How the COVID variants may drag out the pandemic

Canada now has the highest vaccination rates against COVID-19 anywhere in the world. While our public health authorities continue to lift restrictions cautiously, many experts are optimistic this will blunt any future waves of infection. That means fewer and milder cases.

There’s still a wild card though: the variants. These mutated versions of the virus are now the most common forms of COVID in Canada. So, what are they, and how worried should we be about them?

What is a variant of concern?

Every time a virus replicates, it produces slight changes to its genetic code. Most of the time, these changes don’t make any difference, but occasionally they make the virus more lethal, more transmissible, better able to evade immunity, or—most concerning—some combination of these. The longer and more widely a virus circulates, the more chances there are for these mutations to emerge.

What are the variants right now?

There are four variants of concern circulating in Canada. Alpha is the most common. There are more than 216,000 cases across the country as of mid-June, according to CMAJ News. Alpha emerged in the U.K. in September 2020 and was a huge driver of Canada’s third wave. It appeared to affect young people more severely and was 50% more contagious than earlier versions of the virus.

Beta was first documented in South Africa in May 2020. Though it’s less transmissible than Alpha, it appears able to escape the immune response trained by vaccines. It only accounts for about 2,000 cases in Canada.

Gamma, which first emerged in Brazil in November 2020, is less effective at evading immunity than Beta but slightly more transmissible. It accounts for about 15,000 cases, but new research found it can’t compete with other variants.

The most alarming variant at the moment is Delta. It emerged in India in October of last year. It’s 60% more transmissible than Alpha. That means the threshold to reach herd immunity—the point at which the spread of the virus stops without public health interventions—is now higher. As Dr. David Fisman, a Toronto epidemiologist, pointed out, Canada’s current vaccination rates likely would have ended the pandemic were we dealing with earlier strains of the virus. That’s no longer the case.

How well do vaccines work against the variants?

As we discussed in previous posts, all of the available vaccines are very effective at protecting against serious illness and reasonably effective at protecting against milder illness. Thankfully, new research out of the U.K. suggests that the vaccines are similarly effective against both Alpha and Delta. (The study looked at the Oxford-AstraZeneca and Pfizer-BioNTech vaccines, but the Moderna vaccine is, per public health guidance, effectively interchangeable with the latter; the Beta and Gamma variants are less likely to spread because they are less transmissible even though they show some ability to evade vaccine immunity.)

The key difference is that we now require greater vaccine coverage to curb the spread of Delta. As Emily Martin, an epidemiologist at the University of Michigan, told The Atlantic, “Whatever cracks that we have in our program for getting communities vaccinated, that’s what Delta is going to exploit.”

What does this mean for the future?

Delta is taking hold in certain parts of the country but with current vaccination rates plus targeted efforts to direct second doses to affected communities, Canadians remain well protected.

Experts believe it is unlikely any variant will emerge that completely evades vaccines. Still, it’s not impossible. “If you give the virus enough time and replicative cycles, it will sample a very large evolutionary space and find a solution to the problem we’ve presented it with, which is vaccination and widespread immunity,” Alex Greninger, the assistant director of the clinical virology laboratories at the University of Washington Laboratories, told Vox.

When the Alpha variant emerged, it became the dominant COVID variant globally in a matter of months. Delta has now overtaken Alpha.

Many countries won’t have widespread vaccine coverage for at least a few years, which means more opportunities for new variants to emerge that will affect Canadians. Even if travel restrictions were extended indefinitely, it would at best delay the spread of the virus. It now falls to countries like ours to assist countries whose vaccine uptake has been slower. In this case, the cliché rings true: We’re all in this together.

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