Covid-19 Indian Variant B.1.617

How widespread is the Indian Covid-19 variant, and does it underpin the surge there...
27 April 2021

Interview with 

Sharon Peacock, Public Health England & University of Cambridge

INDIA-COVID

India is being very hard hit by Covid-19

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Here in the UK we are also picking up cases in the community of the Covid variant that is circulating in India and might be behind the surge there. So what do we know about it so far? Surprisingly, it’s not that new, as Cambridge University microbiologist Sharon Peacock, who leads COG-UK, the consortium that’s reading the genetic codes of the cases of coronavirus infection that we pick up here, explains to Chris Smith...

Sharon - This particular variant has been around for some time, actually. If you look in the global database, the first genome dates back to around October 2020, there were very small numbers of genomes being deposited into the database then, and by December, that was beginning to pick up. The first case was detected in the UK back in February. And it's been detected now in more than 20 countries.

Chris - And in terms of when we read the genetic code of this variant, what can that tell us about its likely behaviour or the risk it poses?

Sharon - Well, this particular variant has got 13 different mutations in its genome that result in changes in amino acids. That means it could potentially change the way the virus behaves. It has been called a double mutant in the past. Although I think it's important to avoid that because it doesn't have any particular meaning. But what that is referring to is two mutations in the spike protein, that's the protein that interacts with human cells. The numbers given to these mutations are E484Q and L452R. Now the E484Q is important because changes in that particular position in the genome is associated with immune escape. And the second change, L452R, has also arisen in other variants of interest, or under investigation around the world. So that's what people are focused on now. We don't really know what those two mutations together actually do in terms of the biology. We're just really speculating across from findings, from other variants of interest or concern at the moment.

Chris - Why do you think it's taking off in India the way that it is? Do you think there's something about this particular variant in the same way that the so-called Kent variant caused a takeoff of the outbreak in the UK last autumn?

Sharon - It's very difficult to know at the moment. The question is whether it's associated with the variant as a direct cause and effect, or whether it's more to do with human behaviour, large gatherings, a lack of preventive measures. It could also be down to a change in the virus. We saw a surge for the Kent variant in the UK, and that was down to changes in the virus. It could even be a combination of the two. The change in the genome of the Kent variant that we think has led to the transmissibility is not present in the variant detected in India. So I think really the jury is out.

Chris - How likely is it to be able to out-compete and surge ahead as the leading cause of cases here in the UK, like the Kent variant did last autumn?

Sharon - That's a really important question, but quite a difficult one to answer. At the moment the Kent variant causes 98% of all COVID cases in the UK. And so your question is, could another variant, any variant actually, the South Africa variant or the India variant, really get a foothold, and people are actually looking at that to see if they can estimate relative fitness of one virus against another. I think it's too early to say. The key will be to look at the ability of other variants to transmit between people and spread in the population over time.

Chris - So what do you think are really the big questions that scientists like yourself need the answers to about this variant now?

Sharon - We need to understand: is the virus innately more transmissible than other viruses, or other variants. We need to understand if this variant actually could evade immunity from natural infection or vaccination, the third question would be, does this variant cause a change in disease outcome? Does it cause, particularly, more severe disease?

Chris - What's the best way that we can keep everybody safe, given that we can see these sorts of threats emerging and then spreading in other countries around the world at the moment?

Sharon - Vaccination works, and the way to keep people safe, both in the UK and elsewhere is to vaccinate people. Vaccines are highly effective against the Kent variant and they're likely to provide protection against other variants too. So the key for me is vaccination. The next thing we need to do is really to stress the continued importance of our own behaviour, washing our hands, wearing a face mask, ensuring that we are distanced from each other and undertaking activities outdoors. So the two together are really key in controlling both the variants that we understand, but the variants that are yet to come. Variants don't emerge unless disease is occurring. And so our best hope of controlling variants is to actually control disease as a whole. You know, the Kent variant is changing over time. And so we shouldn't only be focused on the issue of border control and importation, and ignore the possibility that the Kent variant actually may develop other mutations that are actually important biologically, including vaccine escapes. So you have to have a dual focus on what is happening.

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