Jun 20, 2021 News
Kaieteur News – With vaccination rates slowing in the United States and other countries struggling to secure vaccines, public health experts have growing concerns that the so-called Delta coronavirus variant, first identified in India in March, could trigger a dramatic rise in cases and deaths in the U.S. and the world.
The Delta variant already accounts for 18 percent of cases in Colorado, Montana, North Dakota, South Dakota, Utah and Wyoming, and about six percent of cases nationwide. It has already spread to more than 70 countries and is now the most dominant variant in India, the United Kingdom and Singapore. Last week, Delta caused more than 90 percent of the new COVID-19 cases in the U.K., leading to a 65 percent bump in new infections since May 1. On Monday, to curb Delta’s spread, the U.K. Government decided to postpone “freedom day,” which would mark the end of public health restrictions.
The Delta variant is 60 percent more transmissible than the Alpha variant – first identified in the U.K. – which in turn was about 50 percent more transmissible than the ancestral Wuhan strain. “It’s a super spreader variant, that is worrisome,” says Eric Topol, founder and director of the Scripps Research Translational Institute. It has features that enable escape from the immune system and is perhaps more evasive than the Beta variant (B.1.351) first identified in South Africa, which was the worst until now, says Topol. “Plus, it has the highest transmissibility of anything we’ve seen so far. It’s a very bad combination.”
Dismayed by the trajectory of Delta in the U.K., Anthony Fauci, Head of the National Institute of Allergy and Infectious Diseases, warned President Joe Biden last week, “We cannot let that happen in the United States.”
The President echoed those sentiments, tweeting “Folks, the Delta variant—a highly infectious COVID-19 strain—is spreading rapidly among young people between 12 and 20 years old in the U.K. If you’re young and haven’t gotten your shot yet, it really is time.” A complete dose of a COVID-19 vaccine is still effective at preventing serious COVID-19 stemming from Delta infection.
Why is the Delta variant so scary?
Freely circulating viruses, especially corona viruses and influenza viruses, which encode their genetic instructions using the molecule RNA, mutate frequently and randomly due to copying errors introduced as they replicate in their human host cells. Some mutations enable the virus to evade antibodies; some enhance its ability to infect a cell; others go unnoticed since they yield no benefits or can even weaken it.
The key to Delta’s success is the collection of mutations the variant has accumulated in the spike protein, which covers SARS-CoV-2 and gives the virus its signature crown-like appearance. These mutations have changed the spike, and as a result, some of the existing antibodies may not bind as tightly or as often, explains Markus Hoffmann, an infectious disease biologist at the Leibniz Institute for Primate Research in Germany. Hoffman and others have shown that Delta and its closely related Kappa variant evade antibodies that were generated through previous infection and vaccination. Some synthetically produced antibody therapies, like Bamlanivimab, were unable to neutralise the Delta variant; but others such as Etesivimab, Casirivimab and Imdevimab were still effective.
The Delta variant has mutations on the spike protein that alter how it interacts with the ACE2 receptor protein, which is found on the surface of lung and other human cells and is the portal to invade the cell. The mutation at location 452 of the spike protein, which is also present in some of the California variants, appears to make the virus more transmissible and helps it spread through the population, explains Mehul Suthar, an immunologist at the Emory Vaccine Center.
If a mutation gives a virus a fitness or reproductive advantage, that mutation tends to evolve independently around the world. Delta, its closely related variants, and the highly contagious Alpha variant all carry a mutation at position 681 of the spike protein, which is thought to be an evolutionary game changer that also makes it easier for SARS-CoV-2 to invade the host cell and spread. This mutation is fast becoming common in COVID-19 viruses around the globe.
In addition to these mutations a recent study, not peer reviewed, shows a variation at position 478 on Delta’s spike that enables the virus to escape from weak neutralising antibodies. This mutation has also become increasingly common in SARS-CoV-2 variants in the U.S., Mexico and Europe since early 2021.
“When you have all of these mutations, then you start seeing a difference in infectivity (of the virus),” says Ravindra Gupta, a professor of clinical microbiology at the University of Cambridge, who has shown in an unpublished study how these variants can have a greater potential to cause disease.
Vaccines less effective against this super spreader
The data from India and the U.K. show that Delta has emerged as the dominant variant in those countries within four to six weeks. That indicates Delta is more transmissible and infectious than the previous variants. There is emerging evidence that it can also cause more severe disease. For example, in Scotland it caused about twice as many hospitalisations than the Alpha variant, which already caused more severe illness than the original SARS-CoV-2.
“This combination of high transmissibility, high severity and escape from vaccines makes Delta a very, very dangerous variant,” says Deepti Gurdasani, a clinical epidemiologist at Queen Mary University of London. Once Delta enters a country, it is going to spread rapidly. “It’s going to be quite hard to contain, and very likely will become the dominant variant in a matter of weeks. It could change the trajectory of the global pandemic.”
While vaccines are still effective against severe disease and hospitalisation caused by the Alpha and Beta variants, they offer less protection against Delta. People who were vaccinated with one or two doses of the Pfizer vaccine produced lower levels of antibodies capable of neutralising the Delta variant compared with the levels generated against Alpha and Beta. In the U.K., 31 percent of all confirmed Delta variant patients who needed emergency care had received at least one vaccine dose.
Similarly, a study under review revealed that after both doses, the Pfizer vaccine showed 88 percent effectiveness against symptomatic disease caused by the Delta variant compared to 93 percent against the Alpha variant. Two doses of AstraZeneca vaccine were 66 percent effective against Alpha but only 60 percent against Delta. But with just a single dose of either of the two vaccines, the vaccine effectiveness was only 51 percent against the Alpha variant compared to 33 percent against Delta. This effectiveness falls below the 50 percent efficacy threshold the FDA had set for designing safe COVID-19 vaccines; in which a vaccine should prevent at least half of the vaccinated people from getting COVID-19 symptoms.
In other studies still awaiting peer review, researchers report that Delta was responsible for most breakthrough infections—which occur after full vaccination—in India leading to a cluster of such cases among fully vaccinated healthcare workers.
There are many vaccine candidates being rolled out around the world and since there are no agreed international efficacy standards, each vaccine might offer a varying degree of protection against new variants. “We need more information about the performance of some of the more widely available vaccines in other parts of the world,” says physician and virologist, Benjamin Pinsky, of Stanford University School of Medicine. “I think folks need to make sure they get vaccinated. And until they are fully vaccinated, continuing with public health intervention is very important,” he says.
A vaccine alone only slows down the progression of a contagious disease by increasing the herd immunity. Until that point, preventive measures such as social distancing and masking are proven strategies for curbing the spread of the virus.
With just 44 percent of the U.S. population fully vaccinated, the majority of people are still vulnerable. Relaxing public health restrictions and declaring victory prematurely could provide an opportunity for the Delta variant to surge–particularly in the fall. (National Geographic)
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