Half of all COVID-19 cases across the country and in Maryland now result from coronavirus variants, with the dominant ones proving a bit more dangerous because they are more contagious and lead to more hospitalizations.
But scientists and public health experts warn that until enough people are inoculated against the disease to end the pandemic, there is a chance mutations will become much more dangerous.
“Every time someone is infected and the virus replicates in them, it can produce mutant strains,” said Matthew Frieman, a coronavirus researcher at the University of Maryland in Baltimore.
“Most have no impact, but every once in a while you have a variant produced that is more fit and able to do something better than the previous parent virus,” he said. “It could be transmitted better or can evade a vaccine or antibodies better.”
As demand for vaccine appears to be waning in some areas before the country reaches herd immunity — when there will be few people left for the virus to target — scientists are focused increasingly on identifying existing and new variants with the potential for havoc.
Already, there are spikes in cases in Baltimore City and other counties in Maryland that experts tie to the B.1.1.7 variant, first reported in the United Kingdom and now the most dominant in the state and country. It is considered highly infectious, but studies have shown that vaccines continue to work against it.
The ongoing genomic testing of coronavirus samples from infected patients could show that the population eventually will need booster shots or even new vaccines, including for those already inoculated. Vaccine makers already are planning for such scenarios, said Frieman, a professor in the school of medicine’s department of microbiology and immunology.
State officials approved emergency contracts Wednesday with the University of Maryland, Baltimore and the Johns Hopkins University to study the genetic makeup of virus samples taken from infected people.
The contracts, worth more than $1.6 million and nearly $1.4 million respectively, began in February and will continue through January 2022.
The university labs, along with the state and commercial labs, have found the B.1.1.7 variant makes up 43% of almost 900 samples tested so far. But they have found small numbers of other variants first seen in South Africa, Brazil and California.
More than 20 variants have been detected around the country, according to the U.S. Centers for Disease Control and Prevention, with about a half-dozen designated as “variants of concern,” meaning they could be more dangerous in some way than the original strain.
State health officials say they need to track these variants closely so they can predict increases in cases and ensure that the health care system is not overwhelmed. That could manifest as a lack of beds for the sick and even lack of basic life-sustaining resources such as oxygen, as is occurring in India during a massive variant-fueled surge in cases there.
Frieman said the gene sequencing involves looking for mutations in some 30,000 pairs of “letters,” or pieces of genetic code, in the coronavirus. Collections of mutations are sent to the CDC, as well as an international consortium, to assess whether they are singular cases or have the potential to be a bigger threat.
The Biden administration sees the variants as such a concern that it announced April 16 that it would deploy $1.7 billion from the latest coronavirus relief act for sequencing and infrastructure to support surveillance. Maryland is set to get $4.2 million.
Sequencing of samples has already grown to about 29,000 a week nationwide from 8,000 in early February, and the funds are expected to push the number higher and to more corners of the country.
Scientists at Hopkins had been researching coronavirus mutations for months before they were asked to test samples from infected patients at affiliated hospitals for the massive genetic sequencing effort.
Heba Mostafa, a professor of pathology at the university, has been doing some of the lab work where samples have grown to 300 to 400 per week. She said Hopkins is working to train more staff so the lab and state can reach and maintain a goal of assessing 10% of all COVID-19 cases in Maryland.
She said she views B.1.1.7 as “not a scary strong variant.”
But, she added, “this is evolving, and an emerging variant can change the disease severity, or change the response to a vaccine. If we are proactive and have data in real time, we can act quickly.”
In the meantime, state officials want everyone to keep wearing masks and keep their distance until enough people are vaccinated.
The state recently launched a “No Arm Left Behind” initiative that directs vaccination outreach to seniors, college students and employers. The effort also expands call center communications for non-English speakers and an ad campaign involving physicians.
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The moves at the state, as well as local, level aim to address access issues and hesitancy to be vaccinated.
Dr. Jinlene Chan, assistant secretary of the Maryland Department of Health, said the state needs to reach both at-risk minority groups but also younger people, who are being hospitalized with COVID-19 at greater rates because of the circulating variants. They appear to be fueling upticks in cases.
“More younger people are traveling for work, or just leaving the house,” as more restaurants, bars, businesses and schools have reopened, Chan said.
“It’s a challenge because everyone is incredibly tired of all the masking,” she said. “And some younger people feel like they won’t get sick so why bother. The reality is younger people are getting sick and hospitalized.”
Tracking variants will help state officials understand where and how to target resources and how well the vaccine continues to work, she said. So far, Chan noted that only a small number of people have become infected since they were vaccinated, which is expected even when vaccines are extremely effective.
It’s good news that vaccines still work against the variants, said Caitlin Rivers, a Johns Hopkins epidemiologist and epidemic preparedness expert. But it remains crucial to continue to track mutations, she said.
“Toward the fall I worry about other variants,” said Rivers, a senior scholar at the Hopkins Center for Health Security in the Bloomberg School of Public Health. “After B.1.1.7 runs its course, there might be more room for another one to circulate more widely.”