The Government Created the Conditions for the New COVID Strain to Emerge
Epidemiologist Deepti Gurdasani and neuroscientist Hisham Ziauddeen explore how the new variant of the Coronavirus in Britain is likely to have developed and warn that an urgent Zero COVID strategy is the only option to prevent it happening again
Reports that a new strain of the Coronavirus may be linked to the recent surge of infections in England has led to serious concerns in the UK and across the globe.
On 19 December, the Government announced stricter restrictions for much of the south-east of England and partly reversed its widely criticised plans to ease COVID-19 restrictions over Christmas. In the days since, all travel to and from Dover and Folkestone has been stopped and more than 40 countries have imposed travel bans on Britain because of concerns about this new strain.
What is the new variant and how did it come to be?
The newly identified UK variant, called B.1.1.7, first showed up in the surveillance data in September. It spread rapidly across London, the south-east and Kent during November and now accounts for at least 60% of infections in the capital.
The rapid increase in the frequency of this variant has coincided with rapid increases in cases in south England, with exponential rises occurring even during lockdown. According to the Government’s New and Emerging Respiratory Virus Threats Advisory Group, this has spread 70% faster than the previous strain and could increase the reproduction number by between 0.4-0.9. This would make the virus much harder to control, although the variant has not been linked to causing more severe disease.
Viruses mutate and adapt as they multiply. Mutations occur randomly and at a predictable rate. Most have no impact on the transmissibility of the virus or the disease it causes. Over the course of 2020, more than 4,000 mutations have been identified in the part of the SARS-CoV-2 genome that codes for its spike protein. It is the spike protein that binds the human ACE-2 receptor and allows the virus to enter and infect human cells. Given this critical role, it is also the part of the virus that most vaccines have been targeted to.
Most of these mutations have little or no impact on the virus. Any mutations that make the virus less fit are weeded out as they are less likely to transmit. However, rarely, a mutation can occur that may make the virus more transmissible or help it adapt to certain conditions – such as the pressure from specific treatments or widespread immunity in the population (for example, due to vaccination). These mutant strains can out-compete other strains and become the dominant strain and there have been some such adaptive mutations that we were already aware of.
Even so, B.1.1.7 is unusual, in that it has 23 mutations or places in its genome where it differs from the original strain. Of these, eight are in the spike protein coding region and include some mutations that were already known but in a unique combination that has not been seen before. These include two mutations called N501Y and 69/70del.
N501Y allows the virus to infect and cause disease in mice and therefore move between species. It may also help the virus bind to the ACE-2 receptor more strongly, which may make it more transmissible. N501Y is also present in the new viral strain that has rapidly become dominant in South Africa and been linked to surges in cases there. 69/70del was detected during the mink outbreak in Denmark and has arisen separately many times in different parts of the world. This mutation was recently seen to develop in an infected person who was treated with convalescent plasma from people who had recovered from COVID-19 and contained antibodies against the strain of virus they had fought off. 69/70del is thought to have helped the virus escape from those antibodies.
This is not the first time viral adaptation has been reported in SARS-CoV-2. D614G spread rapidly across the globe earlier in the year, being a dominant mutation in strains now, and is thought to have increased the ability of the virus to transmit by about 20-30% by different estimates. We have now seen mutations that allow the virus to move between species and create new animal reservoirs, become more transmissible and escape immune responses, showing us the potential of the virus to adapt.
Too Little, Too Late
Viruses mutate and adapt as they multiply and, if we continue to have high levels of transmission in the population i.e. more cases, this provides fertile ground for new mutations to arise.
Sadly, but very avoidably, this is exactly what the Government has provided. Through repeated negligent decisions and consistently late actions, the Government has not only missed many opportunities to control the virus in the UK but actively worsened it.
September, when cases were once again rising sharply, was another example of the Government deciding not to act. Ignoring the recommendations of its own scientific advisors, it invited known proponents of the pseudoscientific ‘herd immunity’ approach, including Professor Carl Heneghan, Professor Sunetra Gupta, and Anders Tegnell (the architect of the disastrous Swedish strategy) to advise it. This led to a very late lockdown in November – at which point our health services were at critical capacity and case levels were too high to be brought down sufficiently with a four-week lockdown.
The second lockdown had minimal impact in London and the south-east of England, where the B.1.1.7 variant was already rapidly increasing in frequency and exponential growth soon resumed. Despite the high number of cases at the end of lockdown, the Government went ahead and eased restrictions anyway.
The much vaunted but highly flawed and dangerous Christmas policies, and the very poor communication around them, made the existing confusion about the severity of the epidemic, even worse. The Government paid no heed to the repeated warnings from scientists that allowing households to mix during Christmas would lead to a surge in cases. Entirely predictably, it had to backtrack on the policy, just a few days before Christmas, throwing people’s plans into chaos, and leading to crowded scenes at train stations.
Along the way, when it became clear that schoolchildren were likely contributing significantly to the spread of the virus, the Government denied this and last week issued legal threats to schools that moved to remote learning because of concerns about increasing transmission. It has since seemed to accept the important role of schools in transmission but denying it for so long and refusing to consider any mitigatory measures in schools, even those recommended by the World Health Organisation, has contributed to where we are now.
A Zero COVID Strategy
The UK now has more than 30,000 daily confirmed cases of COVID-19, with cases doubling every week. Hospital capacity is critical in many areas. Our economy is in tatters. What can we do about this?
Viruses need to multiply to mutate and adapt. That is where we can reduce risk. These developments emphasise once again that a zero COVID-19 strategy – as has been successfully followed by many countries in south-east Asia, and by New Zealand – is the only way forward.
We need to urgently contain the spread of the virus and eliminate these strains to protect our societies and our precious vaccine resources. The vaccines have brought renewed hope that life may return to a kind of normal in the near future, but they are only one element of the strategy. We cannot take them for granted and need to protect them by minimising the risk of new strains emerging.
As vaccines are rolled out more widely, this will likely exert pressure on the virus and select for adaptations that can escape vaccine elicited immune responses. The best way to prevent this is to minimise transmission which will reduce the risk of such events.
Achieving zero COVID-19 if this strain is significantly more transmissible will be more challenging, but it can be done with political will and commitment, and with public support. But we cannot do this alone. Experience shows us that such efforts need cooperation with our neighbours.
Yet, at a point where we desperately need a common strategy to stamp out the virus, we find ourselves at our most isolated point, taken there by the wilful actions of our Government. The banning of travel to and from the UK by most of Europe is eerily reminiscent of the steps taken by countries to prevent importation of cases from Wuhan in February. Our isolation seems poignant symbolically. On the verge of Brexit, and shunned by our closest partners, we have become the epicentre of a new wave of the pandemic in Europe.
Once again, we are at a point where scientists are asking the Government to take urgent action to save lives. There is a clear way forward. The question now is whether we continue down a path of exceptionalism, isolation, pseudoscience, death and destruction, or learn from our mistakes and change course now.
Deepti Gurdasani is an epidemiologist and Senior lecturer at Queen Mary University of London. Her research focuses on epidemiological and genetic factors that influence global health. Hisham Ziauddeen is a psychiatrist and neuroscientist at the University of Cambridge