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COVID-19: UK Perspective On Variants, 3/4/21 · The SHEA Podcast

• 0:07
  SPEAKER_00: Welcome to the Rapid Response Podcast brought to you by the Society for Healthcare Epidemiology of America, Shay, promoting the prevention of healthcare associated infections and antibiotic resistance and seeking to advance the field of healthcare epidemiology and antibiotic stewardship.
• 0:22
  SPEAKER_00: I am Dr.
• 0:23
  SPEAKER_00: Jennifer Hanrahan, infectious disease specialist at the University of Toledo, and I will serve as your moderator.
• 0:28
  SPEAKER_00: Discussion on the podcast does not reflect Shay's perspective, but facilitates communication of multiple perspectives and experiences as we go through this challenging time together.
• 0:38
  SPEAKER_00: Shay is excited to launch this episode of the podcast COVID-19 updates, What We Know Now.
• 0:44
  SPEAKER_00: Today's discussion will focus on UK perspective on COVID-19 variants.
• 0:49
  SPEAKER_00: Our speaker today is Dr.
• 0:50
  SPEAKER_00: Sharon Peacock, Professor of Public Health and Microbiology, Department of Medicine, University of Cambridge, and Director of the COVID-19 Genomics UK Consortium.
• 1:00
  SPEAKER_00: Thank you for joining us today.
• 1:02
  SPEAKER_00: Before we start a discussion, I would like to turn it over to Dr.
• 1:05
  SPEAKER_00: Rebecca Wren to get us started with a brief news and guidance update for the week.
• 1:10
  SPEAKER_01: As of the 3rd of March 2021, there have been over 114 million confirmed cases of COVID-19, including over 2.5 million deaths reported to the WHO.
• 1:22
  SPEAKER_01: On March 1st, WHO officials stated new COVID-19 cases are increasing across the globe for the first time in six weeks.
• 1:31
  SPEAKER_01: In particular, over the last week, reported cases rose in all regions except Africa and the Western Pacifics.
• 1:38
  SPEAKER_01: Officials said the spread is highly transmissible variants plus reopening efforts contributing to this increase.
• 1:45
  SPEAKER_01: In the United States, there have been over 28 million total cases and 515 deaths, according to the CDC as of March 3rd.
• 1:54
  SPEAKER_01: Also in the United States, over 52 million persons have received one or more doses of vaccine against SARS-CoV-2.
• 2:03
  SPEAKER_01: On February 27, 2021, the U.S.
• 2:06
  SPEAKER_01: Food and Drug Administration issued an emergency use authorization for the third vaccine for the prevention of COVID-19.
• 2:14
  SPEAKER_01: The EUA allows the Janssen COVID-19 vaccine to be distributed in the U.S.
• 2:20
  SPEAKER_01: for a use in individuals 18 years of age and older.
• 2:23
  SPEAKER_01: The FDA has determined that the Jansen COVID-19 vaccine has met the statutory criteria for issuance of an EUA.
• 2:30
  SPEAKER_01: The totality of the available data provides clear evidence that the Jansen COVID-19 vaccine may be effective in preventing COVID-19.
• 2:38
  SPEAKER_01: The data also shows that the vaccine's known and potential benefits outweigh its known and potential risks.
• 2:44
  SPEAKER_01: The Jansen COVID-19 vaccine uses replication incompetent adenovirus type 26, also known as AD-26, to deliver a piece of the DNA to make the distinctive spike protein of the SARS-CoV-2 virus.
• 2:58
  SPEAKER_01: While adenoviruses are a group of viruses that are relatively common, AD-26, which can cause the cold symptoms in Pink Eye, has been modified for the vaccine so that it cannot replicate in the human body to cause illness.
• 3:11
  SPEAKER_01: After a person receives this vaccine, the body can temporarily make the spike protein, which does not cause the disease again, but triggers the immune system to learn to react defensively, producing an immune response against SARS-CoV-2.
• 3:23
  SPEAKER_01: The anti-CoV-19 vaccine is administered as a single dose.
• 3:27
  SPEAKER_01: The available safety data to support EUA include an analysis of over 43,000 participants enrolled in an ongoing randomized placebo-controlled study being conducted in South Africa, certain countries in South America, Mexico, and the U.S.
• 3:43
  SPEAKER_01: The participants, over 21,000 of whom received the vaccine, and 21,000 of whom received saline placebo were followed for a median of eight weeks after the vaccination.
• 3:54
  SPEAKER_01: The most common reported side effects were pain at the injection site, headache, fatigue, muscle aches, and nausea.
• 4:00
  SPEAKER_01: Most of these side effects were mild to moderate in severity and lasted one to two days.
• 4:04
  SPEAKER_01: Each vial of the vaccine contains five doses, does not need to be reconstituted, and can be stored at between 36 to 46 degrees Fahrenheit.
• 4:13
  SPEAKER_01: On February 28, 2021, the ACIP or Advisory Committee on Immunization Practices issued an interim recommendation for the use of the Jansen COVID-19 vaccine in persons age greater than or equal to 18 for the prevention of COVID-19.
• 4:28
  SPEAKER_01: ACIP stated the Yansen COVID-19 vaccine has high efficacy against COVID-19 associated hospitalizations and deaths.
• 4:35
  SPEAKER_01: Persons may receive any ACIP recommended COVID-19 vaccine and are encouraged to receive the earliest vaccine available to them.
• 4:43
  SPEAKER_01: Use of all EUA authorized COVID-19 vaccine is critical in controlling the pandemic.
• 4:49
  SPEAKER_01: A morbidity and mortality report earlier release on February 27th entitled Reduction in COVID-19 patients requiring mechanical ventilation following implementation of a national COVID-19 vaccination program in Israel between December 2020 and February 2021.
• 5:05
  SPEAKER_01: This report provides efficacy data outside of controlled clinical trials.
• 5:09
  SPEAKER_01: Israel initiated a national vaccine campaign in December of 2020, prioritizing persons aged greater than 60 and other high-risk populations.
• 5:18
  SPEAKER_01: By February 2021, two-dose vaccination coverage was 84% among persons aged greater than or equal to 70 and 10% among those aged less than 50.
• 5:28
  SPEAKER_01: The ratio of COVID-19 patients aged greater than or equal to 70 requiring mechanical ventilation to those less than 50 years declined 67% from between October to December 2020 to February 2021.
• 5:42
  SPEAKER_01: These findings provide preliminary evidence of the efficacy of vaccine in preventing severe cases of COVID-19 at the national level in Israel.
• 5:50
  SPEAKER_01: A systematic review and meta-analysis evaluating association of convalescent plasma treatment with clinical outcomes in patients with COVID-19 disease was published in JAMA on February 26th.
• 6:01
  SPEAKER_01: This study sought to answer the question is treatment with convalescent plasma associated with improved clinical outcomes?
• 6:08
  SPEAKER_01: Included in the study were a meta-analysis with four peer-reviewed and published randomized clinical trials, including 1,060 patients with COVID-19 treated with convalescent plasma versus control.
• 6:19
  SPEAKER_01: The risk ratio for mortality was 0.93.
• 6:22
  SPEAKER_01: After the addition of six unpublished randomized clinical trials and 10,000 patients, the risk ratio for mortality is 1.02.
• 6:30
  SPEAKER_01: Neither finding was statistically significant.
• 6:32
  SPEAKER_01: No statistically significant associations with benefit were seen for hospital length of stay, mechanical ventilation use, clinical improvements, or clinical deterioration.
• 6:42
  SPEAKER_01: The WHO and European Observation on Health Systems and Policy has published a new policy briefing called Calling on Decision Makers to Support Patients with Long COVID.
• 6:52
  SPEAKER_01: They noted one in 10 people will experience the illness for 12 weeks after having COVID-19.
• 6:59
  SPEAKER_01: This is written for decision makers and briefly summarize what is known about the condition, who and how many people suffer from it, diagnosis and treatment, and how countries are addressing the issue.
• 7:09
  SPEAKER_01: In a report in JAM and Network Open, researchers sought to determine are surgical masks associated with episodes of oxygen desaturation or respiratory distress among children.
• 7:19
  SPEAKER_01: In this cohort study of 47 infants and young children in Italy, wearing surgical masks for 30 minutes was not associated with changes in respiratory parameters or clinical signs of respiratory distress.
• 7:31
  SPEAKER_01: These findings suggest that surgical masks among children may be promoted during the COVID-19 pandemic, especially in view of the reopening of schools.
• 7:40
  SPEAKER_01: And that's it for the news this week.
• 7:42
  SPEAKER_00: Thank you, Dr.
• 7:43
  SPEAKER_00: Wren.
• 7:43
  SPEAKER_00: I now want to move into the discussion with our speaker.
• 7:46
  SPEAKER_00: Thank you again, Dr.
• 7:47
  SPEAKER_00: Peacock, for joining us today.
• 7:49
  SPEAKER_00: It's an absolute pleasure, and thank you so much for inviting me.
• 7:52
  SPEAKER_00: First, can you tell our listeners about your role and what you are doing as director of the COVID-19 Genomics UK Consortium?
• 8:00
  SPEAKER_00: Yes, I'd be delighted to do that.
• 8:02
  SPEAKER_02: So we set up our consortium back on the 1st of April 2020, nearly a year ago now.
• 8:07
  SPEAKER_02: And I direct the consortium, which is a network of 16 sequencing facilities around the United Kingdom, including the four public health agencies, together with the Welcome Sanger Institute.
• 8:19
  SPEAKER_02: And our purpose is to provide genome sequence data for SARS-CoV-2 to the public health agencies for public health action.
• 8:27
  SPEAKER_02: So that's our key purpose.
• 8:29
  SPEAKER_02: But we're also a research network.
• 8:31
  SPEAKER_02: So the majority of us are actually academics.
• 8:33
  SPEAKER_02: And so we also undertake a lot of research around SARS-CoV-2 genomes as well.
• 8:38
  SPEAKER_00: And can you talk about some of that research that you have done around COVID-19?
• 8:43
  SPEAKER_02: Yeah, so it's a question of where to start.
• 8:45
  SPEAKER_02: We've focused on many aspects.
• 8:47
  SPEAKER_02: So some of it is very practical.
• 8:49
  SPEAKER_02: We've looked at how to improve sequencing, how to make it faster, more efficient, and cheaper.
• 8:55
  SPEAKER_02: So the methodology has been a really important part of our applied research.
• 8:59
  SPEAKER_02: We've also developed numerous pieces of software because without that, it's really difficult to analyse the genomes that we generate.
• 9:06
  SPEAKER_02: And it makes it easier for everybody else to do that.
• 9:08
  SPEAKER_02: But that's very applied and developmental.
• 9:10
  SPEAKER_02: We've also done research on many other aspects.
• 9:13
  SPEAKER_02: For example, we've looked at introduction of SARS-CoV-2 into the United Kingdom and Wales and Scotland as separate countries over time so that we really understand the importance of travel on the disease in our country.
• 9:25
  SPEAKER_02: We've looked at issues such as transmission in hospitals, care homes, universities, workplaces, but much more focused now.
• 9:33
  SPEAKER_02: We're looking at research relating to the emergence of the variants that we're seeing of the virus, which have particular characteristics of concern.
• 9:42
  SPEAKER_02: And so a lot of our work is currently focused on the variants themselves, demonstrating that whether they're more transmissible or not, etc., and really defining those characteristics.
• 9:51
  SPEAKER_02: So we go really across the spectrum.
• 9:53
  SPEAKER_02: Anything that has a genomic flavour, then we do try to support.
• 9:57
  SPEAKER_02: We also support a lot of national course studies in the country.
• 10:00
  SPEAKER_02: So a large epidemiological surveillance studies, we apply sequencing to that.
• 10:05
  SPEAKER_02: And anybody else who wants to ask us for sequencing, we're very keen to try and support the national studies in the country.
• 10:11
  SPEAKER_02: That sounds like a lot of work.
• 10:13
  SPEAKER_02: Well, it is, you know, we have 400 people in the consortium, and it's a wonderful network of largely academics, many of whom who are volunteers.
• 10:22
  SPEAKER_02: It is quite a lot of work, but I hope that there's much more to come.
• 10:25
  SPEAKER_00: So, Dr.
• 10:26
  SPEAKER_00: Peacock, you've been quoted as saying that what is known as the Kent variant is going to sweep the world in all probability.
• 10:33
  SPEAKER_00: What is the evidence that this variant is more transmissible?
• 10:37
  SPEAKER_00: And can you tell us if this variant and others are spreading more effectively?
• 10:41
  SPEAKER_02: Yes.
• 10:42
  SPEAKER_02: Well, that's a quote that I will probably be hanging around me for a long time.
• 10:46
  SPEAKER_02: It's interesting.
• 10:47
  SPEAKER_02: It comes from a 25-minute podcast.
• 10:50
  SPEAKER_02: And it can be quite challenging to scientists who are trying to explain things in some detail to have one line taken out and then used extensively.
• 10:58
  SPEAKER_02: But it's true that the B117 variant, which was first detected in Kent, appears to be more transmissible.
• 11:05
  SPEAKER_02: So if we just start on our geographical scale, right now this variant's been reported in at least 94 different countries.
• 11:13
  SPEAKER_02: And so it's clearly spread across the world.
• 11:15
  SPEAKER_02: And when we look at the number of genomes that have been generated in different countries, the UK is at top of the leaderboard.
• 11:22
  SPEAKER_02: It's got a very large number of genomes, more than 100,000 now, followed by Denmark and then the United States actually, Belgium and France.
• 11:29
  SPEAKER_02: And actually, much of the numbers here really relate to how much sequencing you're doing.
• 11:35
  SPEAKER_02: So I'll come on to your question of why we know it's more transmissible in a moment, but just simply knowing the transmissibility around the world is very limited by the amount of sequence data.
• 11:44
  SPEAKER_02: And so the more we can sequence, the more you will know the transmissibility around the world.
• 11:48
  SPEAKER_02: And it wouldn't surprise me if we detect it extensively across the world.
• 11:53
  SPEAKER_02: Now, in terms of transmissibility, when we first detected a surge in Kent, we were in lockdown and everybody else had falling disease rates, but Kent was continuing to surge despite lockdown.
• 12:06
  SPEAKER_02: Now there are several explanations for this, one being that people's behaviour, a super spreader event.
• 12:12
  SPEAKER_02: And so we didn't immediately jump to the conclusion that it was a new variant.
• 12:16
  SPEAKER_02: And in fact, it was the first time really that new variants came to light.
• 12:19
  SPEAKER_02: Before that, we weren't so aware of variants, but we certainly knew about variants, but not in the way that this has really changed our entire thinking.
• 12:26
  SPEAKER_02: So we knew that there was an outbreak or a surge in cases, and it was at that point that we put together the epidemiological information with the fact that the genome was really quite unusual compared to what was circulating.
• 12:39
  SPEAKER_02: It had 23 different changes in the genome, which was a lot.
• 12:43
  SPEAKER_02: So that set us off down a path to understand how whether this was more transmissible.
• 12:48
  SPEAKER_02: And we demonstrated that in using a range of different methods.
• 12:52
  SPEAKER_02: One was epidemiological, looking at the reproduction rate, another was genomic, looking at the rate of expansion of the lineage and various different modelling techniques.
• 13:01
  SPEAKER_02: And the evidence looks very strong now that this is more transmissible.
• 13:06
  SPEAKER_02: It's difficult to say exactly how much more.
• 13:08
  SPEAKER_02: I usually say around 50% because the studies they range from 30 to 70% more transmissible.
• 13:14
  SPEAKER_02: So I go somewhere in the middle.
• 13:16
  SPEAKER_02: But it's clear that it's more transmissible.
• 13:18
  SPEAKER_02: And once it had developed in Kent and London, it became really the dominant lineage in our country and now accounts for about 90% of all cases.
• 13:28
  SPEAKER_00: So should we assume that this variant or a similar one or other variants are going to continue to occur and propagate?
• 13:35
  SPEAKER_00: That's a very important question, but quite difficult to answer.
• 13:39
  SPEAKER_02: There's likely to be many variants in the world that we don't know about because we are not able to sequence in many parts of the world.
• 13:46
  SPEAKER_02: And so there are probably many variants out there.
• 13:48
  SPEAKER_02: What we're seeing at the moment, really since about November or so, is a burst of evolution of the virus.
• 13:55
  SPEAKER_02: So we know that there are three major variants of concern, in particular ones that are first detected in the UK, in South Africa, and Brazil, and all eyes are on those because we know quite a lot about those.
• 14:06
  SPEAKER_02: But actually, in the last few weeks, we've also seen other variants emerging that are of increasing interest and concern.
• 14:14
  SPEAKER_02: And so it's difficult to know what the trajectory is going to be like going forward.
• 14:18
  SPEAKER_02: So there are various possible outcomes.
• 14:20
  SPEAKER_02: The first is that we've seen as much as we're going to see, and that we can say, well, there's the variants and that's the end of it.
• 14:26
  SPEAKER_02: I suspect that's unlikely to be the case, although the mutations that these variants have in them are really converging.
• 14:32
  SPEAKER_02: So there's a relatively small number of mutations in those variants that appear to be important.
• 14:37
  SPEAKER_02: The alternative option is that we continue to see more variants arising around the world.
• 14:42
  SPEAKER_02: I wouldn't want to take a bet on which is likely to be, but if more variants do arise in the coming weeks and months, it wouldn't be that surprising.
• 14:50
  SPEAKER_02: And that may be an ascertainment issue.
• 14:53
  SPEAKER_02: For example, with sequencing now and we can actually detect things, but new variants may still occur.
• 14:58
  SPEAKER_00: And so when viral mutations occur, do they generally provide a survival benefit to the virus or can they actually be detrimental to the virus?
• 15:08
  SPEAKER_02: I mean, as you know, the mutations occur completely randomly and occur about once or twice a month in a given virus, although that sounds quite low.
• 15:17
  SPEAKER_02: But if there's more than a hundred million cases of COVID-19 on the planet, that's a lot of opportunity to mutate.
• 15:23
  SPEAKER_02: The virus will only mutate when it's going through a replication cycle in someone's body.
• 15:28
  SPEAKER_02: So there's plenty of opportunity to mutate.
• 15:30
  SPEAKER_02: And the mutations that arise, they're simply mistakes in the genome when they're replicating.
• 15:35
  SPEAKER_02: And they've got three possible outcomes.
• 15:37
  SPEAKER_02: The majority are likely to be neutral, they don't matter at all to us or the virus.
• 15:43
  SPEAKER_02: Some will be detrimental to the virus, and so we're unlikely to see those appearing because the lineage will likely disappear.
• 15:50
  SPEAKER_02: The ones we worry about are the ones that are detrimental to us, but they have to provide a fitness advantage to the virus.
• 15:56
  SPEAKER_02: And so this is kind of a survival of the fittest or natural selection.
• 15:59
  SPEAKER_02: But if a mutation arises purely by chance at a particular point, but that point is associated with a fitness advantage to the virus, by which I mean it can spread more between us, it can evade our immune response, then that is when that could be propagated in the population, and actually that lineage has a fitness advantage versus other viruses.
• 16:18
  SPEAKER_02: And so it really is survival of the fittest.
• 16:21
  SPEAKER_02: We're only seeing a very small number of variants arising with these properties that we worry about, but they're selected for because it gives a fitness to the virus, and it's in the context of lots of cases of disease in a population that has partial immunity now.
• 16:35
  SPEAKER_02: So the ability to partially evade our immune response is clearly an advantage to the virus.
• 16:40
  SPEAKER_00: One of the things that we have been curious about is whether the clinical illness has changed with these variants.
• 16:46
  SPEAKER_00: For example, you know, back in the fall, we started to notice that people were starting to show up in the United States later than what we were seeing in the spring in terms of clinical deterioration.
• 16:57
  SPEAKER_00: So in the spring, we were typically seeing worsening shortness of breath by days 10 to 12.
• 17:02
  SPEAKER_00: And then we started to notice that we were seeing it more around days 17 and even later.
• 17:07
  SPEAKER_00: And I'm wondering if there is any relationship between these clinical variants and clinical illness.
• 17:13
  SPEAKER_00: And is it a surrogate for a particular variant?
• 17:15
  SPEAKER_02: It's quite difficult to tell.
• 17:17
  SPEAKER_02: When we were looking at whether the variant in the UK was associated with a different disease syndrome, the way I interpret the observations is that the scientific data is quite noisy to start with.
• 17:27
  SPEAKER_02: What we're doing is we're talking about scientific data well before peer review, well before, you know, they're published.
• 17:33
  SPEAKER_02: And so there's quite a lot of debate in the community and quite a lot of variation in the findings.
• 17:37
  SPEAKER_02: So if we look at the Kent variant that first arose in Kent, there were three major studies that looked at whether symptoms were different with the new variant versus the old ones.
• 17:47
  SPEAKER_02: And two of the very large studies suggested that there was less likelihood to have a change in taste or smell, but were more likely to have classical symptoms of cough, sore throat, and so on.
• 17:58
  SPEAKER_02: But a third study, a very large study, based on 1.76 million users, the Zoe app actually showed no difference in symptoms, type, severity, duration of disease, etc.
• 18:09
  SPEAKER_02: And so it's actually quite difficult to know.
• 18:12
  SPEAKER_02: And so you couldn't actually exclude it.
• 18:15
  SPEAKER_02: But I think the question is is it important enough to really change the way clinicians behave or people behave?
• 18:22
  SPEAKER_02: And my advice would be if somebody has any symptom that suggests a COVID-19, then go and get tested.
• 18:29
  SPEAKER_02: Because I don't think that this clinical syndrome is sufficiently sharp enough, really, to be able to say either you've got COVID or you've got a particular variant.
• 18:39
  SPEAKER_02: It's not a useful thing to particularly do.
• 18:41
  SPEAKER_02: So I think focusing on if you've got a symptom, go and get tested and see if you have got it, and then take the appropriate action is the thing.
• 18:47
  SPEAKER_02: And perhaps if you do retrospective sequencing, you might find a really clear signal that it's due to a variant.
• 18:52
  SPEAKER_02: But in some ways, it's more of an academic question.
• 18:55
  SPEAKER_02: And I'm sure that you'll find the answer out.
• 18:57
  SPEAKER_02: But for us, the story was quite mixed.
• 19:00
  SPEAKER_00: Has there been any further information on whether the strain or this variant is more deadly?
• 19:06
  SPEAKER_00: There was some research saying that we couldn't say conclusively.
• 19:09
  SPEAKER_00: Do we have any further clarity on that?
• 19:11
  SPEAKER_02: Well, Nerve Tag are our group that consider these types of questions in the UK.
• 19:16
  SPEAKER_02: And it was back on the 11th of February that they produced their latest report, as far as I'm aware at least, that said that it was likely that infection was likely to be more severe and require hospitalization and be associated with a greater risk of death.
• 19:30
  SPEAKER_02: I would say two things really.
• 19:32
  SPEAKER_02: One is that the increased risk of severe disease and death is actually relatively low.
• 19:37
  SPEAKER_02: So taking a say, for example, a thousand people in there of 60, and you may expect 10 people to unfortunately die, with this increase, you might expect 13 or 14 people to die.
• 19:47
  SPEAKER_02: That's a tragedy for those people who do die, but it's not a massively.
• 19:51
  SPEAKER_02: So I think we have to keep it in perspective.
• 19:53
  SPEAKER_02: But the other thing is that the evidence I don't think is absolutely definitive.
• 19:57
  SPEAKER_02: So what we're looking at here is a balance of probabilities based on a range of different pieces of evidence.
• 20:02
  SPEAKER_02: And again, you know, when you're bringing lots of studies together, interpreting that can be quite noisy.
• 20:06
  SPEAKER_02: So at the moment, Nerftag believes that it's likely to be the case, but they haven't said definitively yet.
• 20:12
  SPEAKER_02: I know they're still considering that question at the moment.
• 20:15
  SPEAKER_00: We also know that this variant seems to infect more children than the original virus.
• 20:20
  SPEAKER_00: Is this something that you have seen and agree with?
• 20:23
  SPEAKER_02: Well, knowing that you were going to ask that question, I look back over our publications and I looked at a technical report from Public Health England back in January and looked at the sex age pyramid between pre-B117 and B117, and there was actually no difference in the distribution by age.
• 20:42
  SPEAKER_02: And so this was an early observation perhaps, but looking at the latest data, that doesn't really hold up.
• 20:48
  SPEAKER_02: So it doesn't appear to affect a different category of ages, or in particular, children.
• 20:54
  SPEAKER_02: And now when you think about it, it's actually causing 90% or more of all cases.
• 20:58
  SPEAKER_02: And so that's unlikely to really stack up either.
• 21:01
  SPEAKER_00: Okay.
• 21:02
  SPEAKER_00: What is the effect of masking and social distancing and controlling these variants?
• 21:06
  SPEAKER_00: The UK Health Secretary mentioned infections from variants are declining.
• 21:10
  SPEAKER_00: Is this due to strict precautions or is something else going on?
• 21:15
  SPEAKER_02: Well, these variants are no different from any other variants, and so they will be controlled by exactly the same measures.
• 21:21
  SPEAKER_02: So hands, face, space, we need to keep those up because they will control the variants effectively.
• 21:27
  SPEAKER_02: So that's the first thing to say.
• 21:29
  SPEAKER_02: But actually, thinking about the decline, that's likely to be due to several factors.
• 21:34
  SPEAKER_02: First of all, the UK has been in quite a stringent lockdown for some while, and that's just beginning to ease off now.
• 21:40
  SPEAKER_02: But that's one reason why we're having a decline in cases, and I'm so pleased to see that.
• 21:45
  SPEAKER_02: But the second reason, and actually there's some early evidence, is that actually our vaccination program that's rolling out is leading to a reduction in hospital admissions.
• 21:54
  SPEAKER_02: And so we vaccinated over 20 million people with their first dose of vaccine now.
• 21:59
  SPEAKER_02: And there's Very early evidence from Public Health England and others that that is beginning to have an effect in the populations that were vaccinated first.
• 22:07
  SPEAKER_02: That would be the way you'd see the first signal.
• 22:09
  SPEAKER_02: So in people 80 and over and in the older age groups.
• 22:12
  SPEAKER_02: And so there's a reduction in severe disease and admission to hospital.
• 22:17
  SPEAKER_02: And you know, the vaccines look as if they're being effective in reducing the amount of disease in our country.
• 22:23
  SPEAKER_02: So I would say that we have been in quite a prolonged lockdown plus vaccination.
• 22:27
  SPEAKER_02: And that is very likely to be the reason why the disease is declining.
• 22:31
  SPEAKER_02: So it's a combination of strict precautions plus vaccination that's helping us pull out of the other side of what's been quite a protracted wave of infection.
• 22:40
  SPEAKER_00: Well, that's great news that the vaccines are having an effect.
• 22:44
  SPEAKER_00: That's very welcome news.
• 22:45
  SPEAKER_00: Dr.
• 22:46
  SPEAKER_00: Peacock, what is the UK's capacity for widespread sequencing of the variants and how does this compare to the US?
• 22:54
  SPEAKER_02: Well, we sequence around 30,000 SARS-CoV-2 viruses every week.
• 22:59
  SPEAKER_02: We're planning to do more than that, but we aim to get at least a 10% of all positive cases sequenced.
• 23:06
  SPEAKER_02: I have to say that in the last surge that it dipped down to 5%.
• 23:10
  SPEAKER_02: But at the moment, we're more like 25% of people who go into hospital.
• 23:15
  SPEAKER_02: We're able to sequence their virus.
• 23:16
  SPEAKER_02: And we're aiming to go up to 10% or more for community cases.
• 23:20
  SPEAKER_02: And of course, because we have that sequencing capacity, as disease starts to decline, we can actually sequence more.
• 23:26
  SPEAKER_02: And I would like to sequence more.
• 23:27
  SPEAKER_02: I think the more we can sequence at the moment, the better.
• 23:30
  SPEAKER_02: So we'll continue to expend that 30,000.
• 23:32
  SPEAKER_02: Now, in terms of the US, I'm following that closely.
• 23:35
  SPEAKER_02: And I listened with great interest to a podcast on the 17th of February with Rochelle Walensky, who was talking about how much sequencing the US were able to do.
• 23:45
  SPEAKER_02: And there's clearly an ambition in the US to link together commercial labs and academic universities and state labs.
• 23:53
  SPEAKER_02: And she was talking about being able to sequence 750 samples per week from every state lab and was talking in terms of thousands a week and ultimately to get to 25,000 a week.
• 24:02
  SPEAKER_02: So I would say that the US are certainly on an upward trajectory on their sequencing.
• 24:07
  SPEAKER_02: But what we found is that it's not simply the sequencing that is the difficult bit.
• 24:12
  SPEAKER_02: You can get up a machine that does many thousands of sequences a day.
• 24:15
  SPEAKER_02: It's actually connecting the data and the data across from the patient to the public health agency who need to take some action and linking that all up together and the logistics of getting the samples flowing effectively.
• 24:27
  SPEAKER_02: So it's kind of the glue of the whole system, really, and not just the sequencing that's going to be the challenge.
• 24:32
  SPEAKER_02: And so, I mean, I look forward to seeing how that the US progress and they have got some incredible capacity, capability, and experts.
• 24:40
  SPEAKER_02: So I'm quite sure that you'll be seeing more, well, we'll all be seeing more sequence data from the US, and I look forward to seeing that efforts progress.
• 24:48
  SPEAKER_00: So it sounds like you think that sequencing is necessary from a public health standpoint.
• 24:54
  SPEAKER_00: It's critical.
• 24:55
  SPEAKER_02: We haven't talked much about the variants today, but variants mean that the behavior of the virus is changing, not just because of transmissibility, but because some of the variants have mutations that mean they can partially evade the immune responses.
• 25:09
  SPEAKER_02: Not fully, but they can certainly mean that the vaccines can be less effective.
• 25:13
  SPEAKER_02: My advice is to definitely go and get a vaccine because the vaccines are effective against most of the virus circulating at the moment on the planet.
• 25:21
  SPEAKER_02: So go and get your vaccination.
• 25:22
  SPEAKER_02: This is the way we can get on top of the pandemic and really drive down numbers.
• 25:27
  SPEAKER_02: However, the virus will continue to evolve, and as many of us become immune, then it's quite possible that the virus will mutate so that it can try and avoid the immune response.
• 25:39
  SPEAKER_02: And already vaccine developers are looking at how to revaccinate against the variant first detected in South Africa.
• 25:46
  SPEAKER_02: So those trials are beginning already now, the booster doses, to look at whether that really can contain that virus.
• 25:52
  SPEAKER_02: So over time, vaccine redevelopment and sequencing are kind of really close partners.
• 25:58
  SPEAKER_02: And so as we come out of the pandemic and this disease becomes more endemic, rather like flu, you can see a situation where we're really handling this like flu and giving regular booster doses for the circulating variants that we're concerned about at the moment, so that we stay on top of it in just the same way that we try and stay on top of influenza.
• 26:20
  SPEAKER_00: So, one more question about the sequencing.
• 26:22
  SPEAKER_00: How do hospital labs or public health labs determine which isolates should be sequenced?
• 26:27
  SPEAKER_00: So, how do we make sure that we're actually getting the information that we need?
• 26:31
  SPEAKER_00: We've thought long and hard about that.
• 26:32
  SPEAKER_02: It's such a critical question.
• 26:34
  SPEAKER_02: So we took a pragmatic decision that half of our sequence power would be sequenced in a way that didn't bias the collection at all.
• 26:42
  SPEAKER_02: So for people in hospital and people in the community, half of all of our sequencing would be unselected random sequencing across the entire country, so that we'd pick up any sort of pockets of change around the country.
• 26:54
  SPEAKER_02: And that has proved actually very effective in picking up variants of concern compared with targeted testing.
• 27:01
  SPEAKER_02: The other half we use in very targeted ways, for example, outbreak investigation.
• 27:06
  SPEAKER_02: We use it in our national core studies, looking at kind of epidemiological surveillance in a kind of more targeted way.
• 27:12
  SPEAKER_02: But that unselected sampling and sequencing is really critical so that you don't bias your collection and you try and capture that.
• 27:19
  SPEAKER_02: Now that's going to be a challenge across the US being such a big country.
• 27:23
  SPEAKER_02: But going back to Rochelle's podcast, it very much sounds as if sequencing in the state labs would give you coverage.
• 27:30
  SPEAKER_00: Dr.
• 27:31
  SPEAKER_00: Peacock, do you have any last words of wisdom for our listeners about how we in the United States can effectively fight back against these variants?
• 27:38
  SPEAKER_02: I'd have a few words actually.
• 27:40
  SPEAKER_02: First of all, go and get your vaccination when you're called up.
• 27:44
  SPEAKER_02: It's vital that we're vaccinated.
• 27:46
  SPEAKER_02: That's a key thing that we need to do.
• 27:48
  SPEAKER_02: Second of all, wear a mask, wash your hands, socially distance.
• 27:53
  SPEAKER_02: This is really important.
• 27:54
  SPEAKER_02: And those two things together are really vital.
• 27:57
  SPEAKER_02: The third is that our scientists need to be sequencing our virus so that we know what is circulating.
• 28:03
  SPEAKER_02: But ultimately, my final words are that we should be optimistic because I believe that we've been incredibly, I mean, our science has been extraordinary and move very fast.
• 28:14
  SPEAKER_02: So I believe that we're going to be able to get to a position where this virus hasn't gone, but we're managing it like we would influenza.
• 28:20
  SPEAKER_02: It's going to be at much lower rates than it is now if we do those things and put them in place so that we can tackle it.
• 28:26
  SPEAKER_02: And so I would end on a note of optimism.
• 28:29
  SPEAKER_02: Don't be depressed about the variants.
• 28:30
  SPEAKER_02: They are a fact of life for anybody who deals with pathogens.
• 28:34
  SPEAKER_02: Evolution is a matter of what you would expect, but actually we have all of the tools to deal with it if we're willing to get our vaccine and follow the rules about hand space and space.
• 28:43
  SPEAKER_02: So I'm looking forward to an environment where we can actually get back to some normality in the next few months and years.
• 28:50
  SPEAKER_00: Thank you so much, Dr.
• 28:51
  SPEAKER_00: Peacock.
• 28:52
  SPEAKER_00: That was really valuable information, and we really appreciate your time today.
• 28:57
  SPEAKER_00: It's an absolute pleasure, and thank you for inviting me.
• 29:00
  SPEAKER_00: Thank you very much to our speaker for sharing your perspectives and experiences.
• 29:04
  SPEAKER_00: This podcast can be accessed on Shay's online education center, Learning CE, under the Rapid Response Program.
• 29:11
  SPEAKER_00: You will also find resources such as the recorded webinars, healthcare facility, outbreak preparedness, and the SHA COVID-19 town halls.
• 29:19
  SPEAKER_00: New members can now receive 50% off 2021 SHA membership by using the coupon code WELLCOME2021 until March 31st.
• 29:27
  SPEAKER_00: This concludes this episode of the Rapid Response Podcast.
• 29:31
  SPEAKER_00: Thank you for tuning in.