The first known case of the new variant B117, was recorded on 20 September and sequenced in early October. Further analysis and a December report said that the rate of transmission of the variant, known as B.1.1.7 or VUI 202012/01 (variant under investigation, year 2020, month 12, variant 01), was 71% higher than for other variants, and that it may also have a higher viral load.

There is currently no evidence that this strain causes more severe illness, although it is being detected in a wide geography, especially where there are increased cases being detected.

The new variant has mutations to the spike protein that the three leading vaccines are targeting. However, vaccines produce antibodies against many regions in the spike protein, so it’s unlikely that a single change would make the vaccine less effective.

The message from experts speaking at a Science Media Centre briefing on covid-19 was also coherent with this line of thought in that the new variant was unlikely to make vaccines ineffective. Peter Openshaw, Past-President of the British Society for Immunology and Professor of Experimental Medicine at Imperial College London, who sits on NERVTAG, said, “We know that natural infection or vaccination will produce quite an array of antibody responses. Although it’s predicted that some of the mutations that are present in the new variant will affect some of the sites that are recognised by the antibodies, it does not seem likely that it will affect all of them.

“It’s clearly important that all of this is tested, and people are working away in the laboratories as we speak to try to get some preliminary answers within the next few days, but it’s not quick science. We have to wait until they can grow the virus and test different serums. So this information could come out in the next few weeks.”

Therefore, as of now, the vaccine would be effective for the new variant as well.

Over time, as more mutations occur, the vaccine may need to be altered. This happens with seasonal flu, which mutates every year, and the vaccine is adjusted accordingly. The SARS-CoV-2 virus doesn’t mutate as quickly as the flu virus, and the vaccines that have so far proved effective in trials are types that can easily be tweaked if necessary.

Sharon Peacock, director of Covid-19 Genomics UK (COG-UK) consortium said (as reported in the BMJ, Dec. 16, 2020), “With this variant there is no evidence that it will evade the vaccination or a human immune response. But if there is an instance of vaccine failure or reinfection then that case should be treated as high priority for genetic sequencing.”

The response to this question is still under discussion as evidence from new studies, interim results from phase III vaccine trials, and previous data from phase I and phase II trials support the notion that memory T cell responses to the vaccines, along with B cell antibody responses—in simpler terms, B-cells produce antibodies and similarly, T-cells are the central players in the immune response to a viral infection. These together, should provide good and possibly enduring immunity to SARS-Cov-2. With continuing public health measures, they should help lay a pathway out of the pandemic. High vaccine uptake will be critical to achieving individual and population immunity.¹ 

However, according to the WHO², “It’s too early to know if COVID-19 vaccines will provide long-term protection. Additional research is needed to answer this question. However, it’s encouraging that available data suggest that most people who recover from COVID-19 develop an immune response that provides at least some period of protection against reinfection – although we’re still learning how strong this protection is, and how long it lasts. Most COVID-19 vaccines being tested or reviewed now are using two dose regimens.”

Therefore, for now, we can’t be certain if the COVID-19 vaccine will be effective enough to completely protect one from COVID-19. That is why we must not rely on a future vaccine to fight this pandemic – we must use all the tools we already have at our disposal, such as use of masks, physical distancing, hand hygiene, respiratory etiquettes, avoiding crowds, testing, contact tracing, quarantine/isolation.

Source:

1 Covid-19 vaccines: delivering protective immunity. BMJ 2020;371:m4838. doi: https://doi.org/10.1136/bmj.m4838
2 https://www.who.int/news-room/q-a-detail/coronavirus-disease-(covid-19)-vaccines?

In the last few weeks, there has been a steady rise in the number of COVID infections in the south and east England. Samples from infected people have exposed the new virus. Already 1108 people have been infected with the new strain. The new variant of the Coronavirus found in the UK has been named VUI-202012/01 (the first “Variant Under Investigation” in December 2020) and is defined by a set of 23 mutations, including one on the receptor binding protein on the spike protein used by the virus to enter the human cells..

In common terminology, this virus is being referred to as the B117 and epidemiologists and virologists have found that B117 is 70% more transmissible than the other strains raising concerns of super-spreading events. One of its most significant mutation is an N501Y mutation in the spike protein that the virus uses to bind to the human ACE2 receptor. Changes in this part of spike protein may, in theory, result in the virus becoming more infectious and spreading more easily between people. This basically means that the spikes of the coronavirus with which they attach themselves to the healthy cells have mutated. This helps the coronavirus infect cells at a faster rate. The reproduction rate of this UK strain is also higher than other strains (reproduction rate refers to the number of people who can be infected from one infected person). 

Is it more dangerous then? We still don’t know that and are awaiting research and results to collate data on this particular aspect. Mutations that make viruses more infectious don’t necessarily make them more dangerous. The WHO has stated that “While initial assessment suggests that 202012/01 and 501Y.V2 do not cause changes in clinical presentation or severity, if they result in a higher case incidence, this would lead to an increase in COVID-19 hospitalizations and deaths.” 501Y.V2 is the new variant detected in South Africa.

A number of variants have already been detected in the UK. For example, the D614G variant is believed to have increased the ability of the virus to be transmitted and is now the most common type circulating in the UK, although it doesn’t seem to result in more severe disease.

Adapted from

1 Covid-19: New coronavirus variant is identified in UK. BMJ 2020;371:m4857. doi: https://doi.org/10.1136/bmj.m4857 (Published 16 December 2020)
2 Covid-19: What have we learnt about the new variant in the UK? BMJ 2020;371:m4944. doi: https://doi.org/10.1136/bmj.m4944
3 SARS-CoV-2 variants. Disease Outbreak News. 31 December 2020. https://www.who.int/csr/don/31-december-2020-sars-cov2-variants/en/

A 2021 January publication¹ discusses pregnancy during the Covid-19 Pandemic in greater detail. There are many unknowns for pregnant women during the pandemic. Clinical experience of pregnancies complicated with infection by other coronaviruses e.g., Severe Acute Respiratory Syndrome and Middle Eastern Respiratory Syndrome, has led to pregnant woman being considered potentially vulnerable to severe COVID-19 infection. Physiological changes during pregnancy have a significant impact on the immune system, respiratory system, cardiovascular function, and coagulation.² These may have positive or negative effects on COVID-19 disease progression.³ The impact of SARS-CoV-2 in pregnancy remains to be determined, and a concerted, global effort is required to determine the effects on implantation, fetal growth and development, labor, and neonatal health. Asymptomatic infection presents a further challenge regarding service provision, prevention, and management.

From the current evidence base, it is difficult to draw absolute conclusions on whether pregnant women are at increased risk of severe consequences of COVID-19. Most women will experience mild or asymptomatic disease with no lasting consequences⁴; however, some centers have seen increased rates of ICU admission, and the need for mechanical ventilation in pregnant women. The lack of detailed data makes identification of risk factors, and the definitive comparison of pregnant and nonpregnant cohorts impossible. The lack of universal COVID-19 testing means that it is likely that the majority of cases go undetected. Vertical transmission is probable, but it appears rare, and in the majority of neonates, it has minimal impact. However, once more, this is impossible to fully assess until neonatal testing is routine. There are a number of unknowns, in particular, whether COVID-19 is an independent risk factor for preterm birth, whether infection during pregnancy is likely to lead to long-term adverse effects in offspring, and whether this effect is dependent on gestational age at infection. 

The review published in the journal Physiology Reviews¹, further summarizes the research findings:

1. The risk factors for severe COVID-19 are similar in pregnancy to the general population.
2. Vertical transmission is plausible, but mechanisms are uncertain. Severe neonatal disease appears to be rare.
3. Antenatal corticosteroid use for threatened preterm birth is likely to be safe for the mother, and corticosteroid use for severe maternal disease may be beneficial.
4. Mothers with COVID-19 should be encouraged to breastfeed if they are able but should wear personal protective equipment to do so.
5. Asymptomatic COVID-19 in pregnancy appears to be common but is of uncertain clinical significance.

Source:

1 Wastnedge EAN, Reynolds RM, van Boeckel SR, et al. Pregnancy and COVID-19. Physiol Rev. 2021; 101(1): 303–18.

2 Abdoli A, Falahi S, Kenarkoohi A, et al. The COVID-19 pandemic, psychological stress during pregnancy, and risk of neurodevelopmental disorders in offspring: a neglected consequence. J PsychosomObstetGynaecol 2020;41:247–48.doi:10.1080/0167482X.2020.1761321.

3 Baud D, Greub G, Favre G, et al. Second-trimester miscarriage in a pregnant woman with SARS-CoV-2 infection. JAMA 2020;323:2198–2200. doi:10.1001/jama.2020.7233.

4 Breslin N, Baptiste C, Gyamfi-Bannerman C, et al. Coronavirus disease 2019 infection among asymptomatic and symptomatic pregnant women: two weeks of confirmed presentations to an affiliated pair of New York City hospitals. Am J ObstetGynecolMFM 2 2020:100118. doi:10.1016/j.ajogmf.2020.100118. 

Ecological studies have suggested fewer COVID-19 morbidities and mortalities in Bacillus Calmette–Guérin (BCG)-vaccinated countries than BCG-non-vaccinated countries. However, these studies obtained data during the early phase of the pandemic and did not adjust for potential confounders, including PCR-test numbers per population (PCR-tests).¹

In the absence of specific therapy, researchers have been exploring potential preventive and therapeutic options. There was a huge  buzz about the protective effect of Bacille Calmette-Guérin (BCG) vaccine in COVID-19. Based on epidemiological correlations, many unpublished preprints hypothesized that the BCG vaccine may offer protection against COVID-19. It gained so much popularity that within 20 days three randomized controlled trials (RCTs) got registered, and many more are in the pipeline.² However, to make an informed decision, it is critical to understand the mechanism of action of BCG, and appraise the robustness of the evidence.

The basis of the possible use of the BCG vaccine against COVID-19 lies in its non-specific effects (NSEs) over the immune system.³ The NSEs of BCG are mainly mediated by potentiating innate immune response through epigenetic mechanisms, which act as de novo enhancers to boost the immune response against a secondary challenge.^3-5 This enhancing response is popularly known as ‘trained immunity’ and is very characteristic of BCG. This trained immunity also offers protection against a variety of pathogens (Salmonella, Shigella, malaria, respiratory viruses, etc.) other than Mycobacterium tuberculosis, and forms the basis of its use in bladder cancer, melanoma etc.

However, in terms of COVID-19 context, the relationship between BCG and COVID-19 is being proven by looking at correlation/ association among two data set (BCG vaccine coverage and COVID-19), without acknowledging the variables like the difference in testing strategies, reporting bias, demographics, nation’s ability to respond to the pandemic, prevalence of co-morbidities, and different stages of the pandemic across various countries might have a significant impact on these associations/correlations and must be interpreted carefully. Therefore, at this stage, this association should be considered as a hypothesis only and should be tested through appropriately designed studies. Though the epidemiological association between BCG and COVID-19 is striking, it does not prove causal relationship unless tested in well-designed clinical trials.

Also, it should be noted that the NSEs of the BCG vaccine have not been well-studied in human beings and their clinical relevance is unknown.^2,3

A December 2020 study⁶ also states that besides unproven efficacy of the BCG vaccine, believing such reports and going for revaccination with BCG can put at serious risk patients with primary or secondary immunodeficiency. The report further states that even if the BCG vaccine is effective in preventing COVID-19 deaths or reducing its severity, the effect of this vaccine and its relevance is yet to be proven. Furthermore, It is very difficult to compare the epidemiologic data about COVID-19 in different countries. There are countless factors, mainly social and related to the healthcare system, which can be more decisive than the hypothesis of trained immunity induced by BCG. Until now, we can say that BCG’s protective role is, at least, insufficient, given many other factors that corroborate SARS-CoV-2 infection and/or its severity.

Therefore, in the absence of evidence, the BCG vaccination for the prevention of COVID-19 cannot be recommended. Despite the fact that greater BCG vaccine coverage may reduce the risk of deaths due to COVID-19, this needs to be further studied by observational studies and confirmed by randomized clinical trials.

Source:

1 Urashima M, Otani K, Hasegawa Y and Akutsu T. BCG Vaccination and Mortality of COVID-19 across 173 Countries: An Ecological Study. Int J Environ Res Public Health. 2020;17(15):5589.
2 World Health Organization. Bacille Calmette-Guérin (BCG) vaccination and COVID-19. Available from: https:/ /www.who.int/news-room/commentaries/detail/ bacillecalmette-guérin-(bcg)-vaccination-and-covid-19.
3 SAGE Working Group on BCG Vaccines and WHO Secretariat. Report on BCG vaccine use for protection against mycobacterial infections including tuberculosis, leprosy, and other nontuberculous mycobacteria (NTM) infections. World Health Organization; 2017. Available from: https://www.who.int/immunization/sage/ meetings/ 2017/october/1_BCG_report_revised_version_online.pdf. Accessed April 14, 2020.
4 Moorlag SJCFM, Arts RJW, van Crevel R, Netea MG. Non-specific effects of BCG vaccine on viral infections. Clin Microbiol Infect. 2019;25:1473-8.
5 Arts RJW, Moorlag SJCFM, Novakovic B, et al. BCG vaccination protects againstexperimental viral infection in humans through the induction of cytokines associated with trained immunity. Cell Host Microbe. 2018;23:89-100.e5.
6 Sarinho E, Goudouris E, Solé D. BCG vaccine: Worrying proposal for COVID-19. Vaccine. 2020;S0264-410X(20)31593-0. doi: 10.1016/j.vaccine.2020.12.026.