What we know about the new C.1.2 coronavirus variant

A new variant found in South Africa is getting attention for the number and types of mutations it contains and the speed at which they occur. While much of the world’s focus has been on the Delta variant of coronavirus, a new variant has been identified in South Africa. Currently referred to as the C.1.2 variant, it is yet to be called a variant of interest or concern by the World Health Organization (WHO), but is drawing the attention of scientists due to the number and types of mutations it contains and the speed at which the mutations have occurred.

C.1.2 is reported to be the variant carrying the most mutations since the original “wild” variant emerged in China. A pre-print study put out by South Africa’s National Institute for Communicable Diseases said the C.1.2 variant was first identified in the Gauteng and Mpumalanga provinces in May 2021; it has since been found in other South African provinces as well as in the Democratic Republic of the Congo, Mauritius, New Zealand, Portugal and Switzerland.

According to the preprint, there are several mutations carried on the C.1.2 variant – and some of these may make it more transmissible and even evade vaccine protection, though this is yet to be formally concluded.

For a variant to be declared a “variant of concern” by the WHO it must be proven to show “increased transmissibility, virulence or change in clinical disease, and a decreased effectiveness of public health and social measures”; it is too early to say if this is true of C1.2. WHO spokeswoman Margaret Harris told a United Nations briefing that they were monitoring the variant but it does not appear to be spreading.

Mutations are part of the course of many viral diseases that spread as quickly as the coronavirus. The more people the virus infects the more likely it is to mutate. When the coronavirus enters a human cell its main job is to instruct the cell to make more copies of the virus; these then leave the cell and infect other cells in their human host. The process of viral replication is relatively fast and errors can be made in the copying of viral DNA – these are known as mutations.

Most mutations are either harmful to the virus, and that particular virus dies out quickly, or confer no benefit at all. But every now and again a mutation that is advantageous to the virus will randomly occur – be it making it more transmissible or even making it partially resistant to vaccines.

For the C.1.2 variant to become dominant it will have to outcompete with Delta. That will mean increased transmissibility, being able to bind to human host cells and infect people quicker than Delta currently does.

A major concern with the C.1.2 variant is the speed at which it has mutated and the number of mutations it contains. Another reason scientists want to monitor C.1.2 closely is that some of these mutations look similar to those that have helped the Delta variant become the dominant strain across the world, while others align with what we have seen previously with the Beta variant. Any time these mutations are seen in a new variant it is important to keep an eye on how it spreads and what it does.

Although levels of the C.1.2 variant are still low among the South African population, it remains a concern to local public health experts and scientists across the world. The variant has emerged from the C.1 lineage which was one of the corona virus lineages that dominated during the first wave of infections in South Africa in mid-May 2020.

Currently, Delta remains the dominant variant in South Africa and much of the world. For the C.1.2 variant to become dominant it will have to outcompete with Delta. That will mean increased transmissibility, being able to bind to human host cells and infect people quicker than Delta currently does. Scientists refer to this as a virus’s “affinity” – how well it can grab onto and enter human cells; C.1.2 will have to have a better level of affinity than Delta to become dominant.

The bottom line is that it remains to be seen whether C.1.2 is indeed more transmissible than Delta or if it can partially evade the immune response triggered by the vaccine or previous infection. It will take time and detailed laboratory studies to confirm the types of mutations C.1.2 harbours and any advantages they may confer. What remains important and certain is that vaccinations are still the best way to protect against serious symptoms of COVID-19 and reduce the number of deaths that are still occurring worldwide from this disease.

Progress report: How to make schools safe this autumn

For children and parents in many countries, September heralds the start of a new academic year. It is a time of excitement, filled with shopping trips for new school uniforms and stationery, that marks the end of the summer holidays. Many of us remember the feeling well and do our best for our children in order to make the transition into the next school year as enjoyable as possible. But this year is different, there is the looming worry of COVID and other respiratory diseases that are expected to spread as children mingle with each other in indoor spaces.

Many countries have pressed on with vaccinating 12-15-year-olds against COVID to help mitigate the burden of disease in this population, but there are still countries that are yet to decide on whether vaccinating younger groups is in their best interests. Whatever decision the overriding health authority has made for your country, there is still likely to be a significant number of 12-15-year-olds who are not vaccinated and, of course, anyone below the age of 12 will not have been vaccinated at all. This means we must rely on other measures to reduce the spread of corona virus and other respiratory viruses among children while at school.

While hand hygiene, mask-wearing, social distancing and regular testing remain important tools in reducing the spread of COVID, the rules around them will vary from country to country and even schools within the same country. What is becoming glaringly obvious is how important good ventilation is in reducing the spread of the virus.

It is now widely agreed by scientists worldwide that the corona virus mainly spreads through aerosol particles, that is, it is airborne. The WHO updated its website to include the airborne route as a mode of transmission for the virus. This means that people carrying COVID can breathe cough or sneeze it out in tiny particles that float and linger in the air; these particles get breathed in by other people who then become infected. Aerosol particles containing the virus can remain suspended in the air and linger for hours if there are no good ventilation or air filtration systems that move the particles out of that enclosed space.

Airborne transmission is different from the much talked about “droplet spread” mechanism (that drove the idea of social distancing) that refers to much larger droplets coughed, sneezed or even talked out by an infected person who contains the virus. These droplets are too big and heavy to become airborne and are usually pulled down out of the air by gravity after travelling 1-2 meters.

Fomite spread refers to the spread of the virus through contaminated surfaces, something that is unlikely to have been a big driver of COVID infections in the real world. It is now widely accepted that droplet and fomite spread alone cannot account for the numerous super-spreading events and differences in transmission between indoor and outdoor environments observed during the pandemic, that airborne spread will have played a crucial part in. Other airborne viruses include the ones responsible for the common cold – also known as rhinoviruses – flu viruses, as well as chickenpox and measles.

It is important to remember that many young people exhibit mild or no symptoms of COVID and may attend classes without knowing they are harboring the virus. At the same time, there are clinically extremely vulnerable children in schools and colleges that are at increased risk of getting seriously sick with COVID and they deserve to be protected. Additionally, even healthy young people and children can get sick with the virus, and some can go on to develop long COVID.

This generation of children has suffered enough because of the pandemic; we must act now to make schools fun, exciting and safe places to be again. After a year of seeing intermittent school closures due to COVID outbreaks, it is vital that schools and education facilities be kept as COVID-safe as possible to ensure no further disruption to our children’s education – this means accepting the cost of reducing airborne transmission in our classrooms and acknowledging that if this is not done, the longer-term price we will pay for our children’s health and education will be much higher.

It is vital that governments look into ventilation systems in schools as well as invest in appropriate air filtration systems. Studies looking at other airborne viruses show that a low ventilation rate increases the risk of exposure to virus-laden aerosols indoors. Airflow strongly influences the transport of aerosol particles; greater airflow outdoors leads to better dispersion of these particles and less risk of virus transmission.

Carbon dioxide sensors can be used to monitor levels of exhaled air and whether ventilation is adequate – the higher the level of CO2 in a room the more likely the air is to contain exhaled aerosols that hold viruses, including that which causes COVID. Opening windows and doors are ways to improve ventilation and airflow, but this is not always practical. Some classrooms may not have outside-facing windows, and for other children, opening a window in autumn may make the classroom too cold an environment in which to learn effectively.

High-efficiency particulate air (HEPA) filter systems are ones made up of extremely fine fibres arranged in a way that removes 99.97 percent of particles from the air down to at least 0.3 microns in size, including those containing viruses. HVAC (heating, ventilation, air conditioning) filter systems also keep air moving and can remove viral-containing aerosols.

By combining all of these things – good ventilation, monitoring carbon dioxide levels and investing in air filtration systems – alongside social distancing, hand-washing and mask-wearing (where appropriate), schools can ensure they are doing all they can to reduce the spread of corona virus and other airborne viruses in their classrooms.

All of this requires investment and money – and in a year where many countries have suffered economic hardships as a result of the pandemic, this may be a bitter pill for some governments to swallow. But they must then ask themselves what the alternative is likely to be. This generation of children has suffered enough because of the pandemic; we must act now to make schools fun, exciting and safe places to be again.

In recent months, a number of high-profile anti-vaxxers have contracted COVID-19, some of whom have gone on to die of it. Dick Farrel – who was a right-wing radio and TV host in Florida, US, and a fierce critic of the COVID vaccines and of Dr Anthony Fauci, often urging his listeners not to get the vaccines – contracted and died of COVID last month. A Cambridge educated solicitor in the UK, Leslie Lawrenson, who told his social media followers to “trust” in their own immune systems and not get the vaccines, died of COVID at his home. There have been many others and each one is a sad case.

As doctors, we are taught to treat the patient in front of us, that we must not withhold treatment based on a patient’s beliefs or inclinations, and that this is a vital part of being a healthcare professional. If someone who is strongly opposed to masks or COVID vaccines becomes sick with the coronavirus, I would like to think that all healthcare professionals would offer them the same treatment and care given to those who are vaccinated and wore masks.

When I hear stories of people opposed to vaccines dying from COVID-19, my overwhelming emotion is sadness. These people are, in a way, victims themselves. They have bought into the many conspiracy theories online and have surrounded themselves with people who genuinely believe the misinformation out there is true. Once you are in that deep, I can imagine it is a difficult place to escape from.

A new study that is awaiting peer review suggests that the risk of suffering a breakthrough COVID infection with the Delta variant after being fully vaccinated with the Moderna vaccine may be much lower than the risk for those who received the Pfizer vaccine

Breakthrough infections refer to people who contract COVID despite being fully vaccinated.

The study looked at fully vaccinated people across Minnesota, Wisconsin, Arizona, Florida, and Iowa. Both Pfizer and Moderna are mRNA vaccines and are effective in preventing serious illness from coronavirus, even against the Delta variant, but the study suggests that Moderna offers more effective protection from getting COVID after being fully vaccinated.

Overall, the researchers found the Moderna vaccine conferred a twofold risk reduction against breakthrough infection compared with the Pfizer vaccine. They concluded, “Our observational study highlights that while both mRNA COVID-19 vaccines strongly protect against infection and severe disease, further evaluation of mechanisms underlying differences in their effectiveness such as dosing regimens and vaccine composition are warranted.”

Isn’t it time we learned to live with COVID?

This is a question I get asked all the time, usually from people who are understandably fed up with how COVID has affected their lives and some of their freedoms, people who just want to go back to life pre-pandemic. I understand their frustrations – COVID has adversely affected my life in a number of ways too – but I do not think we are at a point where we can rest on our laurels and decide to live with the disease.

Wealthy countries have done well with vaccines, but poorer countries remain largely unvaccinated, and the risk of new variants emerging remains high – we must do all we can to get vaccines over to them so they too can protect themselves. Even those countries that have done well with vaccines are still seeing high numbers of COVID cases, mainly driven by the highly infectious Delta variant and groups of adults who are yet to be fully vaccinated. These people remain at risk of significant illness – both short- and long-term – so now is not the time to stop pushing for the uptake of vaccines and actions that help reduce the spread of the disease.

Children remain a big uncertainty – although less likely to get seriously sick, this is not a given and some of them will get very unwell and suffer from long COVID. We have seen large numbers of children in the US, many of whom were previously well, admitted to hospital with COVID; schools need better systems in place to reduce the spread of the disease and, in my opinion, we need to get on vaccinating children aged 12-15.

Of course, there is the clinically extremely vulnerable to think of, those people who through no fault of their own have an underlying condition that makes them prone to serious illness from corona virus or who may have a compromised immune system that means the vaccines are not as effective for them – we cannot simply ignore their risk.

Whether we reach a point in time where COVID becomes endemic and is a disease we learn to live with is certainly possible, but the time for that is not now. There are still huge numbers of the world’s population at risk and we must continue to work hard to drive infection numbers down while increasing the numbers of people taking up vaccines.

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