COVID-19: Variants, vaccine and mask considerations

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My goal today is to kick off a running series of answers to commonly asked questions. 

Dr. Strangevariant or How I Learned to Stop Worrying and Love the Spike Protein (that is the most obscure movie reference I’ve used yet)

Should we worry about COVID-19 variants? And do the vaccines work against the COVID-19 variants?

No, or maybe a little, and yes.

There are three primary variants being discussed in the media: the United Kingdom variant (B.1.1.17), the South Africa variant (B.1.135) and the Brazil variant (P.1). Let’s break these variants down by disease considerations and then vaccine considerations.

Disease considerations

These three variants are reported to be more contagious, and the U.K. government has said that the U.K. variant “may” be more virulent as well. I reviewed the data for contagiousness. Here is a small peek behind the curtain: essentially U.K. public health authorities mapped disease spread by location and then compared that to data on human movement in those locations (think cell phone data) and which variant was common. They found that places that had the new variant had higher levels of virus activity, even though the apparent level of human activity was the same as in areas without the new variant.

Does this analysis “prove” that these variants are more contagious? No, but frankly there is no way we can get the type of data we would need to “prove” such a conclusion, certainly not as fast as we would want. The conclusion of increased contagiousness is reasonable and as compelling as we can get in these situations.

I am skeptical of increased virulence based on the hemming and hawing I heard both from U.K. and U.S. public health officials. I think the jury is still out on that one.

And I am not terribly concerned about the contagiousness of these variants for a few reasons. The method of transmission is still the same, and masks still work. I have not found any evidence or commentary to suggest masks are ineffective in this case. I’ll get into the issue of “double-masking” below.

Vaccine considerations

The U.K. variant poses no concern at all for vaccine effectiveness. Both Pfizer and Moderna have released data showing that blood from immunized patients neutralize the U.K. variant just as readily as previous variants. (By the way, there is no reason to suspect any difference in terms of effectiveness or immunologic data between the Pfizer and Moderna vaccines. I think immunologic data for one mRNA vaccine can be extrapolated to the other mRNA vaccine as well.)

The South Africa and Brazil variants are slightly (please note the italics emphasizing the word slightly) different stories. I won’t get into the nitty gritty science, so here’s the summary. These variants are slightly harder to neutralize but both vaccines still neutralize the virus. Think of it this way: If the Tampa Bay Buccaneers win the Super Bowl by two touchdowns or one point, they still win the game.

Remember that immunity is a complex phenomenon that occurs along a spectrum. And immunity looks different depending on if we’re discussing immunity in one individual or in a large population. Even if these variants reduce vaccine effectiveness (which I don’t think they will) in one person, that doesn’t mean the vaccine goes from 95% effective in preventing disease to 0%. It may only mean the difference between 95% and 70% in that one person. That isn’t ideal, but it is not catastrophic. At present I do not have any concerns about vaccine “failure,” certainly not on a population basis.

Moderna announced that “out of an abundance of caution” they will start studying a new version of their vaccine that would use the spike protein from the South Africa variant instead of the original spike protein. That’s nice to hear, but it will be a while before brand new versions of vaccine are available, and by that time, they may not be needed. This raises another important point: these mRNA vaccines can be changed much more rapidly than more “traditional” vaccine technologies. So even if we had to change vaccines — which I don’t think we will — we could do that.

In other words, these variants are, uh, variable, but there is no evidence that they will have a meaningful impact on the vaccines.

Mask considerations

I’ve seen a number of news reports, including some commentary by Dr. Anthony Fauci, on the issue of double masking, specifically due to concerns of increased contagiousness from new variants. Here’s how I think about it:

1. The best mask is the type you wear. If you find wearing two masks or wearing a N95 mask irritating, and it leads you to taking it off, then just stick with one mask.
2. Homemade or similar masks should preferably be two-ply cloth that fits snugly on your face. Surgical style masks are also reasonable.
3. Vented masks are not a good idea. The whole point is to minimize your breath from reaching shared air.
4. Wearing two masks will likely further reduce your risk of spreading or “catching” the virus because it increases the likelihood of a snug fit and also adds an additional barrier. If you have a decent two-ply mask that is worn snuggly, you’re already reducing risk quite a bit, so any additional masks make a low risk even lower. (As a funny aside, the idea of layering masks on top of masks on top of masks in an attempt to gain the absolute maximum protection reminds me of this MADtv commercial on the Mach 20 razor.)
5. Wearing a N95 mask should maximally reduce your risk of spreading and catching the virus, but are more expensive. They are not absolutely necessary, and you should not feel compelled to have one. But if you want that extra relative risk reduction, go for it.

Lots more to come. Stay tuned: same bat time, same bat station.

Stay safe, and go make some lemonade.

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