White Coat, Black Art·The Dose | Q&A

What do I need to know about the new COVID variants?

Infectious disease specialist and virologist Dr. Samira Mubareka says the presence of seemingly more infectious coronavirus variants in Canada is a public health emergency and existing public health rules around social distancing, masks, and hygiene may have to be tightened.

Presence of new coronavirus strains in Canada a ‘public health emergency,’ expert says

A shopper wears a mask as he passes a government sign on a bus stop in London, England. The seemingly more infectious variant first detected in the U.K. is now in Canada. (Kirsty Wigglesworth/The Associated Press)

Yet another term has been added to the growing lexicon of COVID-19 language: "variants of concern." 

That's what the World Health Organization is calling the new and seemingly more infectious strains of the coronavirus first discovered in the U.K., South Africa, and Brazil. Scientists have said these strains could be as much as 50 per cent more transmissible.

"Even though it isn't necessarily causing enhanced disease or severity of disease, just by sheer volume, by sheer numbers, there could be increased morbidity and mortality — so more sickness and death — because there will be more people getting infected," said Dr. Samira Mubareka, an infectious disease specialist and virologist at Sunnybrook Health Sciences Centre in Toronto.

The new variants have so far been found in Ontario, Alberta and B.C. Officials in Ontario say there is evidence that the strain first found in the U.K., known as B117, is spreading in the community. And in B.C., the variant initially detected in Brazil has been found in someone without any travel history. 

Dr. Samira Mubareka, an infectious disease specialist and virologist at Sunnybrook Health Sciences Centre in Toronto, says the new coronavirus variants could spike COVID-19 cases and overwhelm health-care systems in parts of Canada. (Kevin van Paassen/Sunnybrook Health Sciences Centre)

The good news? Dr. Mubareka and other experts are confident the approved vaccines will work on these variants. 

The bad news, she says, is that these variants could bring a frightening escalation of the pandemic before vaccination is widespread.

Dr. Mubareka, who works with the Canadian Sequencing Network which detects and unpacks these kinds of variants, says these new strains represent a "public health emergency."

A paramedic walks past a row of ambulances after transporting a patient Friday, January 15, 2021 in Montreal. (Ryan Remiorz/The Canadian Press)

Unless action is taken by governments, officials, and individuals, some areas of Canada could see their health-care systems overwhelmed with new COVID-19 cases, she told The Dose and White Coat, Black Art host Dr. Brian Goldman.

Here's part of their conversation.

What do we know about the extent to which these variants are circulating in Canada?

We don't know. Are we at the point where it has just entered the country and we've been very fortunate in identifying some of the early cases, or is this just the tip of the iceberg? 

We really don't have a firm sense of that. We certainly have identified it in individuals who have either travelled or were exposed to travellers. And there have been cases which are thought to be community acquired. So there's no clear travel history associated with those cases. But what proportion of all cases are B117 today? We don't know. 

How do we test for these variants in Canada? 

There are various approaches that can be taken to try and understand this [the rate of community spread]. They all lead towards more sequencing. Sequencing is when you actually decode the virus from beginning to end, the entire genetic code from start to finish of the virus. 

We're aiming to sequence a much greater proportion, at least five per cent, if not more, of the positive cases detected in Canada. 

It's critical that not only we detect it, but that we also pass on the information to the epidemiologists and the modellers who can use that information to try and understand what the rate of spread may be and then subsequently what the impact could be on people's health, the health-care system and ultimately, even the economy. 

Scientists say the approved vaccines for coronavirus should work against the new variants, although more research is needed. (Ben Garver/The Berkshire Eagle/The Associated Press)

What worries you most right now about these new strains? 

I think the biggest concern for me is not knowing how prevalent they are out there. I would feel much better if we knew where they were and exactly how much we have to deal with. It'll be really key. 

We're already looking at fairly ugly projections for the next month or so, again, depending on where you live. But if we have a firm grasp of what proportion of positives are variants with enhanced transmission, we can plan better. In my mind, this is a public health emergency. 

What steps can individuals take in the face of these new variants?

Someone characterized this as a race between the vaccine and the variant. I don't know if it's that straightforward, but it really emphasizes the important role that each of us can play. I don't think there's any question that what we've been doing is, at minimum, what's currently required. 

There has been a proportion of individuals who have not complied with that guidance. I think it's important to underscore the need to, at the very least, continue to physically distance, to wear masks, to decontaminate surfaces and to wash our hands. 

Scientists say the new coronavirus variants could mean stricter rules around mask wearing and social distancing, but more data is needed first. (The Canadian Press)

Are the current rules around social distancing and mask wearing and hand and surface hygiene enough? 

There's no doubt in my mind that those are all absolutely essential. Does more need to be done at all of those levels? That is of a greater, more important question. Recommendations along those lines need to be backed up by data. We need to start doing the work that's required to determine whether or not those interventions are sufficient.

But I think as long as people are making exceptions, bending the rules or worst-case scenario, not following them at all, it's hard to even stop talking about enhancing the rules further. 

If this were to be characterized as a race between the virus and the vaccine, which will win?

I'm an optimist, so I'm rooting for the vaccine and for the fantastic science that's gone behind developing the vaccine. This is really another catalyst to spur on a rapid rollout for the vaccine. And I know people are working incredibly hard to make that a reality. I think it's absolutely key that we swing into action as quickly as possible before this variant really takes hold.

Q&A edited for length and clarity.

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