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SARS-CoV-2 Variants of Concern in the United States—Challenges and Opportunities JAMA, 17th February, 2021 https://jamanetwork.com/journals/jama/fullarticle/2776739?utm_source=jamalive&utm_medium=social_jama&utm_campaign=product_marketing&utm_term=walensky0217&utm_content=manual_mb Rochelle P. Walensky, MD, MPH1; Henry T. Walke, MD, MPH1; Anthony S. Fauci, MD2 January 10, 2020, the first genomic sequence isolated in Wuhan As of February 3, 2021, 468,000 sequences uploaded to public domain 3 specific viral lineages reflecting VOCs, B.1.1.7, B.1.351, and P.1. B.1.1.7 lineage September 2020, first detected, UK, December 2020 In at least 80 countries In at least 33 US states B.1.1.7, potential, reverse the present downward trend in new infections Highlighted the risk of domestic and international travel February 3, 2021, B.1.1.7 variant in the US is now approaching 1%, with prevalence in some states exceeding 2% B.1.351 lineage October 2020, South Africa, December 2020 In at least 41 countries South Carolina and Maryland Demonstrated reduced response to previous ‘wild type’ antibodies Lymphocyte response may well be the same P.1 lineage December 2020, travellers from Brazil Minnesota Zambia B.1.351 variant Early December to 22 of 23 samples (96%) sequenced December 2020 to early January 2021 16-fold increase in COVID-19 incidence The possibility of a similar experience in the US is a real threat First Level of community transmission must be aggressively decreased consistent use of face masks, physical distancing, restrictions on high-risk and high-capacity settings, frequent hand washing, delaying travel, widespread diagnostic testing and screening to swiftly identify and isolate infectious individuals, particularly those who are asymptomatic, and quarantine contacts Second Increased genome sequence surveillance Third CDC’s 750 samples per week, to more than 6000 Fourth Accelerate SARS-CoV-2 vaccination nationally and globally CDC is leading a comprehensive suite of studies to assess the actual effectiveness of these vaccines Looking out for breakthrough infections Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine https://www.nejm.org/doi/full/10.1056/NEJMoa2034577 NEJM, (December 31st) A two-dose regimen of BNT162b2 conferred 94.8% protection against Covid-19 in persons 16 years of age or older After 1 dose, efficacy = 52.4% NEJM, (17th February) But if you take data after 2 weeks …. https://www.nejm.org/doi/pdf/10.1056/NEJMc2036242?articleTools=true One Pfizer dose, vaccine efficacy of 92.6% (based on FDA data) One Moderna dose, vaccine efficacy of 92.1% (based on FDA data) Uncertainty about duration of protection with a single dose Administration of a second dose within 1 month, little added benefit in the short term Leaving high risk groups completely unprotected Postponement of the second dose is a matter of national security that, if ignored, will certainly result in thousands of Covid-19–related hospitalizations and deaths this winter in the United States hospitalizations and deaths that would have been prevented with a first dose of vaccine.

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