As the UK lifts lockdown restrictions concerns are growing that the new variant, dubbed the “Indian Variant,” may stop the return to normality everybody is hoping for. Unhelpful media articles have run with headlines such as “Indian Variant likely to cause third wave” or “Indian Variant will kill up to 1,000 people per day by Autumn.” (1) (2)
It is important to remember that thousands of variants are in circulation around the world - this is how all viruses behave. Viruses change every few weeks and, whilst these changes are expected, they are unpredictable in terms of exactly what aspect of the virus will change. Most variants have such minor changes from the original virus that they are insignificant and viruses can even mutate to become weaker but a few will have more marked changes and become "variants of concern".
Variants of concern are labelled as such because they may prove more infectious and/or more lethal. They may also go unrecognised by the body's immune system, so called “escape mutants”, which means a vaccine that worked pre-mutation is no longer as effective. However, if the vaccine continues to prevent serious disease and death, perhaps by reducing the illness to a milder form, that would still be hugely beneficial.
What is a variant or mutation?
The word “mutation” is often used in the media and films to signify something dangerous, alien and/or deadly. Scientifically it simply means a change in the genetic makeup of a living organism. These changes are needed for the process of evolution of a species and can be a change for the better, allowing an organism to adapt to its environment and survive. Other mutations have deleterious effects, for example cancer is caused by gene mutations. (3) (4)
Of itself, “mutation” is a neutral term and does not imply a good or bad process, only a natural one. Whilst some viruses can mutate to become more serious, it is just as possible for a virus to mutate into a less deadly form and cease to cause serious illness. (5)
All the COVID-19 variants have mutations (or changes) in the protein spikes that project from the virus surface. These spikes are the structure the vaccines target so there is concern that changes in the spikes may render the vaccines less effective. However, the human body makes many different types of antibody in response to either infection or vaccination - known as a polyclonal response – which means it is highly unlikely a new variant will not be recognised by any of the body’s antibodies. (6)
None of the current COVID-19 variants have rendered the approved vaccines ineffective but work is ongoing to see if they reduce their effectiveness.
Background to the Indian Variant
Labelling variants as UK, South African, Indian etc is not particularly helpful. It actually means these are the countries where they are first identified rather than where they originated from. However, as they are coded with a series of letters and numbers it is the quickest way to identify which variant is which when discussing them.
The Indian variant was first identified across India in October 2020 and scientists across the world are working to establish if this latest variant, officially called B.1.617, is more infectious and/or more deadly. Although the media is reporting it as a “double mutation” (because it has more than one change) and using emotive language to describe it there is no such term as "double mutation" scientifically. (7)
Variants are labelled by scientists as of Interest, Concern or High Consequence. (8)
Scientists have already noted that this latest variant has some changes similar to those identified in other variants but have not yet labelled it as a “Variant of Concern,” it is a "Variant of Interest." (There are no variants of high consequence (the most serious level) at the time of writing.)
Current Status of Vaccination against the Indian Variant
Confidence is growing that the current vaccines being used in the UK are all effective against the variant. Work in the laboratory has shown that the South African COVID-19 variant causes the largest drop off in vaccine efficacy, both the UK and the Indian variants only weaken the vaccine response a little. (9)
As more and more real world data is collected it will become clearer how well the vaccines are working but the situation so far is looking promising. Although cases of infection with the variant have been rising in some parts of the UK, this has been primarily in non-vaccinated people. Crucially hospital admissions and deaths have not increased in line with cases. It is hoped this means that the vaccines are protecting against serious illness and deaths but,as hospital admissions always lag two to three weeks behind rising case numbers, firm conclusions should not be made yet.
As Dr Mike Tildesley, Associate Professor at the University of Warwick, says: “As we progress to step three of the government roadmap, we have seen the emergence of a new, more transmissible variant that has taken hold in several areas of the UK. Whilst the vaccination campaign has been progressing extremely successfully since January, it is important to remember that the vaccines are not 100% protective and the presence of a more transmissible variant exposes people to increased risk, even if they have been vaccinated. Therefore it is vital that as many people as possible, regardless of age or health status, take up the vaccine when offered. Young and healthy people, whilst not highly at risk of developing severe disease, are still able to transmit the virus and by getting vaccinated, they reduce the risk not just to themselves, but to the elderly and the vulnerable, even if they have previously taken the vaccine. The relaxations on 17th May are extremely important for people’s mental health and well being after a lengthy period with severe restrictions in place, but the emergence of the new Indian variant serves as a reminder that we need to continue to ease carefully out of lockdown and continue with the vaccination campaign in order to minimise the risk of a resurgence occurring over the coming weeks.” (10)
In Conclusion
The Indian variant may become the dominant strain of COVID-19 in the UK bumping the UK variant from that position. There is no evidence yet that the vaccines will not work against it but full immunity is not reached until both doses of vaccine have been given. Currently a large proportion of the population have had a single dose or no vaccine at all and remain at risk of both catching and transmitting the virus. With this in mind the government is ramping up vaccination, both by rolling it out to younger age groups as quickly as possible (especially in variant hotspots) and by asking people to get their second dose sooner than the original planned 12 weeks. People who have received their first dose of any vaccine are eligible for the second dose from eight weeks later now. (11)
As cases rise in some areas of the UK all eyes are on the figures for hospital admissions and deaths. Currently at their lowest levels since last summer, if they stay there over the coming weeks the vaccine is winning in the war against the virus. If hospitals begin to see the kind of surge in cases that occurred in January this year there are going to be some very difficult decisions to make about just how much further the UK can really unlock.
