But the emergence of several coronavirus mutations has cast a pall over the plan to “return to normal.” Variants from the United Kingdom, South Africa and Brazil appear to be more contagious than the original strain of COVID-19. Ohio State University researchers have already identified a strain identical to the U.K. variant in Columbus, and the U.S. Centers for Disease Control and Prevention has predicted the U.K. variant could be the dominant strain in the United States by next month.
Adding to the concern are early tests that indicate those strains, in addition to a concerning mutation that affects the spike protein on the virus, may be more resistant to the vaccines long been considered our best hope of controlling the crisis.
South Africa halted the use of an AstraZeneca-Oxford vaccine that has not been approved for use in the U.S. because data showed it was not effective at preventing mild to moderate illness. Data shows the Pfizer/ BioNTech and Moderna vaccines being used in the U.S. still provide ample protection against variants, and substantially reduce the risk of severe illness. But if the virus continues to evolve, can the vaccines keep up?
Experts told cleveland.com that although the virus may continue to mutate, there’s no reason to think it will render the vaccines ineffective. Pharmaceutical companies are already in the process of updating their vaccines to provide protection against the emerging variants, but the existing vaccines should provide enough protection to get the pandemic under control.
The prevalence of variants is partly the result of a global failure to contain the spread of COVID-19, experts said. The virus has had ample opportunity to evolve while infecting more than 100 million people worldwide.
Vaccines should limit the spread of infection, and that should reduce the chance that another concerning variant might emerge, said Gigi Gronvall, senior scholar at Johns Hopkins Center for Health Security. There will be even fewer chances for those mutations to occur if everyone who is still waiting for a vaccine continues to follow precautions like wearing face masks.
“Once community spread is reduced, we have less to fear from variants anyway,” Grovnall said. “Stop giving the virus opportunities to give us surprises.”
We may need to keep wearing masks until enough of the population is vaccinated; the U.S. has said it plans to have enough doses to vaccinate 300 million Americans by the end of the summer or the early part of the fall. The risk should be substantially lower once everyone is vaccinated and protected against severe illness and hospitalization, experts say.
“If we turn this virus into something that is annoying to get, but you have virtually no chance of going to the hospital or dying, that’s a pretty manageable dynamic for us to be existing in with this virus,” said Stephen Goldstein, an evolutionary virologist in the University of Utah’s department of human genetics. “The big problem with this virus is that it’s overloading health systems and killing people. If all it was doing was making people feel crummy for a few days, we wouldn’t be shutting the world down to try to stop it.”
Restrictions like limiting restaurant and movie theater capacity may need to stay in place until we can vaccinate everyone, but they can eventually be eased.
Updating the vaccines to account for the variants could take a few months, but pharmaceutical companies don’t need to start from scratch, experts said. Goldstein is optimistic that if we can reach herd immunity through vaccination, COVID-19 could kill fewer than the 12,000 to 61,000 people influenza has killed each year since 2010.
“I think even with the current vaccines, with some decreased efficacy against mild and moderate disease, we can have this virus killing many fewer people than influenza does every year,” Goldstein said. “And we’re not shutting everything down because of influenza.”
The Rise of the Variants
Viruses commonly mutate over time; past coronaviruses have mutated to the point where they’re still circulating and causing cold-like symptoms. But COVID-19 mutations are notable because the coronavirus didn’t need to find a reason to survive. It was already “dominating,” said Mark Cameron, an infectious disease researcher and associate professor at Case Western Reserve University“The virus isn’t being challenged necessarily to survive and infect us around the world. It’s doing that, yet it’s still evolving to become more transmissible,” Cameron said.
Experts have also hypothesized that some of the variants may have arisen in people who are infected for a long period of time – the “long haulers” who have symptoms that linger for much longer than a typical case.
Those people are often immunocompromised, said Michael Oglesbee, director of Ohio State University’s Infectious Disease Institute. If the virus gets into their system, it can remain for much longer than 10 days, giving it ample opportunity to replicate and mutate.
“The average person who is infected and clears the infection in 10 days – the virus is probably not going to change,” Oglesbee said.
Because the most notable variants are more contagious, experts worry they threaten to derail any progress we’ve made containing the spread of infection. The proliferation of the COVID-19 variants just increases the urgency to scale up vaccination, said Dr. Keith Armitage, medical director of the Roe Green Center for Travel Medicine and International Health at University Hospitals.
“We should be worried that it’s become more contagious,” Armitage said. “It’s all the more reason to get the vaccine out as quickly as possible.”
Can the Vaccine Keep Up?
The good news, experts say, is that pharmaceutical companies should be able to stay ahead of the mutations.Coronaviruses do not change as rapidly as other viruses: A prior study on a separate, seasonal coronavirus found it took roughly eight years for that virus to evade an immune response, Goldstein said. He expects the virus that causes COVID-19 will have a similar evolution.
“I don’t think there’s anything particularly special about this coronavirus,” Goldstein said. “It doesn’t have superpowers.”
On the other hand, the process of updating the current vaccines is much quicker. The sequences of the new variants can be added to the vaccines immediately. Those updated vaccines should provide even more protection against the variants, further reducing their risk to the public.
The biggest obstacle to updating the vaccines is production. It could take a while to make and distribute the updated vaccines, but they’ll likely be available in a matter of months, said Dr. Lee Harrison, an infectious diseases expert and professor at the University of Pittsburgh Graduate School of Public Health.
“We are not by any means starting at square one,” Harrison said. “This is going to be a pretty accelerated process.”
It’s unclear whether everyone who’s already been vaccinated by then will need some type of booster shot to protect them against the variants. Harrison said that could depend on the state of the pandemic once the updated shots are available; there could be more urgency to protect against the variants if they’re widespread in a few months’ time.
Also unclear is whether we’ll need to keep getting the coronavirus vaccine once the pandemic is under control. We may not need to get it every year like the flu shot, but possibly every few years, experts said.
“I think even if it does mutate, it’s not known when people will need a booster shot or if they need a variation of the vaccine,” Armitage said. “I don’t think we know.”
What Does the Future Hold?
If coronavirus variants become dominant in the U.S., we’ll need to wait several months for pharmaceutical companies to update the vaccines and distribute the new versions. Until then, even those who’ve been vaccinated will be at risk for getting sick with mild or moderate symptoms.However, that doesn’t mean the current vaccines will be “worthless,” Goldstein said. They’ll just be a bit less effective.
“We might have to accept, at least while companies are updating vaccines, that people are still going to get infected and potentially even get sick with this virus,” Goldstein said. “But as long as the vaccines remain highly effective at preventing hospitalizations and disease – which we have no reason to think they’re not right now – I don’t see why we would keep things shut down.”
The most notable barrier to getting “back to normal” could be the public’s reluctance to get the vaccine. Experts have estimated that roughly 80 percent of the population needs to be vaccinated to reach herd immunity, but polls have found many Americans are hesitant to get vaccinated.
If fewer than 80 percent of Americans are vaccinated, we may need to keep certain coronavirus restrictions in place, Oglesbee said. You’ll still need to wear a face mask when you’re out in public, and concerts and sporting events will still need to limit capacity to prevent the spread of infection, he said.
The variants represent a “curveball” in the return to normal, but we’ve always had the playbook for preventing infection, Harrison said. As long as we take precautions, we can avoid the mild to moderate illness they can cause if you’ve been vaccinated.
“It’s not like you’ve got this crazy virus out there that you’ll get no matter what you do. You can still prevent yourself from getting it,” Harrison said. “That’s a really important thing to stress.”
Cameron acknowledged that the proliferation of the variants is frustrating because it comes on the heels of the good news of the vaccines being approved and hospitalizations decreasing after a brutal holiday season. The biggest challenge could be making sure everyone continues to take precautions until the vaccines are widely available, he said.
“I’m hoping the public doesn’t just throw up their hands at this crossroads,” he said. “We need to stay vigilant because these variants have a better ability to transmit among us. So we need to double down on all these [precautions] we’re taking every single day.”
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