Welcome to Plugging the Gap (my email newsletter about Covid-19 and its economics). In case you don’t know me, I’m an economist and professor at the University of Toronto. I have written lots of books including, most recently, on Covid-19. You can follow me on Twitter (@joshgans) or subscribe to this email newsletter here. (I am also part of the CDL Rapid Screening Consortium. The views expressed here are my own and should not be taken as representing organisations I work for.)
This is the graph that has me worried — from the Financial Times:
The worrying bit is right at the end in red. These are the new Covid cases in South Africa that are all now from a new strain of coronavirus, B.1.1.529. Today the news is back like March 2020 all over again. Airlines stocks are falling and oil prices are coming down; last week’s economic worry is no longer a thing.
The previous Covid variants, Alpha in most of the world, Beta in South Africa and then Delta all had to outcompete each other. But if you look at where South Africa was in November, Delta had been beaten and case numbers were at their lowest since May 2020. In other words, B.1.1.529 did not outcompete other variants. It looks more like a new thing. The question is: is it new enough to matter?
By matter, I mean it in the usual self-centred way. Will it matter for us? Are we already protected against B.1.1.529 or is this effectively a new pandemic with a more infectious property than COVID-19 and unknown severity?
Let’s review the news that would push you towards thinking this is very bad. South Africa had reduced some restrictions in October and November. But no measures had been completely lifted as they have been in many parts of Europe and the United States. In particular, stay to home policies have not changed throughout the pandemic while most policies have not changed in some time.
Why is that bad news? Well, we can’t point to a large easing of restrictions to explain why there are new cases. Indeed, the cases are taking off even though there is still a pandemic mindset in place.
Let’s look at B.1.1.529 itself. This is from The Conversation:
B.1.1.529 carries certain mutations that are concerning. They have not been observed in this combination before, and the spike protein alone has over 30 mutations. This is important, because the spike protein is what makes up most of the vaccines.
We can also say that B.1.1.529 has a genetic profile very different from other circulating variants of interest and concern. It does not seem to be a “daughter of delta” or “grandson of beta” but rather represents a new lineage of SARS-CoV-2.
There are two issues here. There are lots of mutations in the spike protein. Second, it is not coming from existing variants.
The number of mutations in the spike protein mean that we do not know if B.1.1.529 should be considered a new variant, possibly to be named ‘Nu’ of COVID-19 or a new coronavirus. There is a grey area that I don’t quite understand but the WHO has classifying metrics and so will eventually decide.
But if it isn’t a variant arising from Delta that has been circulating in the world as the dominant strain, then where did it come from? A possible answer is from animals. SARS-CoV-2 spread throughout the world. We also know it spread to animals. For instance, a very high proportion of deer in the US seems to have been infected. What may have happened is that it has circulated in a wild or farm animal population for many months, mutated a ton and now has made the jump back to people. That process would cause us not to classify it as a new variant, i.e., mutating in people and then spreading, but instead a new disease. In other words, perhaps we should be treating this as COVID-21.
This highlights a key unknown. Will our vaccines for COVID-19 work against COVID-21? And by work, this means limit spread and/or limit severe disease?
Epidemiology is a strange discipline in that bad news is often good and vice versa. Here’s the good news: South Africa have only vaccinated 24% of their population (28% with at least one dose). That news is not what people consider “good” but for our purposes here it means that B.1.1.529 is spreading in a population with a low vaccination rate. If that is the case, we have good news in the sense that it is not bad news that would be “B.1.1.529 is spreading in a highly vaccinated population.”
What does the data say? Not a lot yet. There are cases of vaccinated people being infected with B.1.1.529 but that doesn’t tell us a lot about spread and nothing about severity. We now have to let the epidemiologists do their job to see if they can tease out what is happening before cases grow too much.
The other good news is that B.1.1.529 is showing up in current Covid tests. From The Conversation:
Fortunately, it seems that all diagnostic tests that have been checked so far are able to identify the new virus.
Even better, it appears that some widely used commercial assays show a specific pattern: two of the three target genome sequences are positive but the third one is not. It’s like the new variant consistently ticks two out of three boxes in the existing test. This may serve as a marker for B.1.1.529, meaning we can quickly estimate the proportion of positive cases due to B.1.1.529 infection per day and per area. This is very useful for monitoring the virus’s spread almost in real time.
That’s just as well because as you know — repeat after me — pandemics are an information problem. This means that our current monitoring is going to pick this up which also hopefully means that it isn’t running around the population in a very hidden fashion.
The New Waiting Game
This feels somewhat like February 2020 because we are in a new waiting game. Some countries are restricting travel to and from Africa but I suspect that is already too late.
If we were really serious about pandemic prevention, we would take the vaccines we have and pour them into Southern Africa. They may not work, but if they don’t work, they’re of no use to any of us.
In the meantime, we should also accelerate third booster shots with doses we have on hand rather than just keeping them in storage for some reason. (Yes, I know that may conflict with the first suggestion but likely not really).
Finally, all of our vaccines being produced are for the original Wuhan version of Covid. Why? I have no frigging idea. The whole point of mRNA vaccines was that we can tweak them. Why aren’t we doing this?