducted in South Africa have shown that it helps the virus trick its victims’ immune systems. Researchers there mixed the mutated viruses with the blood serum of patients who had recovered from COVID-19. It turned out that the antibodies were only able to render the mutants harmless to a small extent, meaning the South African mutant could infect people who have already been sick with COVID-19 or were at least infected with SARS-CoV-2. In other words, people who were believed to have immunity. But this also means that treatments using monoclonal antibodies will no longer work as well. And that vaccines currently available are less reliable.
“The vaccines that were designed for the previous variants will lose effectiveness,” says Alex Sigal, who heads a branch of the Berlin Max Planck Institute for Infection Biology in Durban, South Africa. “This has been shown most dramatically with AstraZeneca’s vaccine.”
The vaccine had only 10 percent efficacy left, although these are preliminary and not representative results. “The solution is the redesign of the vaccines targeting the new variants,” says Sigal. “What we are checking now is to see if antibodies to the new variants are cross protective, that is they can target both old and new,” he says. “If yes, this might be a solution.”
And if not? How will we deal with them? And how alarming are these findings? Austria was hit hard by the wave of the coronavirus that emanated from the ski resort town Ischgl – it should be an example of what people had been hoping for: that people can become immune to SARS-CoV-2.
But rather than having developed herd immunity, it appears that the E484K mutation is also reinfecting people who had earlier strains of the coronavirus. That would mean that in Germany, as is now the case in Tyrol, small islands of infection could form again and again where the disease had already passed through with a high number of cases – in Saxony in the east, for example, which has been hard hit, or Heinsberg, the site of the first major outbreak in Germany last year, or Tischenreuth.
And it wouldn’t necessarily take the South African or Brazilian variant for that to happen. Evolution seems to favor escape mutations everywhere where many immune systems are already armed against the previous, more harmless SARS-CoV-2. In Britain, B.1.1.7 has also further mutated to acquire the “eeek mutation,” with which it may be able to reinfect people who have recovered from a previous coronavirus infection.
“We have already seen 28 cases of B.1.1.7 with the E484K mutation to date in Britain,” says Jeffrey Barrett of the Wellcome Sanger Institute in Cambridge, where more than 60,000 positive virus samples have been sequenced and analyzed since December. The mutation has now occurred at least three times independently. “Viruses are always mutating,” Barrett says. “The appearance of a worrisome mutation like E484K on top of the B.1.1.7 variant was inevitable.”
That’s exactly what can happen if vaccination is as slow as it is in the European Union, but where high infection rates are still raging: SARS-CoV-2 is adapting. That’s why it’s so important to keep the number of “new infections as low as possible everywhere in the world,” says Barrett.
So how smart is it in a situation where you have a high infection rate like the one seen in Germany to reopen schools for in-class teaching, as the eastern state of Saxony did this week? Or as other states are planning on doing in March? “By doing so, we risk letting B.1.1.7 slip out of our control,” warns Meyer-Hermann of the Helmholtz Institute for Infection Research. “Because then we won’t get into the low case rate zone in time.”
It is indisputable that schools, like any place where many people meet, contribute to the incidence of infection. Most recently, a large representative study of Austrian schools showed that children are just as likely to get infected as adults, including primary school pupils.
And since the mutants began their rampant spread around the world, another awful suspicion has been added to the list: that the new pathogens are increasingly infecting children. Tests in Corzano, for example, showed that 10 percent of the northern Italian municipality’s 1,400 inhabitants were infected with B.1.1.7 and that 60 percent of those infected were primary school- and day-care aged children.
In Israel, doctors with the Association of Pediatricians recently sent an alarming letter to the country’s health minister. They had found that more than 50,000 children and teenagers had tested positive for SARS-CoV-2 in January – the largest number ever, even more than in the first and second waves. Cyrille Cohen of Bar-Ilan University told the British Medical Journal that since mid-December, when B.1.1.7 emerged in Israel, the proportion of new daily infections among under-10-year-olds has risen by almost a quarter. Although the vaccines haven’t been approved yet for use in children, Israel now wants to become the first country to vaccinate risk patients under 16 years of age.
Schools, which were supposed to reopen as part of Israel’s successful vaccine campaign, remain closed. “It is my opinion that we should still reopen gradually,” Cohen told the British Medical Journal, “until we understand better the infection pattern of this new variant.”
Still undetected at the time in autumn, the mutant in England spread primarily through schools. Observers were astonished at the number of cases, which increased especially among children and adolescents. As the incidence continued to skyrocket in November, pubs and restaurants were closed, people were strongly encouraged to work from home and the number of social contacts allowed was restricted.
But even with all those measures in place, they were unable to stop B.1.1.7.
In Canterbury, in the southeast English county of Kent, the weekly incidence rose to around 600 cases per 100,000 inhabitants. “And other places around here were much higher,” reports a translator who has lived in Canterbury for years and keeps a close eye on the coronavirus situation.
It wasn’t until the strict “Tier 4” lockdown imposed by Prime Minister Boris Johnson just before Christmas in some regions that the tide turned. Many people are only allowed out of the house to buy groceries and rarely even go outside to get fresh air. “I haven’t been in the city center for ages,” says the translator.
The good news coming out of Britain is that it is possible to keep B.1.1.7 in check with strict containment measures. The number of cases has also fallen sharply in Ireland after strict lockdown measures there, as well. Schools and most stores in the country are closed. And people are only allowed to leave their homes if they have a valid reason.