Lack of national surveillance leaves Utah, other states ill-equipped to handle COVID-19 variants, the U. doctor says.
(Rick Egan | The Salt Lake Tribune) Zeanne Timbol will conduct a test for COVID-19 at the Intermountain Salt Lake Clinic on Saturday, January 2, 2021. Two cases of the British variant have been discovered in Utah so far.
Health officials were initially unsure how to investigate the first known case in Utah of the more contagious “British” coronavirus variant, according to emails from federal, state and provincial agencies.
But that initial uncertainty may reflect the shortcomings of a nationwide disease surveillance system that relies too heavily on state and private laboratories to detect changes in infectious diseases, a Utah doctor said last week.
“Our knowledge of variants that originate in the United States and how they spread is, I hate to say, quite patchy and spotty,” said Dr. Sankar Swaminathan, infectious disease specialist for the University of Utah, in a statement. press conference Thursday.
“We don’t really have a coordinated, integrated national system for high-level proactive detection of genetic variation. … For that reason I would say that we really have a very, to be honest, insufficient knowledge. “
Summit County announced on Monday that a third Utahn – a woman there between the ages of 20 and 44 – had contracted the variant. The second case, in Utah County, was announced by state officials last week.
Without a national genomic surveillance system, Swaminathan said, it’s impossible to know how easily the British variant has spread in Utah and other states since the first Utah patient was confirmed with the variant in mid-January.
On Jan. 14, county health officials received word that the man’s test sample had undergone genetic sequencing by the Utah Public Health Laboratory as part of its monitoring of variants of the virus – and he had contracted the so-called ‘British variant. . “
The man had already been identified as possible contact by another person who tested positive for the coronavirus in late December, the emails said. But it was two days after the man’s case was confirmed, on Jan. 16, that a county epidemiologist wrote that she had interviewed the man and patient who had likely infected him.
Neither had recently traveled, she reported, and the source patient was unaware of where he had been exposed to the virus.
In the meantime, health officials made the matter known to the public the day after it was established, but they seemed unsure how to proceed. County health officials were unsure whether it would be possible to find out if the patient the man uncovered also had the variant, or whether the contact tracking should be treated differently for patients with the variant.
“Is there a specific type of inquiry form that must be completed for a variant case?[s]? wrote an epidemiologist from the province.
“Should we do more thorough research?” wrote Dr. Dagmar Vitek, director of the medical department of the province’s health department. Collect PCR [a genetic COVID-19 test] on him and contacts, order, view all his contacts? “
A scientist at the Utah Public Health Laboratory warned that the variant could only be confirmed in the source patient if he was still spreading the virus more than two weeks after he was diagnosed; his original diagnosis was in an antigen test, with a sample that could not be used for genome sequencing.
“There had been discussion before about handling several cases to quickly identify a trip and identify a potential source,” Nicholas Rupp, spokesman for the Salt Lake County Health Department, wrote Monday when asked about the released emails. .
County officials decided that for variants of COVID-19 they would go back to thorough contact tracking, with researchers tracking each contact individually, Rupp said. For most COVID-19 cases, district investigators have moved to a “shared responsibility model,” where tracers ask patients themselves to warn some of the people they may have interacted with.
The U.S. Centers for Disease Control and Prevention asked for details on the man’s case the day after the variant was identified, emails show. But the CDC didn’t ask for the sample to run its own full genomic sequencing until Jan.20.
It is not clear what information, if any, the CDC’s sequencing produces about the Utah Public Health Lab’s sequencing. State health officials could not be immediately reached for comment.
The British variety, called B117, is significantly more contagious than the species that previously dominated the United States, but it is not yet known whether it is more likely to cause serious illness.
“There isn’t much evidence for that yet, but there is that concern with some of the less characterized species. And we just don’t know how much of a problem that is, ”said Dr. Swamainathan.
As of Thursday, the Utah Public Health Lab had identified just two cases of the British variant, state epidemiologist Angela Dunn said at a news conference. “But keep in mind that we only sequence 10 percent of all our positive results,” said Dr. Dunn.
That’s “a lot nationally compared to other states,” she said. “But we are still not able to sequence every person who becomes positive. So the fact that we found two means it’s here. It has already been distributed throughout the community. And that means that we have to be extra careful when it comes to taking preventive measures. ”
The more the virus spreads, the more likely it is to develop harmful mutations, Swamainathan said.
“It is not necessary for these things to come from abroad,” he said. “With the transmission levels we have here, we will also get our own homegrown variants.”