By Karen L. Kier
Pharmacist on behalf of the
ONU HealthWise team
Several news outlets have been reporting on mutations or changes to the COVID-19 virus known as SARS-CoV-2. What are these mutations all about?

They are important and may have a dynamic impact on the COVID-19 pandemic. The first mutation or change in the virus is what scientists believe caused this disease to jump from an animal source to a human source.

The original SARS-CoV-2 is actually called the wild type by scientists who work with viruses and look for mutations. The mutations are then given names based on the way they mutate from the original virus.

Should we be concerned about the mutations and how this could impact our ability to overcome the pandemic?

How does this change the activity and effectiveness of the vaccines in the United States?

Five mutations
Scientists do not believe these mutations are random and that this virus is starting to outsmart the science to date. Right now, scientists are looking at five mutations around the world and tracking the infection rates and disease patterns. They are determining if the vaccines will continue to be effective by laboratory testing.

Very little data on vaccine effectiveness with mutations has been gathered in humans but studies have started. The answer to these questions really has to do with the mutations and how active they are in altering the spike protein. The COVID-19 and SARS-CoV-2 research continues on a daily basis and new science and information continues to evolve. 

Besides the science of whether the vaccines will still work, another concern with the mutations is the possibility of getting a COVID-19 infection a second or third time. Globally, we know that it is possible to get COVID-19 more than once as the COVID-19 antibodies wear off. Now there is a worry about the mutations.

Scientists have shown that the antibodies formed by a COVID-19 infection did not neutralize or stop a new infection with the mutated South African virus strain.  So a COVID-19 infection may not provide short-term immunity to a mutated strain. This means that the COVID-19 infection can continue to spread to those who have had a previous infection.  However, both Pfizer and Moderna have shown some activity of their mRNA vaccines against the South African strain.

In addition, Moderna is working on a booster vaccine that would add extra protection for the new mutation. This concept is not new since this is exactly what is done for the annual influenza (flu) vaccine. Each year an updated flu vaccine is announced to cover new strains that have emerged and caused disease. 

The predominate strains
So what are the five predominate strains in the world right now? The B.1.17 mutation was first identified in Spain and has now spread across Europe.

This mutation has not been shown to be more contagious or more transferable at this time. This is contrast to the United Kingdom mutation known as B.1.1.7 that has been shown to transfer faster from person to person. Initial reports indicated that the B.1.1.7 spread faster but did not cause a higher rate of death.

Some newer data suggests that this may not be true and that the B.1.1.7 mutation may have a higher death rate.  More analysis needs to be done to verify this information.

Pfizer and Moderna have shown that their mRNA vaccine does work against the B.1.1.7 mutation. The South African mutation is known at B.1.351.  Although the mRNA vaccines do have activity against this mutation, it is a reduced activity.

So more research has to be done to determine how much protection the mRNA vaccine transfers for this mutation. The last two mutations are from Brazil.  This mutation is B.1.1.28 with a P.1 and P.2 alteration. Scientists are most concerned with the P.1 mutation and continue to do research on the potential impact.

Five days ago
Five days ago, the medical literature published a case report of a potential second infection in a Brazilian patient with the mutated strain of the virus. The issue with this case report is that the patient still got the infection despite having active antibodies from the previous infection.

This is a storyline that researchers will continue to explore as these mutations become more common around the world. 

The best measure for controlling mutations is to stop the spread of the virus. Why the concern? Healthcare professionals are relating this to “COVID-19 burnout.”

The worry is the level of COVID-19 burnout that many are experiencing with the pandemic lasting most of 2020 and continuing into 2021.  Many have tired of the requirements of social distancing, masks, and the restriction on large gatherings and this has been termed “COVID-19 burnout.” 

As hard as it is to stick to the Center for Disease Control and Prevention (CDC) guidelines, it is important to maintain this caution to stop the spread of mutating SARS-CoV-2.

The vaccine administration will also not eliminate the need for following guidelines because of these virus mutations and the vaccines can take months to confer immunity. Keep in mind that the vaccine is not 100% protective and precautions continue to be warranted.

For more information, reach out to your healthcare professional or the ONU HealthWise Pharmacy at 419-772-3784.