The lack of national surveillance leaves Utah, another state ill-equipped to handle COVID-19 variants, says the U.S. doctor.
(Rick Egan | The Salt Lake Tribune) Zeanne Timbol administers a COVID-19 test at the Salt Lake Intermountain Clinic on Saturday, January 2, 2021. To date, two cases of the UK variant have been detected in Utah. .
Health officials at first were unsure of how to investigate the first known case in Utah of the most infectious variant of the “UK” coronavirus, according to emails from federal, state and county agencies.
But that initial uncertainty may reflect the shortcomings of a national disease surveillance system that relies too heavily on state and private labs to detect changes in infectious diseases, a Utah doctor said last week.
“Our state of knowledge about the variants that are emerging in the United States and how they are spreading is, I don’t like to say, quite irregular and lacking,” Dr. Sankar Swaminathan, infectious disease specialist at the University of Utah. press conference Thursday.
“We don’t really have a coordinated and integrated national system for the high-level, proactive detection of genetic variation. … For that reason, I would say we really have a lot of knowledge, to be honest, inadequate. “
Summit County announced Monday that a third Utahn, a woman between the ages of 20 and 44, had hired the variant. The second case, in Utah County, was announced by state officials last week.
Without a national genomic surveillance system, Swaminathan said, it is impossible to know how easily the UK variant has spread to Utah and other states since the first Utah patient was confirmed with the variant in the middle of gener.
On Jan. 14, county health officials received the news that the man’s test sample had been subjected to genetic sequencing by the Utah Public Health Laboratory as part of its surveillance of virus variants and that he had hired the so-called “UK variant”. “.
The man had already been identified as possible contact by another person who tested positive for coronavirus in late December, according to emails. But it was two days after the man’s case was confirmed, Jan. 16, that a county epidemiologist wrote that he had interviewed the man and the patient who probably infected him.
Neither had recently traveled, he reported, and the source patient did not know where he was exposed to the virus.
Meanwhile, health officials announced the case to the public the day after their identification, but they seemed uncertain how to proceed. County health officials were unsure whether it would be possible to know if the patient who exposed the man also had the variant or if contact tracking should be handled differently for patients with the variant.
“There is a specific type of research form that needs to be completed for the variant case[s]? ”Wrote a county epidemiologist.
“Do we need to do more thorough research?” wrote Dr. Dagmar Vitek, director of the medical division of the county health department. “Collect PCR [a genetic COVID-19 test] about him and the contacts, sequence, look at all your contacts? “
A scientist at the Utah Public Health Laboratory warned that the variant could be confirmed in the home patient only if the virus was still shedding, more than two weeks after diagnosis; its original diagnosis was in an antigen test, with a sample that could not be used for genome sequencing.
“There had been a prior discussion about handling various cases to quickly identify any trip and identify a potential source,” Nicholas Rupp, a spokesman for the Salt Lake County Department of Health, wrote Monday when asked about the emails. published electronics.
County officials decided that for various cases of COVID-19, a thorough contact tracing would be done, where investigators track each contact individually, Rupp said. For most COVID-19 cases, county investigators have moved to a “shared responsibility model,” where tracers ask the same patients to alert some of the people they may have had contact with.
U.S. Centers for Disease Control and Prevention requested details of the man’s case the day after the variant was identified, according to emails. But the CDC did not request that the sample perform all of its genomic sequencing until Jan. 20.
It is unclear what information, if any, the CDC sequencing produces about the Utah Public Health Laboratory sequencing. State health officials could not be contacted immediately for comment.
The British variant, called B117, is substantially more contagious than the strain that has previously dominated the United States, but it is not yet known if it is more likely to cause serious illness.
“There’s not much evidence of that yet, but there’s this concern in some of the strains that have been characterized the least. And we really don’t know what the issue is,” Dr. Swamainathan said.
As of Thursday, the Utah Public Health Laboratory had identified just two cases of the UK variant, state epidemiologist Angela Dunn said at a news conference. “But keep in mind that we’re only sequencing 10 percent of all our positives,” Dr. Dunn.
That’s “very much compared nationally to other states,” he said. “But we are not yet able to sequence all the people who become positive. So just because you’ve found two means you’re here. It is already spreading through the community. And that means we have to be very careful when it comes to taking preventative measures. ”
The more the virus spreads, the more likely they are to develop harmful mutations, Swamainathan said.
“These things don’t necessarily come from abroad,” he said. “With the transmission levels we have here, we will also have our own variants of own production.”