Coronavirus in 2021: new variant & long COVID

Public health expert Nisreen Alwan unpacks coronavirus strategies. When might the pandemic end?
12 January 2021

Interview with 

Nisreen Alwan, University of Southampton


Coronavirus particles over "2021".


The most crucial science coming in 2021 has got to be an end to the pandemic. Right now, in January, coronavirus rates are at an all time high here in the UK, with test results suggesting over sixty thousand new infections every day - seemingly the highest rate in the world, with the USA close behind. Some are saying the UK numbers reflect a new variant of the coronavirus known as B117 that appears to be more transmissible, and has come to dominate in tested samples. As a result prime minister Boris Johnson has announced another lockdown, saying that it's specifically to contain this new variant. Public health expert Nisreen Alwan joined Phil Sansom, as well as special guests Giles Yeo and Barbara Sahakian to unpack the prime minister's reasoning...

Nisreen - The whole world is watching a disaster unfold, unfortunately, in the UK with this new variant. The answer to the question really is it's very difficult to say if it's entirely responsible for the rise. I think there is enough evidence - maybe not very strong evidence, but multiple sources of evidence pointing to one direction - that this new variant B117 is more transmissible, maybe 50 to 70% more transmissible. But the control measures weren't really working very well even before this variant was announced. These include isolation; so we were hearing reports a lot of people who needed to isolate weren’t isolating for all sorts of reasons; and also the contact tracing wasn't working very well. And also we had different measures, we had what we call the tiers, different restriction measures in different places in the UK, different behaviors also leading up to Christmas. It's very hard to disentangle and say with certainty it was entirely due to this new variant.

Phil - What about schools? Because Prime Minister Johnson also said the following:

Boris Johnson - Primary schools, secondary schools, and colleges across England must move to remote provision from tomorrow.

Phil - How much spread is there in schools? Because this has been a really fraught topic.

Nisreen - Transmission in schools is not really considered controversial anymore. COVID transmission happens in schools, and I don't think as well that this is new with just the new variants. So for example, the latest statistics we had from the Office of National Statistics point that one in thirty-three secondary school age pupils had COVID, and one in fifty of those 2-10. The other bit of evidence which is really interesting is from SAGE, which is the scientist committee advising the government. And they produce evidence looking at how much children transmit, and they found actually that children were more likely to be the index cases, and that means they're more likely to bring the infection into the home. Obviously this is evidence also based on modelling, so there are always margins of uncertainty around it, but I don't think it's controversial anymore that transmission happens. And therefore, when schools do go back at full class sizes, we need to have really good measures to control infection.

Phil - Giles, could I ask you as a geneticist, have you looked at this new variant? Do you know anything about what makes it so special? Because the coronavirus mutates all the time.

Giles - Yeah, exactly. So like all viruses - cold viruses, the HIV virus - viruses, because of their rate of replication, actually mutate all the time. I just want to point out I'm not a virologist and I'm definitely not an expert on this, but I can think of a few things through my reading, through just listening to people, that concern the scientists about why this could be real. First, this B117 variant is not a single variant; it's actually a series of different changes within the genome, the RNA genome of the virus. A couple of them - and this is the concerning thing - actually happened within the spike protein itself. Now the spike protein - this is what gives the coronavirus its crown shape - is what actually binds to the cell surface and actually gets into the cell. It's critical for the infectivity of the virus. So there was a biological plausibility for why it could be in more infectious. Secondly, I've seen some preliminary data - it's not been published yet, so we'll have to see what happens - which indicates that it could be more infectious within a petri dish.

Phil - Nisreen, could you bring some of these aspects together for me and help us sort of predict what might happen for the next few months, maybe for the next year?

Nisreen - Well we're all optimistic about having the vaccine. This is the light at the end of this terrible tunnel we are in. If the lockdown is effective enough and it really brings the infection rates down, then it's a bit of déjà vu really for us! Like we said for the first lockdown, we have to come out from it having a really good test, trace, isolate, and support system to really try and contain the infection; and then distancing, wearing the mask, and having fresh air ventilation measures. We need to have these things in place, particularly in school, they need to be prepared from now to have these effective measures; more effective than what was happening, because we can see obviously that what was in schools wasn't effective enough. The other thing about the vaccine: it's really important to understand that vaccinating a minority of the population is unlikely to end the pandemic, because if the virus continues to circulate in the majority of the population, then there's room for it to mutate further, and then potentially have mutations that would affect the effectiveness of the vaccine. Obviously the trial evidence for the vaccine tells us that the vaccine is really effective at preventing severe disease from the COVID infection. The information about whether the vaccine actually prevents transmission is still uncertain, and therefore we need to be cautious around vaccines. They are great - they prevent the vulnerable from getting it - but I think the behavioural changes that we all have to make, and the resources that the governments need to put in to make sure these behavioural changes work, need to continue for a while until most of us are vaccinated, really?

Phil - And we're going to be talking to a virological immunologist later in the program more about the vaccine. Could I ask you Nisreen, if you were optimistic versus pessimistic, what sort of timescale would you give us for the pandemic?

Nisreen - Phil, this is a very difficult question! I don't know. Hopefully if the vaccine really happens quickly and most of us get vaccinated, then maybe by the summer we'll be in a much better place, but until then we really... a lot can happen, as we've seen, in a few months, and let's hope the direction is more positive in the next few months.

Phil - You've also been looking at people who are left with Long COVID symptoms for many months after they get their infection. Since we last reported on that back in the middle of 2020, what new has emerged, and are people getting better from this long term condition?

Nisreen - That's the problem, Phil, is that we don't know how many are getting better because we're not measuring Long COVID in any kind of sensible way. We don't have stats on recovery. We do have some worrying statistics recently that also came from the ONS, the Office of National Statistics, that 1 in 10 people still have symptoms 12 weeks after the onset of infection. And we still don't know the long term effects, the extent of any organ damage. So Long COVID is a big problem and it needs much more attention, and actually at times of crisis like what we're going through now, it's very important to highlight it to people and say, "if you're a younger age and you're healthy, there is a chance that you may not be able to function for several weeks or months, and then also we don't know the long term health effects of it." So that needs to be communicated over and over.

Phil - Just quickly, Barbara, some of these long term health effects do include neurological symptoms, don't they?

Barbara - Absolutely. So there's neurological and psychiatric symptoms, and we don't really know how they're going to pan out in the long term; whether for some people, fortunately they'll get better as time goes on, but for other people it may require treatments to actually get them better. And we'll have a lot of other problems with people who haven't even got the COVID, because there's been so much anxiety and depression amongst people who have just been locked down, because we know that loneliness and isolation is not good for you. It's not good for the brain, it's not good for your wellbeing. And we also know that adolescence at school is a time when you are relying on your peers and interacting with your peers and you're becoming an adult and to miss out on a lot of that behaviour, it's very difficult and could change the way that you start to interact when you come back. And I'm particularly worried also about the very young children, because that is one where they're learning their social cognitive skills and they're learning how to interact and they are developing the theory of mind is social cognition and all these things. But if you're kind of isolated and maybe you're only with your parents and maybe your parents are having to work at home or go out to work, it's very difficult for these children to actually get socialised because there are usually mother and baby groups, so you can be in primary school or whatever, but now that school has been so disrupted. I do worry about how they're going to have this natural development.


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