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Covid-19: Variants, vaccines and masks

26th Feb 2021
Covid-19: Variants, vaccines and masks

(Photo credit: Frauke Riether/Pixabay)

The Government’s vaccine programme seems on course to reach its target of offering a vaccine to everyone over the age of 70 by mid-February. If the vaccine programme continues to roll out as expected it is hoped all over-50s will be offered a vaccine by May.

Much needed positive news as we remain in lockdown and the number of Covid-19 cases still high, although data suggests we have now passed the peak.

The reason for the rapid surge in cases and the second wave and ensuing lockdown is being attributed to new variants of coronavirus emerging that are more infectious than the one that started the pandemic. In the UK, a new variant called the ‘Kent’ variant has emerged to become the dominant strain in many areas and scientists believe it is up to 70% more infectious than the original strain circulating in the UK.

All viruses naturally mutate over time, which is why we need new flu vaccines each year to protect against the new emerging strains of influenza.

The virus that causes Covid-19 is no exception, in fact since it was first discovered over a year ago; thousands of different mutations have emerged. Most mutations do not significantly change how the virus works but occasionally a mutation can lead to some benefits for the virus, for example, enhancing its ability to infect cells or reproduce, making it more infectious.

Recently, several variants have been identified that appear to be more transmissible making it easier for the virus to spread, the ones that are currently of concern include the Kent variant and variants recently identified in South Africa and Brazil. All three have undergone changes to their spike protein – the part of the virus that attaches to human cells. As a result, they seem to be better at infecting cells and spreading.

There is no evidence, so far, that these variants cause more severe disease, but the fact that they spread more easily can cause a surge in cases that leads to more people needing treatment for severe Covid-19, and health systems be overwhelmed.

In the UK, the Kent variant quickly became the dominant strain of the virus in the South East of England shortly after it was identified in September 2020, demonstrating it was more easily transmitted than other variants. Since then, the Kent variant has been identified in 50 other countries.

Last month, the Government announced cases of the South Africa strain had been identified in the UK in people with no history of travel to South Africa, suggesting this strain was now circulating in the community.

The UK is stepping up testing in specific areas where cases have been identified to stop it from spreading in the community. In addition, stricter border controls have been announced for people travelling from countries where the variants have been identified, including South Africa and South American countries.

One of the main concerns is whether vaccines will be as effective against these new strains.

The vaccines were designed around earlier strains of the Covid-19 virus, so scientists are assessing the effectiveness of the vaccines against the new strains. Scientists believe the vaccines will still offer some protection against new variants, reducing the chances of developing more severe forms of the disease. Early results for the Pfizer vaccine suggest it protects against the new variants but is slightly less effective.

Data from the Oxford-AstraZeneca vaccine team suggest their vaccine protects just as well against the new Kent variant but may not be as effective against the South African variant, although it should still protect against severe illness. Similarly, early results from Moderna suggest its vaccine is effective against the South Africa variant, although the immune response may not be as strong or long-lasting.

As and when new variants appear, it may be necessary to redesign and tweak the vaccines slightly to provide better protection from the circulating strains. Scientists say this can easily be done within a matter of weeks or months. This is similar to what happens with the flu jab, which needs to be modified each year to protect against the most common circulating strains.

Whilst the vaccination programme is still underway, we all need to keep vigilant and continue social distancing and washing of our hands. It is also interesting to note that several countries are now increasing their rules and advice on mask-wearing.

At the start of the pandemic many countries, including the UK, were not recommending or enforcing mask-wearing.

The advice seemed to be vague and there was a debate as to how effective they were in stopping transmission. Then as the pandemic continued advice changed and people were encouraged to wear a face covering, be it a cloth mask or medical grade mask.

More evidence became available that a face covering of any sort would help reduce the spread of the virus and eventually in the UK, as in other countries, mask-wearing on public transport and in public areas like shops became compulsory.

Although many of the public were already wearing masks there was still a minority who were reluctant to follow the rules and fines for not wearing a mask were introduced.

Now, with new emerging variants that are more transmissible, many countries are increasing their focus on mask-wearing. Germany has announced that people are required to wear medical-grade (N95 or FFP-2) masks in shops and public transport.

In France, children and teachers in schools are no longer allowed to wear fabric face masks; instead, they now need to wear category 1 surgical masks, which offer a higher level of protection. Here too in the UK, there are calls for medical grades masks only to be worn on public transport.

In the US, mask-wearing has been introduced by President Biden to control the spread of more-contagious variations of the virus. There have also been calls for wearing not one but two masks, especially for those likely to become severely ill if they get infected.

The Centres for Disease Control and Prevention reported new research that showed double-masking or wearing tightly fitted medical masks can reduce exposure to infectious aerosols up to 95%. For double-masking, a surgical mask should be put on first that covers your nose, mouth and under the chin with no gaps on either side.

Then a second mask of cotton fabric is worn over the top, helping keep the first mask snugly in place and provides added protection. Double-masking has been endorsed by Dr Anthony Fauci, President Biden’s Chief Medical advisor, and is recommended in situations where you will be in an enclosed space with several people, such as in shops and on transport.

As the vaccine rollout continues, it is likely that we will have to wear masks and socially distance for some months to come. With the rise of more infectious variants, it would seem that mask-wearing is now a key step to prevent the spread of the virus and that wearing not one but two masks is the way forward.

Rachel Kayani

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