Dr Mark Toshner

Controlling borders is a critical step in the fight against Covid

Controlling borders is a critical step in the fight against Covid
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Over the last two months our fight against Covid-19 appears to have changed dramatically. The emergence of novel variants in the UK, South Africa and Brazil has generated plenty of headlines and concern. We shouldn't panic. But one thing is clear: if we don't act now, we could come to regret it.

In the UK, for obvious reason we have been most focused on the B.1.1.7 variant. The evidence seems pretty clear that it is more transmissible and potentially more severe. Part of the reason we have such extensive data on virus mutations in the UK is the quite astonishing efforts that have gone into sequencing the viral genomes. With somewhere in the region of 50 per cent of the world’s sequencing happening here, it is perhaps not surprising that we are picking variants up quickly and learning about them almost in real time.

In reality, the scientific community has known from day one that this would happen. The only unanswered questions were when this might happen, and what impact viral mutations would have on the transmission and severity of disease.

Thankfully, we now know more about this illness and how to treat it. And, more crucially still, have a vaccine, which is safe and appears to be working well. In Israel, the only country far enough ahead to make any meaningful comments on their effects, the early data looks really encouraging, whether it is measured immune responses or counting the numbers of infections. What's more, it seems that the UK variant does not have any impact on the efficacy of the vaccines.

But if that is the good news, here's the bad news. While we have been focused on the UK variant, some troubling data is emerging on the South African variant. Several papers on the new 501Y.V2 variant have been released as 'preprints', a method of immediately making open data but without going through the normal editorial processes of peer review. These papers suggest this variant is able to evade the antibodies built up in patients exposed to previous Covid-19 infection. If this translates into real life (and out of the laboratory) then it may mean previous exposure to disease no longer completely protects you from getting it again.

Perhaps most worryingly, this has implications for the effectiveness of the currently available vaccines. It is important when you are trying to evaluate how much you should be worried here to understand how the pandemic has impacted on the dissemination, interpretation and just the plain old mechanics of normal science. 

None of these papers have been peer reviewed and discussion is happening online as data emerges on observations that are weeks or sometimes only days old. Often noise and polarised opinions get amplified out of proportion. This is partly because clear black and white opinions are more click-worthy and drive interest. You also have to understand that science happens in relative silos. Scientists in the lab often extrapolate their work when translating it into what might happen in a system as fantastically complex as a human being. Proving my point perfectly, since the first draft of this article and it going into print, Moderna have already issued a press release that their vaccine still works against these new variants in lab tests. Ultimately the best test is what happens to us. So, with these extensive caveats, what do the new variants mean?

The simple answer is this: I don’t know. But we will do soon. There are active vaccine trials in South Africa; within a few weeks, we should start to see if the vaccines are indeed less effective against this new variant. For now, though, it is too early for people to start losing sleep over this, though I suspect most of us are already at this stage anyway. 

Yet that doesn't mean the government shouldn't be taking things very seriously here. Why? Because if we don't act now, and assume the worst about these new variants, it might be too late to act. If we wait several months, the chances of us being able to deal with a new variant which can evade vaccines will be seriously diminished. We could be back to square one in our fight against Covid-19.

Whether or not bad news is confirmed about the new variants, we must accept that viral escape (when the virus mutates to evade the immune systems responses) is going to happen eventually. Though the Sars-Cov-2 virus is not a particularly fast mutating virus, it is prevalent in populations around the world in such high numbers that the opportunities to mutate are just very high.

It is fortunate that the currently working vaccine technology, for example both mRNA vaccines and the Oxford vaccine, are adaptable to new mutations and work on this is already underway. We should also be grateful that the vaccine development pipeline will be even quicker second time around as the regulators will not require the same extensive studies.

The downside is that, as we are now seeing, the challenges of scaling up quickly are huge and if they have to start again it will take months.

Here we come to the difficult bit. What should the government response be? I think we have reached a point where much of the debate should now be finished about what a successful strategy in Covid-19 looks like. Watch pictures of people living a normal life in Australia, New Zealand, Vietnam or Taiwan. What was their playbook? Given the amount of time our government has spent extolling the virtues of border control, it is a relief that they are finally announcing measures to tighten up border control and quarantine people from high-risk areas. Now is the time to re-evaluate what is needed for a Covid-free strategy and be decisive about our ability and desire to do this.

As of Sunday, we had 77 confirmed cases of the SA variant, all linked to travellers into the country. This should be an urgent public health emergency response. Most of the new infections traced by the wonderful sequencing we are doing can be demonstrated to be from lineages of the virus imported after the first lockdown was eased. It is clear that we are going to need a solid border control strategy, an effective track and trace system and, critically, we are going to need an effective system for people self-isolating. These things are achievable. Countries with much more modest resources than us have managed it. We need to demonstrate the humility to learn from them.

We might only get one shot at this now. I fear that after a year of fighting this disease, many people are on the edge of a nervous breakdown and the diminishing returns of lockdown-lite approaches has undermined the collective will to continue. The alternative is simple. The virus runs through us becoming endemic. Aided in part by the many opportunities this will present, it will mutate and we will start the merry-go-round all over again.

Written byDr Mark Toshner

Dr Mark Toshner is a lecturer and director of the Translational Biomedical Research Masters programme at the University of Cambridge.

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