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Rochelle Walensky, MD, MPH, director of the Centers for Disease Control and Prevention (CDC), went through a multi-agency attack plan Wednesday to stop the spread of three COVID-19 variants.
Dr. Rochelle Walensky. AP
As part of the Journal of the American Medical Association (JAMA) Series of questions and answers with JAMA Chief editor Howard Bauchner, Walensky, referred to the plan he coordinated with Anthony Fauci, MD, the nation’s leading infectious disease expert, and Henry T. Walke, MD, MPH, of the CDC, who post wednesday a Network JAMA.
In the point of view article, they explain that the Department of Health and Human Services has established the SARS-CoV-2 interagency group to improve coordination between the CDC, the National Institutes of Health, the Food and Drug Administration (FDA) of the United States, the Biomedical Advanced Research and Development Authority, the U.S. Department of Agriculture, and the U.S. Department of Defense.
Walensky said the first goal is to strengthen vigilance over public health mitigation strategies to decrease the amount of virus circulating.
As part of that strategy, he said, CDC strongly urges non-essential travel.
In addition, public health leaders are working on a surveillance system to better understand SARS-CoV-2 variants. This will increase SARS-CoV-2 virus genome sequencing and ensure that sampling is geographically representative.
He said the CDC is partnering with state health labs to get about 750 samples each week and is partnering with commercial labs and academic centers to get a provisional goal of 6,000 samples per week.
He acknowledged that the United States “is not where we need to be” with sequencing, but has come a long way since January. At that time, they were sequencing 250 samples each week; they currently sequence thousands each week.
Data analysis is another concern: “We need to be able to understand at a basic scientific level what information means,” Walensky said.
Researchers are unsure of how variants may affect the use of treatments with convalescent plasma or monoclonal antibodies. It is expected that 5% of people vaccinated against COVID-19, however, will contract the disease. Sequencing will help answer whether these people who have been vaccinated and who subsequently contracted the virus are among the 5% or if they have been infected by a variant that evades the vaccine.
It is essential to accelerate vaccine administration globally and in the United States, Walensky said.
As of Wednesday, 56 million doses had been administered in the United States.
Three main threats
He updated the numbers on the three biggest threats.
Regarding B.1.1.7, which originated in the UK, he said: “So far we have had more than 1200 cases in 41 states.” He noted that this variant is likely to be approximately 50% more transmissible and 30% to 50% more virulent.
“So far, it looks like this strain has no real decrease in susceptibility to our vaccines,” he said.
The South African strain (B.1.351) has been found in 19 cases in the United States.
The P.1. the variant, which originated in Brazil, has been identified in two cases in two states.
Outlook for March and April
Bauchner asked Walensky what he plans for March and April. He noted that public optimism is high in light of the continuing reductions in the number of cases, hospitalizations and deaths of COVID-19 and the fact that a warmer climate is coming and more vaccines are on the horizon.
“While I’m excited about what might happen in March and April,” Walensky said, “I really know this could go wrong so fast. We saw it in November. We saw it in December.”
CDC models have projected that in March the most transmissible strain B.1.1.7 is likely to be the dominant strain, he reiterated.
“I’m worried it’s spring and we’ll have had enough,” Walensky said. He noted that some states are already relaxing the mandates of the mask.
“Around this time, life will look and feel a little better, and motivation may be diminished for those who may hesitate about the vaccine,” he said.
Bauchner also asked him to consider whether a third vaccine, from Johnson & Johnson (J&J), could soon obtain FDA emergency use authorization and whether its lower expected efficacy rate could result in a tiered vaccination system, with higher risk populations receiving the most effective vaccines.
Walensky said more data is needed to be able to answer that question.
“The data may tell us the best populations to use this vaccine,” he said.
In Phase 3 data, the J&J vaccine was shown to be 72% effective in the United States for moderate to severe disease.
Walensky said it is important to remember that the projected efficacy for this vaccine is higher than that of the flu vaccine, as well as many other vaccines currently used for other diseases.
He said it also has several advantages.
The vaccine has less stringent storage requirements, requires only one dose, and protects against hospitalization and death, although it is less effective at protecting against disease.
“I think a lot of people would choose to get it if they got it sooner,” he said.
Marcia Frellick is a Chicago-based freelance journalist. She has previously written for the Chicago Tribune and Nurse.com and was editor of the Chicago Sun-Times, the Cincinnati Enquirer and the St. Cloud (Minnesota) Times. Follow her on Twitter at @mfrellick.
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