Coronavirus variant in South Africa arouses fear of faster spread, possible reinfection

South African doctors and researchers are fighting a second wave of Covid-19 cases to understand the role a new variant of coronavirus could play in the new wave of infections.

The total number of confirmed cases of Covid-19 in South Africa has passed more than a million this week. On Wednesday, the country of 60 million registered 17,710 new infections, more than any daily case during the first wave of infections, which peaked in July.

“The variant is likely to play a very small role” in the recent wave of infections in South Africa, said Jinal Bhiman, the chief medical scientist at the National Institute for Communicable Diseases in Johannesburg, who has studied the new variant. But, said Dr. Bhiman, “It can also be a perfect storm.”

Several countries have banned travel to and from South Africa due to concerns about the spread of the new variant. Over the past week, labs in Finland, the UK, Japan, Australia and Switzerland have found the South African variant in coronavirus tests conducted there. Researchers in neighboring Zambia said Wednesday that the South African variant now also appears to be the dominant virus there.

It is unclear whether the mutations can affect the efficacy of Covid-19 vaccines.

Richard Lessells, infectious disease specialist at the KwaZulu-Natal Research Innovation and Sequencing Platform, or KRISP – the group of scientists who sequenced the South African variant – said the discovery coincided with another worrying development: doctors are reporting more patients, including health professionals. , who test positive for Covid-19 a second time, after having it in the first wave.

“We are genuinely concerned, and so we need to do the research to understand this variant as soon as possible,” said Dr. Lessells.

Dr. Lessells and doctors treating Covid-19 patients in South Africa said they have not been able to prove whether these repeat positive tests are true reinfections – which many scientists believe are extremely rare – or the resurgence of a previous disease. South Africa’s public health system typically only tests people with Covid-19 symptoms.

Complications: Most South African laboratories do not store coronavirus test samples for more than a few weeks, making it nearly impossible to check if a new infection is the result of another variant of the virus.

Overworked health workers are at high risk of receiving Covid-19 a second time because of their exposure to sick patients and because stress can weaken their immune systems.

“What we’re looking at is a very dark box here, where no one understands what’s inside,” said John Black, head of infectious diseases at Livingstone Hospital in Port Elizabeth, the city hardest hit by the second wave of the South. -Africa. . Dr. Black said he has seen a small number of his patients test positive again, more than three months after their first positive test.

At Tygerberg Hospital, the main public hospital that treats coronavirus patients in Cape Town, doctors see both patients and health professionals test positive again within three months of a previous infection, a spokeswoman said. What doctors don’t know, she said, is whether these repeat positives are due to true reinfections, or to some people carrying the virus for extended periods of time. Health officials are currently checking whether they can isolate the new variant from the new test samples, the spokeswoman said.

An intern doctor at another Cape Town public hospital, interviewed by The Wall Street Journal, said four of her fellow interns had recently tested positive for a second time, after getting Covid-19 early in the first wave. Another doctor at a maternity hospital in another South African hot spot said she tested positive again this week after experiencing Covid-19 symptoms for the second time since August.

A document outlining a new coronavirus testing strategy was distributed Tuesday by the government of the Western Cape Province in South Africa – one of the regions where the new variant is now considered dominant – warned of the risk that people will risk the second. times would get Covid-19.

“Concerns about the increased likelihood of transmissibility and potential resistance to neutralizing antibodies suggests a second infection with Covid-19 is more likely than previously predicted,” says the paper, reviewed by the Journal.

The paper says people who show Covid-19 symptoms a second time after recovering from a previous infection should be retested after 30 days, rather than waiting for the previously recommended 90 days. It says that those people who test positive again should also get an antibody test to confirm if they have a true second infection, because an antibody test can indicate whether a patient is acutely infected or if antibodies are from an older disease.

Meanwhile, South African researchers are growing a live version of the new virus, which will be used to test how the new variant responds to blood drawn from people who have recovered from Covid-19 infection and in people who have a Covid-19 infection. 19 vaccine. . “We should know more in a week or so,” said Dr. Bhiman.

Like the British variant, the South African variant has an unusually high number of mutations, including eight on the spike protein that causes the virus to attach to and infect human cells. One of these mutations, called 501Y, is the same mutation that scientists in the UK say may make the variant more contagious.

Another, called E484K, has been shown in lab tests to increase resistance to lab-made antibodies and serum from the blood of recovered Covid-19 patients, said Dr. Lessells.

“The mutation likely changes the formation of the protein, so the antibodies cannot get a good grip on it,” said Dr. Lessells. But even if more advanced tests on the live virus confirm antibody resistance, he added, Covid-19 vaccines should elicit a broader immune response beyond antibodies.

Dr. Lessells and other researchers also stressed that measures such as wearing masks and social detachment will still stop the spread of the new variety.

South African researchers believe the new variant likely originated in the coastal city of Port Elizabeth, which was hit hard by both the first and second waves of infections. One theory is that the unusually large number of mutations may have been caused by a long-term infection contracted by an immunocompromised person, such as a patient undergoing chemotherapy.

“There is strong evidence that this new variant is due to immune pressure,” said Dr. Bhiman.

Port Elizabeth and other regions where the new variant is now believed to be dominant had a high number of people with antibodies as a result of previous coronavirus infections during the first wave. This, said Dr. Bhiman may have helped make the new variant dominant over variants of the virus that do not have these mutations.

Write to Gabriele Steinhauser at [email protected] and Benjamin Katz at [email protected]