COVID-19 variants put more strain on public health agencies

Even as President Joe Biden plans to federalize the response to the pandemic, new variants of COVID-19 will force national and local public health agencies to step up efforts to track and respond to new strains.

More contagious variants add to the struggle agencies already face to trace contacts, manage healthcare in all jurisdictions, communicate with the public and vaccinate residents. The stakes are huge: Public health officials fear that if more transmissible variants take hold, an even more dangerous outbreak could occur, forcing public officials to impose further restrictions, possibly including closures.

“If a new variant takes over and we don’t do everything we can to prevent it from taking hold, it’s almost like a new pandemic,” said Lori T. Freeman, CEO of the National Association of County. and City Health Officials, a Washington, DC-based membership organization representing local health services. “Public health services could be in danger of being overwhelmed if we don’t take control to adequately control the variants. “

The response of state and local public health agencies has been a question that has plagued them since the onset of the pandemic – whether they will have the resources to take the actions they deem necessary.

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Public health systems are still not ready for the next pandemic

Because genomic testing in the United States lags behind efforts in other countries, scientists do not yet know how widespread the variants are. The Biden administration has promised to speed up these tests quickly, and states will do so too.

For now, with a lot of unknowns about the variants, states are simply urging the public to maintain the same vigilance that public health authorities have urged throughout the pandemic.

Matt Bieber, a spokesperson for the New Mexico Department of Health, for example, said in an email message that while the state is monitoring new strains, “In terms of public health messages, we have emphasized that best practices are COVID-safe practices – mask-wear, hand washing, avoid groups, etc.

Scientists have identified three worrying variants present in the United States: a first discovery in the United Kingdom, another in South Africa and a third in Brazil.

The British variant is the most abundant in the United States to date, with at least 611 cases in 33 states, most of which are in Florida. Maryland has identified three people with the South African variant and South Carolina has identified two. As of last week, the Brazilian variant had only been found in two infected people in Minnesota.

No more stops possible

Dr Leana Wen, a former Baltimore health commissioner who teaches health policy at George Washington University, agreed that the public health measures in place are the best protection against variants, but said a poor adherence could lead to unwanted action.

“The problem is, if much more contagious variants take hold, anything we thought was relatively safe, like opening schools, will be at higher risk,” Wen said.

It is typical for viruses to mutate, said University of Maryland virologist Matthew Frieman. Usually these variations are of no consequence; they do not help the virus to survive and replicate. “Most of the time, these variations do not lead to any clinical outcome,” said Frieman. They are benign and go away quickly.

Scientists used genomic sequencing to identify thousands of mutations in SARS-CoV-2, the coronavirus that causes COVID-19, and found almost all of them to be harmless.

But the three variants first found in Brazil, South Africa and the UK have spread more easily and faster than the original strain of COVID-19.

And data is emerging which suggests that the British variant could be deadlier than the original COVID-19 component. Scientists are also concerned that current vaccines may not be as effective against the variants, and that the variants may not be as sensitive to the therapies now used to treat COVID-19. There is also evidence from South Africa that a previous infection with COVID-19 does not offer protection against the variant identified therein.

Public health officials fear that if the vaccine rolls out not fast enough and Americans do not follow public health guidelines, one of the variants will take hold and become the dominant strain in the United States, and will spread even faster than the original version.

The situation is serious enough to consider revising the vaccination strategy, said Michael Osterholm, an infectious disease expert at the University of Minnesota who was part of Biden’s transition team. Emphasis must be put quickly give as many first doses as possible, he said in an interview with Meet the Press, even though he delays second doses.

Speed ​​up genomic testing

A Washington post in late January revealed that the United States had sequenced 0.32% of his positive cases compared to 6% in the United Kingdom. COVID-19 COVID-19 Data Tracking Site CoV Genetics Reports US Is Sequencing 3 positive samples per 1000 cases compared to over 45 in the UK

Sequencing in the United States, said Frieman, “had certainly not been a priority in 2020. That is changing now.”

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Lack of public data hampers fight against COVID-19

Dr Rochelle Walensky, the new director of the Federal Centers for Disease Control and Prevention, pledged at a press conference to dramatically increase surveillance of variants in the United States by commercial, academic and public laboratories, which each state operates.

The goal, she said, is to increase sequencing nationwide from an average of around 3,000 samples per week to 6,000 or 7,000 by mid-February. Biden’s proposed pandemic relief package includes $ 350 billion for state and local governments, in part to help them with their responses to COVID-19. Help includes money for testing, genomic testing and contact tracing.

Many labs, including more than two dozen state labs, have been performing genomic sequencing on SARS-CoV-2 since the early days of the pandemic, said Kelly Wroblewski, director of infectious diseases at the Association of Laboratories of public health.

California and Minnesota, she said, were aggressive. But their efforts were hampered by poor federal coordination to ensure adequate sampling and data collection, she said. This has left large gaps in knowledge about the location and spread of the variants.

Coordination, she said, is important to ensure sequencing crosses geographic and demographic groups, including race, ethnicity, age and gender, as well as those with severe symptoms of COVID -19 and those who are asymptomatic.

It wasn’t until the end of November, Wroblewski said, that the CDC began to push for a more coordinated national approach. “Things are absolutely going in the right direction now. ”

Prioritizing the sequencing of COVID-19 has costs. This keeps workers away from the large-scale diagnostic tests that follow the spread of COVID-19, as well as the sequencing done to identify other diseases, including cancers, said Freeman of the National Association of County and City Health Officials. .

“You have to make tough decisions,” Freeman said. “Do you want to test as many people as possible or slow down the system a bit to do the genetic testing?” “

Both experts say more federal funding is needed to hire more staff and purchase supplies for increased sequencing.

“Without funding, it will put us even further behind,” Wroblewski said. “If it doesn’t come quickly, it affects scaling and sustainability. “

States have not yet changed their general guidelines on public health, as the measures they have promoted from the start also apply to variants, said Dr Marcus Plescia, chief medical officer of the Association of state and territory health workers. There is not enough data available on the characteristics of the variants to make further recommendations. But, he acknowledged, if the variants start fueling a supercharged spread, states will be forced to consider restrictions or closures again.

Responses to reports that some of the COVID-19 vaccines may be less effective against particular variants, although those that have been tested against the variants appear to keep most people from getting seriously ill are of particular concern to health officials public, he said. . Officials fear such reports may increase people’s reluctance to vaccinate, he said. Some people may be inclined to wait for next-generation vaccines or boosters, which Plescia and other public health officials, including Dr.Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, consider a dangerous mistake.

“There is a lot of concern about the public getting worried and confused and making decisions that don’t make sense,” Plescia said. “Plus, anti-vaccines make things up. I am concerned about all kinds of misinformation being disseminated about the variants.

The more people who are vaccinated, the less likely the virus is to mutate and replicate. Vaccination, health officials insist, is the key to ending the pandemic.

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