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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 on Wednesday to halt the spread of three COVID-19 variants.
Dr. Rochelle Walensky. AP
As part of Journal of the American Medical Association’s (JAMA’s) Q&A series with JAMA Editor-in-chief Howard Bauchner, Walensky referred to the blueprint she worked with Anthony Fauci, MD, the nation’s leading infectious disease expert, and Henry T. Walke, MD, MPH, of the CDC, which was published Wednesday in JAMA network
In the viewpoint article, they explain that the Department of Health and Human Services created the SARS-CoV-2 Interagency Group to provide coordination between the CDC, the National Institutes of Health, the U.S. Food and Drug Administration (FDA), the Biomedical. Advanced Research and Development Authority, the United States Department of Agriculture, and the United States Department of Defense.
Walensky said the first goal is to strengthen vigilance regarding public health reduction strategies to reduce the amount of virus circulating.
As part of that strategy, she said, the CDC is strongly pushing against non-essential travel.
In addition, public health leaders are working on a surveillance system to better understand the SARS-CoV-2 variants. This requires accelerating the genome sequencing of the SARS-CoV-2 virus and ensuring that sampling is geographically representative.
She said the CDC is working with state health laboratories to obtain approximately 750 samples each week and is working with commercial labs and academic centers to obtain an interim target of 6,000 samples per week.
She acknowledged that the United States “is not where we need to be” with sequencing, but has come a long way since January. At the time, they were sequencing 250 samples every week; they are currently sequencing thousands per week.
Data analysis is another concern: “We need to be able to understand at a basic scientific level what the information means,” Walensky said.
Researchers are unsure how the variants may affect the use of restorative plasma or monoclonal antibody treatments. It is expected that 5% of people vaccinated against COVID-19 will contract the disease anyway. Sequencing will help answer whether such individuals who have been vaccinated who subsequently contract the virus belong to that 5% or whether they have been infected with a vaccine-evading variant.
It’s essential to accelerate vaccine delivery worldwide and in the United States, Walensky said.
As of Wednesday, 56 million doses had been administered in the United States.
The three main threats
She has updated the numbers on the three biggest variant threats.
About B.1.1.7, which originated in the United Kingdom, she said, “So far we have over 1,200 cases in 41 states.” She noted that that variant is probably about 50% more transmissible and 30% to 50% more virulent.
“So far, it doesn’t seem like that strain is really any less susceptible to our vaccines,” she said.
The South African strain (B.1.351) has been found in 19 cases in the United States.
The P.1. variant, which originated in Brazil, has been identified in two states in two cases.
Outlook for March and April
Bauchner asked Walensky what she had in mind for March and April. He noted that public optimism is high in light of the continued decline in COVID-19 cases, hospitalizations and deaths, and the fact that warmer weather is coming and more vaccinations are on the way.
“While I’m really hopeful of what could happen in March and April,” said Walensky, “I really know this can go bad so quickly. We saw it in November. We saw it in December.”
CDC models have predicted that by March, the more transmissible B.1.1.7 strain will likely be the dominant strain, she reiterated.
“I’m afraid spring is coming and we’ll all have had enough,” Walensky said. She noted that some states are already relaxing mask mandates.
“Around that time, life will look and feel a little better, and the motivation for those who may be hesitant to get vaccinated may diminish,” she said.
Bauchner also asked her to consider whether a third vaccine, from Johnson & Johnson (J&J), could soon receive FDA emergency approval – and whether the lower expected efficacy rate could lead to a stratified vaccination system, with populations with a higher risk. receiving the more effective vaccines.
Walensky said more data is needed before that question can be answered.
“The data may well point us to the best populations to use this vaccine,” she 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’s important to remember that the expected efficacy for that vaccine is higher than that for the flu shot, as well as many other vaccines currently in use for other illnesses.
She said it also has several benefits.
The vaccine has less stringent storage requirements, requires only one dose, and protects against hospitalization and death, although it is less effective in protecting against contraction of the disease.
“I think a lot of people would choose to buy it if they could get it sooner,” she said.
Marcia Frellick is a freelance journalist based in Chicago. She has previously written for the Chicago Tribune and Nurse.com and has edited the Chicago Sun-Times, the Cincinnati Enquirer and the St. Cloud (Minnesota) Times. Follow her on Twitter at @mfrellick
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