Two years after the start of the pandemic, there is a lot science knows about COVID-19, but there’s also still a lot it doesn’t know. One of the aspects researchers are still grappling with has to do with the evolution of the SARS-CoV-2 virus. How likely are different variants to merge into a new one? What would such a merge mean to the course of the pandemic and to the vaccines we have now?
These and other questions were at the center of a panel on mutations and variants during a Jan. 27 webinar for journalists covering the COVID-19 pandemic.
“Variants, Vaccines and Medications: What Journalists Need to Know to Improve COVID-19 Coverage” was organized by the Knight Center for Journalism in the Americas at the University of Texas, in partnership with UNESCO, funded by the World Health Organization and UNESCO’s Multi-Donor Programme on Freedom of Expression and Safety of Journalists. Recordings of the webinar can be found on YouTube in English, Arabic, French, Portuguese and Spanish.
Angela Rasmussen, a virologist at the Vaccine and Infectious Disease Organization at the University of Saskatchewan, Canada, said one interesting aspect she noticed about news coverage of the pandemic is that every time scientists spot a variant of concern, it is treated almost as a “surprise” – but it shouldn’t be, as viruses evolve and variants are a natural sign of that.
“To me it’s not surprising that if you take an RNA virus like SARS-CoV-2 – or any other RNA virus – and you let it run free on the population, you’re going to get new variants evolving, but the way this is often covered is really credulous,” almost like reporters always reacting, “‘Oh my God, I can’t believe we’ve got a new variant!’” she said.
Rasmussen said researchers and epidemiologists still don’t know the exact origins of the Omicron variant – but suspect it didn’t evolve like previous variants. Something that is not surprising when one knows how RNA viruses work.
“This virus specifically is a generalist, it can infect a number of different species, and we’d expect to see the virus continue to adapt and evolve to whatever host it’s in – but this [variant] has emerged in a different way than the previous variants,” she said.
What scientists did know early on in the pandemic, however, is that SARS-CoV-2 would have a mutation rate similar to other coronaviruses. Unlike influenza, which is made of eight separate genomic pieces – and because of that can mix quite easily among its various types – coronaviruses are made of one genomic piece only, which makes them “mix” at slower rates compared to influenza. However, coronaviruses still have a high mutation rate – and in the case of COVID-19, it was especially helped by failed containment measures in several parts of the world.
For Rasmussen, the media should not be focusing on variants as a surprise element, but rather stress how social behavior is directly contributing to these variants emerging. The lack of proper precautions to reduce transmission, and worldwide accessibility to vaccines, should be the real focus, as these measures can reduce the emergence of new variants.
We think Omicron is a ‘milder’ variant – are journalists to blame?
Kai Kupferschmidt, a reporter for Science Magazine in Germany, said that the ‘mild Omicron’ narrative started when the variant was detected in South Africa, where about 70 percent of people had antibodies against that COVID variant, even if vaccine coverage was low. He warned, however, that reporters should not assume the same scenario would apply to other regions of the world. The rising death rates in countries like the United States, for example, contradict the idea that Omicron is in fact a milder form of SARS-CoV-2.
Purvi Parikh, an allergist and immunologist at Allergy and Asthma Associates of Murray, said the term ‘mild’ makes her cringe – “it conveys the wrong message to the general public, as if [Omicron] is something not to be taken as seriously – and this is contributing to the human behavior of not taking precautions, in combination with the pandemic fatigue,” she said.
In her research and practice as a clinical immunologist, Parikh has seen ‘milder’ forms of the virus in vaccinated and boosted patients that don’t need hospitalization or ICU admissions after being infected.
“But that’s not an absolute – everyday we see people get admitted who were vaccinated, boosted, and even those ‘mild’ people recovering at home (…) get knocked down by the virus, not only while they’re infectious, but even weeks afterwards,” she said.
Also, it is good to remember that even the ‘milder’ forms of infection can lead to long COVID, with debilitating syndromes. Besides, the Omicron-caused COVID-19 infection is not mild to unvaccinated people.
“We’re still seeing those people get intubated and pass away, even with the Omicron variant, and also have a lot of long-standing effects. In fact, the first [Omicron-related] death in the US was somebody who was unvaccinated, but had previous exposure to COVID-19,” Parikh said.
With Omicron, the situation is different than it was with the Delta or Gamma variants. For Kupferschmidt, journalists might be giving too much agency to variants: it is crucial to understand the new variants and to spell out what they mean, “but the most important thing at the moment is the question of what is the immunity of the population among which Omicron is spreading in,” he said.
Can we predict new variants coming along, and can vaccines rule them out?
In a world where three billion people have not yet received their vaccine doses, it is almost certain that more variants are going to emerge, Rasmussen said. Whether these variants are going to have similar properties to Omicron or be more transmissible – or potentially more infectious – is hard to tell. In Denmark, there are some Omicron sub lineages “competing with Omicron original recipe” and this is something that will happen more often. Taking into account current global vaccination status, Rasmussen said, it would be surprising not to see other variants emerge.
Parikh agreed and said “it would be foolish of us to try to make any predictions, because, in this pandemic, the one constant is change and unpredictability. There are so many factors that go into the scenario: human behavior, the delay of vaccine rollout… so it’s only a matter of time [until new variants emerge].” The main concern, she added, should be vaccines and whether they will hold up against future variants or not.
Fori Kupferschmidt, this is a tricky issue for journalists, especially when using the World Health Organization (WHO) nomenclature. Depending on the contagion scenario and other aspects specific to the SARS-CoV-2 virus, what is a sublineage today could become a variant on its own tomorrow. Journalists should dig deep when reporting about it, looking at what differentiates a new variant from a sublineage – and what it means for collective health.
The journalist touched on a thorny issue. Vaccines do decrease the burden of the disease and can avoid deaths from happening, but vaccination alone will not stop variants from emerging. COVID shots should be aligned with efficient containment measures to slow down the pandemic.
“Looking at the world now, it is the countries with the highest vaccination rates that are allowing themselves to let the virus spread unchecked – Denmark is a place where you would expect to see a variant to evolve,” Kupferschmidt said. Defending an equitable distribution of vaccines makes sense as an ethical action – and the pandemic should be, he said, the opportunity to talk about ethical behavior “for the right reasons, which aren’t always self-interest.”
Rasmussen said we will not see COVID-19 disappear anytime soon, as the virus is not a problem for humans alone. “We will not be able to eliminate this virus. There are so many species we won’t be able to vaccinate that can be infected… so variants will continue to emerge. The real question is how much does that matter to us – and that’s where the vaccine equity argument comes in,” she said.
“Variants are here to stay – but the question for the long-term outlook for us is how long they are going to continue to be a huge public health problem for us,” Rasmussen concluded.
Parikh went further.
“Vaccines don’t guarantee zero variants. They’re just supposed to set us up for success [in fighting the virus]. They’re not a guarantee of zero infections, as we see with pneumonia or flu. The point is we want to reduce deaths and hospitalizations – and hopefully reduce transmissibility, too. If there’s less virus replicating within you, then theoretically you should be less likely to pass it on.”
Still, vaccine equity is important, she said, “because everyone deserves to have that protection against a severe disease and against death.”
We need to know more
Some questions are still unanswered, and experts are looking for solutions. For example, whether an infection with Omicron is protective against other SARS-CoV-2 variants such as Delta, is still under scrutiny.
For Parikh, there’s no guarantee that an Omicron infection will be protective against other variants. Data from South Africa suggests, however, that people infected with Omicron could deal better with Delta.
“But on the flipside of that, we’ve been seeing reinfections of Omicron even within six weeks after infection – or people who had Alpha or Delta getting omicron. There’s no guarantee [of protection].”
T-cells, she stressed, have been the most resilient parts of the immune system against variants so far – and Parikh believes they will continue to be so. It could even help to understand why some individuals get seriously ill with COVID-19 while others don’t.
Another question scientists are looking at relates to animal reservoirs enabling new variants of the SARS-CoV-2 virus to emerge. Rasmussen’s laboratory is delving into that question at the moment. There are reports of infections in white-tailed deers and other animals.
“There’s a number of candidate species, but honestly we haven’t started to even scratch the surface of how many animals might actually be out there infected and that do have potentially animal-specific variants of SARS-CoV-2 circulating in those populations,” she said.
Experts have yet to figure out what viral circulation among animals and humans might mean to the evolution of the virus – and how it could impact human public health or animal health.