3 coronavirus variants can make people sicker or spread faster – and experts are monitoring others, including one spreading in India

people wearing masks coronavirus US
People wearing masks in Del Mar, California.

  • There are three coronavirus variants that experts around the world are worried about.
  • These include variants first identified in South Africa, the UK, and Brazil.
  • Others variants, like one first found in India, have concerning features, but it’s not yet clear they’re more dangerous.
  • See more stories on Insider’s business page.

Several coronavirus variants have evolved mutations that mean they spread more easily, make people sicker, escape immune responses, evade tests, or render treatments ineffective.

These are called “variants of concern” by the World Health Organization, and there are three that have spread to the US.

There are various other variants that may have troubling features, which experts are looking into. These are called “variants under investigation,” and include a variant first identified in India.

They differ from the original virus strain in a number of key ways.

Variants of concern

B.1.1.7, first found in the UK

coronavirus hospital UK
A nurse works on a patient in the ICU in London hospital, UK on January 7, 2020.

B.1.1.7 was first detected in two people in south-east England. It was reported to the World Health Organization (WHO) on December 14.

It has been identified in 114 countries worldwide, including the US, where there are more than 20,000 reported cases, according to the CDC. It became the most common variant in the US on April 7. Michigan has the highest proportion of B.1.1.7 cases of any state, accounting for just under 70% of sequenced cases.

B.1.1.7 is between 30% to 50% better at spreading from person to person than other coronavirus variants, according to UK scientists.

B.1.1.7 could be more deadly, but we don’t know for sure

B.1.1.7 could be more deadly. The UK government’s New and Emerging Respiratory Virus Threats Advisory Group (NERVTAG) reported a model on January 21 that showed someone infected with B.1.1.7 is 30% to 40% more likely to die than someone with a different variant.

Community-based studies in England, Scotland and Denmark showed that infection with B.1.1.7 in the community causes a higher risk of severe disease requiring hospital treatment and death.

But there is a lot of uncertainty around the numbers. Two studies published in the Lancet Infectious Diseases and the Lancet Public Health on April 13 indicated that B.1.1.7 was more infectious, but didn’t cause worse illness in hospitalized patients.

COVID-19 vaccines from Pfizer-BioNTech, Moderna, Johnson & Johnson and AstraZeneca all appear to protect against B.1.1.7.

B.1.351, first identified in South Africa

COVID-19, South Africa
Health worker Vuyiseka Mathambo takes a nasal swab from a patient to test for COVID-19 at a Masiphumelele community centre in Cape Town, South Africa on July 23, 2020.

B.1.351 was first detected in Nelson Mandela Bay, South Africa, in samples dating back to the beginning of October 2020. It was reported to the WHO on December 18.

It has been found in 81 countries, including the US, where there are 453 cases reported across 36 states and jurisdictions according to the CDC

B.1.351 is thought to be 50% more contagious than the original strain, according to South African health officials.

It’s not thought to be more deadly. But there is evidence from South Africa that when hospitals came under pressure because of the variant’s spread, the risk of death increased.

B.1.351 may evade the body’s immune response

The variant may evade the body’s immune response, data suggests. Antibodies work best when they attach snugly to the virus and stop it from entering our cells. The B.1.351 variant has mutations called E484K and K417N at the site where antibodies latch on. In early lab tests, antibodies produced by Pfizer and Moderna’s COVID-19 vaccines couldn’t attach as well to B.1.351, compared to the original coronavirus.

We don’t know yet whether this impacts the vaccines’ effectiveness in real-life. A real-world study from Israel published on April 10 suggested that Pfizer’s vaccine provided less protection against B.1.351 than the original coronavirus. But it was focused on those who have already tested positive for the virus, not total infection rates, so we can’t draw firm conclusions. Pfizer has published some data suggesting its vaccine may help protect people against this variant.

Johnson & Johnson’s COVID-19 vaccine was 64% effective at preventing COVID-19 in trials in South Africa, where 95% infections are caused by B.1.351, and 72% effective in the US, where B.1.351 accounts for less than 1% of sequenced coronavirus tests.

AstraZeneca’s COVID-19 vaccine didn’t prevent mild to moderate disease caused by B.1.351 in a trial, and we don’t yet know if AstraZeneca’s shot still protects against severe illness caused by the variant.

It is unlikely that vaccines will become completely useless against the variant. Existing vaccines could be updated and tailored to a new variant within weeks or months, or you may require a booster shot.

P.1, first identified in Brazil, which is twice as contagious

brazil coronavirus
A COVID-19 patient is rushed into a hospital in Brasilia, Brazil on January 11, 2021.

The variant found in Brazil was first detected in four people in Japan, who had traveled from Brazil on January 2. It was identified by the National Institute of Infectious Diseases on January 6, and reported to the WHO that weekend.

It has been found in 40 countries worldwide, including the US, where there have been 497 cases, according to the CDC

P.1 is twice as contagious as the original coronavirus – it was initially detected in Amazonas, north-west Brazil, on December 4, and by January 21, 91% of people with COVID-19 in the region were infected with P.1, according to the WHO.

P.1 has similar E484K and K417T mutations as B.1.351, which means it can evade antibody responses.

This could be the reason P.1 reinfects people who have already caught coronavirus – a study published April 14 showed that previous coronavirus infection only offered between 54% and 79% of the protection for P.1 than for other virus strains.

P.1’s mutations could also mean that vaccines work less well.

COVID-19 vaccines from Pfizer and AstraZeneca work against P.1. Moderna’s hasn’t been tested. Johnson & Johnson’s COVID-19 vaccine was 68% effective in trials in Brazil, where the variant is the most common strain, compared with its 72% efficacy in the US, where P.1 at the time accounted for 0.1% of sequenced coronavirus tests.

Variants under investigation

B.1.427/B.1.429, first identified in California

pfizer covid 19 vaccine distribution
Medical assistant April Massaro gives a first dose of Pfizer BioNTech’s COVID-19 vaccine to nurse Alice Fallago at Desert Valley Hospital on Thursday, December 17, 2020 in Victorville, California.

The variant first found in California consists of two slightly different mutated forms of the virus, called B.1.427 and B.1.429. It is also called CAL.20C, using another naming system. It was first found in California in July and has now been detected across the US and elsewhere, including in Australia, Denmark, Mexico, and Taiwan, according to the Global Initiative on Sharing Avian Influenza Data (GISAID).

B.1.427/B1.429 are estimated to be 20% more infectious than the original coronavirus – they have become the most common coronavirus variants in California, accounting for just under 40% of sequenced cases, according to the CDC. This is likely because of a mutation called L452R mutation, which in early lab studies was shown to help the virus infect cells.

COVID-19 vaccines haven’t yet been tested against this variant specifically. But early lab experiments showed that antibodies produced by previous COVID-19 infections worked only half as well against the variant as they did with the original coronavirus strain.

The Centers for Disease Control and Prevention (CDC) considers B.1.426/B1.429 a “variant of concern”, which means the CDC thinks there’s enough evidence that its mutations change its behavior. But it remains a “variant under investigation” according to the WHO, which means the WHO’s experts haven’t got enough evidence that it’s more deadly, more infectious or evades the immune response.

Read more: COVID-19 Vaccine Tracker: AstraZeneca’s shot proves safe and effective, and is headed to the FDA

B.1.526/ B.1.525, first identified in New York

covid scientist lab coronavirus testing samples
Scientists work in a lab testing COVID-19 samples at New York City’s health department, April 23, 2020.

These two variants were detected in New York in late 2020. They are “variants of interest” because they have mutations that could evade antibody responses. B.1.525 accounts for 0.5% of sequenced coronavirus tests in the US, according to the CDC.

B.1.617, first identified in India

india coronavirus
Mumbai Police personnel are tested for the coronavirus on October 15, 2020.

The variant first found in India, B.1.617 is in fact three distinct viruses. Collectively, they have spread to 17 countries, according to the WHO. All three have been detected in the US, according to GISAID.

B.1.617 is not yet a “variant of interest”, according to the CDC. But the WHO and UK have designated it a “variant under investigation” because it has some potentially worrying mutations.

These mutations could:

  • Make the virus more infectious or it may avoid the antibody response.
  • Make it more infectious.
  • Help the virus avoid the antibody response.

No studies to date have found that any of the variants first found in India are deadlier than earlier versions of the virus, or that it can evade vaccines.

B.1.526, first identified in New York

These two variants were detected in New York in late 2020. They are “variants of interest” because they have mutations that may evade antibody responses. B.1.526 accounts for under 10% of sequenced coronavirus tests in the US, according to the CDC.

P.2, first identified in Brazil

P.2 was first detected in Brazil in April 2020. It’s a “variant of interest” because it has the E484K mutation that may mean it evades antibody responses. Less than 1% of sequenced coronavirus tests in the US are P.2, according to the CDC.

P.3, first identified in the Philippines

P.3 was first detected in the Philippines in February. P.3 has the E484K mutation that may mean it evades the immune response. P.3 hasn’t yet been detected in the US.

B.1.525, first found in UK and Nigeria

B.1.525 was first found in the UK and Nigeria in December 2020. It has the E484K mutation that may mean it evades the antibody response. Less than 1% of sequenced coronavirus tests in the US, according to the CDC.

B.1.617, first found in France

B.1.617 was first found in France in January. It hasn’t been detected in any other countries. It may have mutations that mean it can evade tests.

Human behavior can help stop them spreading

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Ocasio-Cortez elbow bumps a volunteer at the Houston Food Bank.

The WHO has said that everyone should double down on precautions that stop the spread of variants, such as social distancing, hand-washing, mask wearing, and avoiding crowds.

“Human behavior has a very large effect on transmission – probably much larger than any biological differences in SARS-CoV-2 variants,” Paul Bieniasz, a virologist at the Howard Hughes Medical Institute, told Insider.

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The most common coronavirus variant in the US is no worse for kids than adults, despite more children showing up at hospital, experts say

kid hand sanitizer coronavirus
  • The most common coronavirus variant in the US infects kids more than the original virus.
  • But the variant, first found in the UK, is no more infectious or deadly in kids than in adults, experts told Insider.
  • This is despite anecdotal reports that, proportionally, more kids are showing up to hospital.
  • See more stories on Insider’s business page.

The most common coronavirus variant in the US is estimated to be twice as infectious as the original, and can spread quickly amongst children. Anecdotal reports suggest young people are increasingly filling up US hospitals – but experts tell Insider that the variant, called B.1.1.7, isn’t affecting kids any worse than adults.

The variant became the most common strain of the virus in the US on April 7. In Michigan, the state with the most B.1.1.7 cases, hospitalization rates were higher for kids in recent weeks, “therefore they must be sicker,” Rudolph Valentini, chief medical officer for Children’s Hospital of Michigan in Detroit, told Bloomberg on Monday.

“Until now we haven’t seen transmission like this in kids in the pandemic,” Michael Osterholm, an infectious-disease specialist at the University of Minnesota and former advisor to President Joe Biden, told Meet the Press early April. “This B.1.1.7 variant infects kids very readily,” he said.

Higher numbers of kids in hospital doesn’t necessarily mean the variant affects kids differently. Younger people, especially those under 16, are the least likely to be vaccinated. So while many adults are protected from COVID-19, including the variant, kids aren’t, and some are ending up in hospital.

And many experts – including from the UK, where the variant was first detected in December – aren’t convinced it is more infectious for children than adults, and say the variant doesn’t appear to make kids sicker, either.

No evidence variant is not more infectious in kids than adults: Experts

There’s no evidence that B.1.1.7, the name of the variant, is more infectious in children than adults, Damian Roland, honorary associate professor in pediatric emergency medicine at the University of Leicester, told Insider.

“Denmark has kept schools open for young kids (even without masks) and hasn’t exploded,” Dr. Alasdair Munroe, clinical research fellow in pediatric infectious diseases at University Hospital Southampton, said on Twitter March 11.

In Denmark, where there are high numbers of B.1.1.7, those under 20 years old were least likely to transmit the virus to others in the household, and those younger than 10 were less likely to catch it than young adults aged 25 to 45, according to a pre-print study from the University of Copenhagen posted March 5.

Read more: Just 3 governors haven’t gotten their COVID-19 vaccine, Insider found. Here’s who – and why.

Paul Offit, professor of pediatrics at the Children’s Hospital of Philadelphia, who has served on infectious disease advisory panels for the Centers for Disease Control and Prevention (CDC), told CNBC that kids were getting infected more frequently because of how contagious the virus is, not because the variant poses a particular risk to them.

Roland told Insider that “it’s not the variant, cases rise when you’ve got a lot of coronavirus around.”

A spokesperson for The Royal College of Pediatrics & Child Health (RCPCH) told Insider that “cases in children continue to reflect cases in adults generally.” They said that the best way to protect the children is to maintain “low community infection rates.”

B.1.1.7 appears no more harmful to kids

Dr. Stephen Schrantz, an infectious disease expert at University of Chicago Medicine, told CNBC that young people, especially school-aged children, didn’t tend to get sick because their immune systems react less severely to the virus.”

Roland told Insider that kids “very rarely” get sick with COVID-19. “Often it’s children presenting with non-COVID illness and then happen to have it.”

About one-third of kids testing positive with COVID-19 in a London hospital during the second wave of the virus in the UK – when 70% of the capital’s coronavirus infections were caused by B.1.1.7 – were admitted for another illness, according to correspondence published in the Lancet Child & Adolescent Health medical journal in February.

A London-based study published in the same journal around the same time found that severe illness and death from COVID-19 in children was rare, accounting for just under 0.2% of all UK deaths in 10 to 19 year olds, and just under 2% for those under 9. More kids died from COVID-19 when there were lots of infections in the wider community, the study authors said.

Kids coronavirus
A temperature check is taken as students return to St. Joseph Catholic School in La Puente, California on November 16, 2020.

Some children who contracted coronavirus have experienced Multisystem Inflammatory Syndrome in Children (MIS-C), a rare condition that can sometimes cause severe illness or death.

It doesn’t appear that the B.1.1.7 coronavirus variant increases the likelihood of developing MIS-C.

Dr Liz Whittaker, consultant pediatrician at St Mary’s Hospital in London, said in a statement January, when London had high levels of B.1.1.7 cases, that there were lots of children with positive COVID-19 tests, but “only small numbers” with severe disease or MIS-C, and these were within expected levels given the high infection rate at the time.

The number of children hospitalized, admitted to intensive care, or dying from COVID-19 hasn’t changed on a national level following the emergence of the B.1.1.7 variant in the UK, the RCPCH spokesperson said.

In Michigan, those aged 20 to 29 and 30 to 39 years-old are most likely to be infected with coronavirus, according to state data. But while hospital admissions are going up in all age groups by 25% each week, the highest rate remains those 50 to 59 and 60 to 69 – not younger people.

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The coronavirus variant first found in Brazil is developing worrying new mutations that could make vaccines less effective, experts say

brazil coronavirus
A COVID-19 patient is rushed into a hospital in Brasilia, Brazil on January 11, 2021.

  • The coronavirus variant first found in Brazil, P.1, is still mutating, Brazil’s top public health body said.
  • Some of these mutations may make the shot more resistant to vaccines, Fiocruz said.
  • Another study published Wednesday indicated P.1 could reinfect people who previously had COVID-19.
  • See more stories on Insider’s business page.

The P.1 coronavirus variant causing cases to soar in Brazil, Canada, and elsewhere is mutating in “particularly worrying” ways that could make it more resistant to vaccines, researchers from Brazil’s leading public health body have warned.

The variant is also able to reinfect people who have already caught coronavirus, a new study published Wednesday suggested.

Felipe Naveca, a researcher at public-health body Fiocruz, said the new mutations affected the part of the virus that attaches to cells, called the spike protein, and could make vaccines that target this protein less effective, per Reuters.

“We believe it’s another escape mechanism the virus is creating to evade the response of antibodies,” Naveca said. He works in the Amazon city of Manaus, where the P.1 variant is believed to have originated in December.

“This is particularly worrying because the virus is continuing to accelerate in its evolution,” he added.

Naveca said that the new changes appeared to be similar to the mutations seen in the variant first found in South Africa, called B.1.351. In early lab tests, antibodies produced by Pfizer-BioNTech and Moderna’s COVID-19 vaccines couldn’t attach as well to B.1.351 compared to the original coronavirus.

In the separate, new study published Wednesday, researchers said that previous coronavirus infection offered between 54% and 79% protection against future P.1 infection, compared to protection against COVID-19 infection with other virus strains. The study was conducted by the University of São Paulo, Imperial College London, and the University of Oxford.

Read more: Moderna is betting its mRNA technology will lead to a new wave of vaccines for diseases like HIV. Here are the top 5 it’s working on beyond COVID-19.

The public health agency in Canada, where there has been a rise in P.1 cases in recent weeks, said in the statement Thursday that early evidence suggested the P.1 variant may reduce vaccine effectiveness, “making it even more important to control its spread.”

P.1 is about twice as contagious as the original virus and has spread to 36 countries, according to the Global Initiative on Sharing All Influenza Data (GISAID). Just under 500 cases have been reported in the US across 31 states, according to the Centers for Disease Control and Prevention (CDC).

In countries where it is prominent, P.1 is infecting a high number of younger people. Brazil hospital data shows that in March more than half of all patients in intensive care were aged 40 or younger, per Reuters.

Ester Sabino, a scientist at the faculty of medicine of the University of Sao Paulo, told Reuters that further mutations of the P.1 variant were not surprising given the fast pace of transmission.

“If you have a high level of transmission, like you have in Brazil at the moment, your risk of new mutations and variants increases,” she said.

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All the differences between COVID-19 vaccines, summarized in a simple table that you can take to your vaccination appointment

woman getting vaccine
A physician injects someone with the Moderna COVID-19 vaccine.

  • COVID-19 vaccines from Pfizer-BioNTech, Moderna, Johnson & Johnson, and AstraZeneca all have unique features.
  • They vary in effectiveness, side effects, dosage, and ages approved for the shots.
  • Here is a table that compares them all. Scroll down to view it.
  • Visit the Business section of Insider for more stories.

Coronavirus vaccines are the world’s escape route out of a pandemic that has shut down schools, grounded flights, and left millions dead.

Vaccines from Moderna, Pfizer-BioNTech, AstraZeneca-Oxford University, and Johnson & Johnson have been approved in the West. In the US, all of them have been authorized except AstraZeneca’s – in the UK, all of them except Johnson & Johnson’s are authorized.

Each is given as a shot in the muscle of the upper arm.

You might not get a choice about which COVID-19 vaccine you get, but all four offer some protection against severe illness, so the advice is to take one if you are offered it. For the two-dose vaccines, you should have two shots of the same one, where possible.

Speak with your doctor if you are pregnant, breastfeeding, have a specific medical condition, or take medicines -especially if they thin your blood or affect your immune system. Experts have said the COVID-19 vaccines won’t make you infertile. Side effects may start within a day or two and should go away within a few days.

A rare adverse-event associated with AstraZeneca’s COVID-19 shot includes unusual blood clots in the brain. You should seek urgent medical attention if you have a persistent or severe headache lasting more than three days. Other symptoms to watch out for include: shortness of breath, chest pain, painful limbs and tummy pain.

In the US, the Food and Drug Administration (FDA) and Centers for Disease Control and Prevention (CDC) recommended on April 13 that the J&J vaccine’s rollout be paused while authorities looked into reports of rare blood clots in the brain in people who received the shot. J&J temporarily stopped its vaccine rollout in the EU too.

We’ve made a table that gives you the key information for each shot, whether you’ve booked an appointment or not. Scroll down to view it.

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A COVID-19 expert shares his simple sports analogy to explain why vaccines work against variants

coronavirus variants vaccines athletes 2x1
  • There’s concern coronavirus variants can partially evade vaccines made to target the original virus.
  • But research suggests the parts of our immune system activated by vaccines can still fight variants.
  • Experts say to think of vaccines like an elite athlete: They can dominate even when off their A game.
  • See more stories on Insider’s business page.

For a while, Dr. Jeremy Faust struggled to put into words why he was not worried about COVID-19 variants rendering vaccines obsolete.

Faust, an emergency-medicine physician and instructor at Harvard Medical School, was loath to use data to explain his reasoning to nonscientists. Instead, he had a hunch that sports analogies might help people understand him a little better.

Recently, he came up with one comparison that seemed to resonate: Think of our COVID-19 vaccines as world-class athletes.

Even if Serena Williams or Tom Brady is not performing at their absolute best, even if they face a change in the game, and even if they face a strong opponent, they are still extraordinarily hard to beat.

Pfizer’s, Moderna’s, and Johnson & Johnson’s COVID-19 shots, which were all 100% effective at preventing hospitalizations and deaths in clinical trials of tens of thousands of people around the world, are kind of like the Williams or the Brady of vaccines.

Yes, viral variants are on the rise – some of which can evade virus-neutralizing antibodies. But make no mistake: These vaccines, like elite athletes, can still perform very well against them.

“If Serena Williams all of a sudden was 10% less effective than usual, or 50% less effective than usual, she would still kick everyone’s ass,” Faust, who is also the editor of Brief19, a daily review of COVID-19 research, recently told Insider on Clubhouse.

“So far, the variants have not rendered any of the vaccines useless,” Faust said, adding that like Williams or Brady, “they’re still quite impressive,” even when slightly less effective.

Fauci agrees: Vaccines are tough to beat, even for variants

Fauci Baseball

COVID-19 vaccines help our bodies prepare for the possibility of a future coronavirus invasion by teaching them how to fend off an attack from the original “wild-type” coronavirus.

Concerns that these shots could then be less effective against variants come from lab studies involving blood samples from vaccinated people, which showed that vaccinated people produced far fewer antibodies that could neutralize variants compared with the antibodies produced to combat the wild-type virus.

But Dr. Anthony Fauci, who spoke with Insider last week, stressed that drop wasn’t enough to render vaccines ineffective.

These authorized vaccines are also 66 to 95% effective at preventing sickness – far surpassing the US Food and Drug Administration’s 50% efficacy bar for COVID-19 vaccines, making consumers “spoiled,” some vaccine makers have suggested.

“Most people have high enough levels of antibody that even if you diminish it by several fold, we still have enough cushion effect to be able to block any issue of severe disease,” Fauci told Insider.

Like elite athletes, it would take a lot to overcome our highly effective COVID-19 vaccines

Rob Gronkowski Tom Brady

Scientists still don’t know precisely the amount of antibodies needed to keep us safe from a severe COVID-19 infection (just like we don’t know at what point a fatigued Brady or an injured Williams would cease to be some of the greatest athletes of all time).

But, like elite athletes, existing COVID-19 vaccines prompt such a high level of response to start with that even a little kick in the knees from some variants won’t completely stymie their efficacy, according to Alessandro Sette, an infectious-disease expert at the La Jolla Institute for Immunology in California.

“If you need a 10-foot wall to keep the virus out, and you start with a wall 100 feet high, even if the wall is reduced to 50 feet or 20 feet, it doesn’t really matter,” he told Insider.

Fauci has also said antibodies that are effective at combating the original virus can still partially work against variants – this is known as “the spillover effect.”

“It’s like you have a bug spray that is supposed to kill mosquitoes but might kill flies too, though maybe not as well,” Sette said.

Besides, that stark drop observed in neutralizing antibodies doesn’t happen against every variant. The variant first found in the UK, which is the one that is dominant in the US now, is “handled extremely well by the vaccines that are currently in use,” Fauci said.

Our T cells respond equally well to variants as they do to the original virus

Serena Williams

Concerns over plummeting antibody levels also don’t take into account other parts of our immune response to the virus – namely killer T cells that identify and kill infected cells, as well as helper T cells that help B cells make new antibodies.

While antibodies stop infection, your body’s T cell response – which lasts at least six to eight months – can influence how severe that infection will be.

And there’s good news on the T-cell front: Two new studies found people who’ve recovered from the wild-type version of the coronavirus had T cells that could recognize worrisome variants.

Sette compares this phenomenon to people’s facial-recognition skills.

“Maybe I learn to recognize your face, then I meet your sister,” he said. “It kind of looks like you, so I say, ‘OK, that’s probably someone related.'”

One study – led by researchers at the National Institute of Allergy and Infectious Diseases, which Fauci directs – looked at blood samples from 30 people who’d gotten infected with the coronavirus before the emergence of the variants. It found that the patients’ T cells did indeed respond to the variants first identified in South Africa, Brazil, and the UK well enough to give protection.

Sette’s team reached the same conclusion. Its recent research found that after people recovered from the original virus, their T cells could respond to those three variants, as well as one first identified in Southern California.

The La Jolla researchers also looked at blood samples from people who’d gotten Pfizer’s or Moderna’s shots and found that their T cells responded just as well to the variants first found in the UK, Brazil, and Southern California as they did to the original virus.

In the case of the variant first found in South Africa, T-cell responses decreased by up to 33% but were still detectable. That indicates vaccines most likely prevent deaths and hospitalizations for cases involving variants, even if they’re not quite as effective against stopping infections by those strains.

The likeliest explanation for why the same set of T cells can recognize different variants, according to Fauci, is a phenomenon called cross-reactivity: Helper and killer T cells developed in response to a given virus are capable of reacting to a similar but previously unknown variant.

Top athletes can perform well even when the game changes. These COVID-19 vaccines are the same.

Michael Jordan golfing

Great athletes can still perform relatively well when the game changes.

LeBron James was training for the NFL during the NBA’s 2011 lockout. Michael Jordan played baseball after initially retiring from the NBA in 1993 (albeit, not nearly as well), and he’s got a decent golf game, too.

The only problem when it comes to the performance of our vaccines is: We just don’t quite know where their limits might lie.

“I worry more about the next variant than the current ones,” Faust said.

There may someday be some variant that will pack a wallop to our authorized vaccines, which would make booster shots essential.

But until then, the human body, when primed by a COVID-19 vaccine, seems a lot like an elite athlete: tough to compete against, even when some new, somewhat unfamiliar opponents (like viral variants) arrive on the scene.

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Fauci says vaccines likely work against coronavirus variants: ‘I don’t believe that there’s anything to panic about’

fauci vaccine
Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, prepares to receive his COVID-19 vaccine at the National Institutes of Health on December 22, 2020 in Bethesda, Maryland.

More than 61 million Americans have been fully vaccinated against the coronavirus. Although some questions linger about whether the vaccines protect us against new, more contagious variants, Anthony Fauci thinks the concerns are overblown.

“I don’t believe that there’s anything to panic about at this point,” Fauci told Insider.

That’s because of a new study on T cells – a type of white blood cell that plays a key role in our immune systems – led by researchers at the National Institute of Allergy and Infectious Diseases, which Fauci directs.

The results showed that people who’d recovered from the original, or “wild type,” version of the coronavirus had T cells that could recognize the variants found in South Africa, Brazil, and the UK.

“Why it’s so important to get vaccinated? Because vaccination is not only going to protect us against the wild type, but it has the potential – to a greater or lesser degree – to also protect against a range of variants,” Fauci said in a White House briefing last week.

T cells aren’t phased by variants

Some of the concerns that vaccines could be less effective against variants come from lab studies involving blood samples from vaccinated people. In one such study, researchers exposed these blood samples to the variant from South Africa, then measured the antibody responses to that variant and to the original virus. They found that vaccinated people produced fewer antibodies that could neutralize the variant than the original virus.

Since the variant from South Africa has similar mutations to the one found in Brazil, it seemed likely vaccines would be less effective against that strain, too.

However, that research didn’t look at T cells. While antibodies stop infection, your body’s T cell response can influence how severe that infection will be. A February study found that patients who developed coronavirus-specific T cells within the first 15 days of their infection had milder COVID-19 than patients whose T cells kicked in later.

There are two crucial types of T cells: killer T cells identify and destroy infected cells, and helper T cells inform B cells about how to craft new antibodies.

t cell
A human T lymphocyte (also called a T cell).

So researchers at the National Institute of Allergy and Infectious Diseases looked at blood samples from 30 people who’d recovered from the coronavirus prior to the emergence of the variants. They found that the patients’ T cells did indeed respond to these variants well enough to give protection.

A similar study from the La Jolla Institute for Immunology in California reached the same conclusion. That team measured how T cells from people who’d been previously infected with COVID-19 responded to new variants. The research, which has not yet been peer-reviewed, showed that after people recovered from the original virus, their T cells could respond to the variants from the UK, South Africa, Brazil, and Southern California.

The same should then be true of T cells developed as a result of vaccines, since the shots prompt our immune systems to respond in the same way they would to an infection.

The La Jolla researchers have evidence that’s indeed the case. They also looked at blood samples from people who’d gotten Pfizer’s or Moderna’s shots, and found that their T cells responded just as well to the variants from the UK, Brazil, and Southern California as they did to the original virus.

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People arrive at Jackson Memorial Hospital in Miami, Florida, to receive COVID-19 vaccines, January 6, 2021.

In the case of the variant from South Africa, T cell responses decreased by up to 33% but were still detectable. That indicates that vaccines most likely prevent deaths and hospitalizations for cases involving variants, even if they’re not quite as effective against those strains.

“Would it be better if all vaccines were 100% effective in preventing infections? Of course,” Alessandro Sette, an infectious-disease expert at the La Jolla Institute, told Insider. “Is it good not to die and have vaccines be 100% effective at preventing hospitalization? Yes.”

T cells last months, if not years

The likeliest explanation for why the same set of T cells can recognize different variants, according to Fauci, is a phenomenon called cross-reactivity: Helper and killer T cells developed in response to a given virus are capable of reacting to a similar but previously unknown variant.

Sette compares this phenomenon to people’s facial-recognition skills.

“Maybe I learn to recognize your face, then I meet your sister,” he said. “It kind of looks like you, so I say, ‘Ok that’s probably someone related.'”

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Richard Biggs, a biology major at the University of Colorado, Boulder, gets his first dose of the Moderna vaccine, Match 26, 2021.

T cells are also important because they stick around for a long time.

Sette’s group found in a January study that T cells in a majority of recovered COVID-19 patients persist for at least six to eight months after infection. Other research has shown that white blood cells developed in response to certain viruses can last for years. T cells specific to smallpox, for example, take about 10 years to disappear after an infection.

T cells specific to SARS, a coronavirus that shares 80% of its genetic code with this new one, also linger for years. One study found responsive T cells in blood samples from people who’d survived SARS 17 years later.

Sette said he’s optimistic that vaccine-induced T cells will last just as long as T cells from a coronavirus infection.

“There’s no indication the immune response will rapidly decay,” he said.

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Charts show the US on the brink of a 4th coronavirus surge as variants spread and states relax restrictions

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Revelers flock to the beach to celebrate spring break in Fort Lauderdale, Florida, on March 5, 2021.

  • US coronavirus cases have increased 12% in the last week. About 30 states are reporting upticks.
  • Experts think the spread of a more infectious, deadlier variant is partially to blame.
  • Charts show how cases are spiking in the six states seeing some of the most dramatic increases.
  • See more stories on Insider’s business page.

Although 23% of the US population is now vaccinated against the coronavirus, the director of the Centers for Disease Control and Prevention has warned of “impending doom.”

In a press briefing on Wednesday, Rochelle Walensky said the US is in “a critical moment in our fight against the pandemic.”

In the last seven days, average daily case numbers have trended up in more than 30 US states. The country’s daily number of new cases has risen 12% during that time, according to Walensky. Hospitalizations nationally increased 5%, on average, over the last two weeks.

“For the health of our country, we must work together now to prevent a fourth surge,” Walensky said earlier this week.

US deaths are still trending down overall, but spikes in mortality typically appear at least three weeks after cases go up. And 900 Americans dying of COVID-19 per day is still far too many, Walensky said.

Not all states are seeing equal surges – the rise in new COVID-19 cases is more pronounced in the Northeast, Michigan, and Florida.

Anthony Fauci, President Joe Biden’s chief medical advisor, said states with new case spikes share commonalities: They are either loosening restrictions on indoor activities and gatherings too quickly, or they’re being disproportionately affected by infectious coronavirus variants, like the B.1.1.7 variant first found in the UK. Or both.

“This tension between the desire to start opening up and the risk associated with B.1.1.7 is placing us in a precarious position,” Yonatan Grad, an infectious-disease researcher at Harvard’s T.H. Chan School of Public Health, told STAT. “It would be great if people could wait a little bit longer until we get higher levels of vaccine coverage.”

States with more variant cases are seeing surges

Florida’s cases have increased 8% in the last two weeks, as hordes of college students and spring breakers flocked to beaches near Miami for vacation.

CDC data shows Florida has both the highest total number of B.1.1.7 cases – 2,351 – and a higher proportion of total cases linked to the variant than any other state: 13.2%. Studies have found that this mutated strain is 50% to 70% more contagious than its predecessors.

“More infections will result because of B.1.1.7,” Walensky said Wednesday. B.1.1.7 is responsible for about 26% of US cases to date.

Michigan is also struggling with B.1.1.7’s spread. It has 15% of the US’s total cases linked to that variant: more than 1,230. Studies suggest people who get infected with B.1.1.7 are up to 64% more likely to die than those who get other coronavirus strains.

Michigan’s weekly average of new daily cases have increased almost fourfold in the last five weeks, despite a statewide mask mandate. Jackson and Flint have some of the highest case rates in the US.

Daily hospitalizations in Michigan have more than doubled in the last month.

New York, too, is seeing a new spike that could be due to infectious variants – both B.1.1.7 and another variant called B.1.526, which was first detected in New York City in the fall.

Epidemiologist Dr. Jay Varma, New York City’s senior advisor for public health, told Gothamist that together, B.1.1.7 and B.1.526 accounted for more than half of New York City’s coronavirus cases in mid-March.

The state’s weekly average of new daily cases rose 42% over two weeks. Together with New Jersey, it has one of the highest per-capita case rates in the US.

Large gatherings and a lack of masks lead to more transmission

Many states experiencing surges have also loosened coronavirus-related restrictions on masks and gathering sizes in the last month, contrary to recommendations from the CDC.

“Consistently, three times a week for 10 weeks, Dr. Walensky has said, ‘Wear a mask, avoid crowds, socially distance, and don’t travel unless it’s absolutely essential,'” Andy Slavitt, an administrator on Biden’s COVID-19 advisory team, said during the Wednesday briefing. “We repeat that in all our conversations with governors. We repeat that in all our conversations with local officials.”

However, Florida, along with 17 other states, no longer have mask mandates. Texas Gov. Greg Abbott lifted the state’s mask mandate on March 10, and also eliminated capacity restrictions for all Texas businesses, including restaurants and bars.

Texas’s weekly average of new daily cases has remained above 3,200 for the last six months.

New Jersey, another new hot spot, has seen its average number of new daily cases increase by more than 50% since March 1.

New Jersey Gov. Phil Murphy allowed restaurants and businesses, including gyms and salons, to increase their capacity to 50% starting March 19. Murphy also said earlier this month that indoor events can include up to 150 people.

New York Gov. Andrew Cuomo, meanwhile, recently announced that arts and entertainment venues can reopen starting April 2, holding up to 100 people indoors and 200 people outdoors. He eased restrictions on weddings, sporting events, and concerts earlier this month.

Pennsylvania, too, is seeing a surge that coincides with its recent reopening.

The state will allow restaurants to increase indoor seating capacity to 75% starting this Sunday. Since March 1, Pennsylvania guidelines have allowed indoor concert venues and arenas to operate at 15% capacity.

The state recorded roughly 28,300 new cases in the week ending March 30: a 33% increase from the week prior.

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The US hasn’t authorized AstraZeneca’s vaccine for 2 main reasons. That could change in April.

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French Health Minister Olivier Veran receives the AstraZeneca-Oxford COVID-19 vaccine on February 8, 2021.

  • The US hasn’t authorized AstraZeneca’s vaccine because its trial is still going.
  • Vaccine experts have also questioned inconsistencies in the company’s global studies.
  • AstraZeneca’s US trial results will likely clear up confusion in April.
  • See more stories on Insider’s business page.

After more than a dozen countries paused the use of AstraZeneca’s coronavirus vaccine due to concerns about blood clots, the European Medicines Agency concluded on Thursday that the vaccine doesn’t increase the risk of clotting.

The World Health Organization, too, recommended that countries continue to administer AstraZeneca’s vaccine, since the benefits of the shot “outweigh its risks.”

The US, however, never greenlit the vaccine in the first place, for two main reasons. The first is that AstraZeneca’s US trial is still ongoing. The trial was delayed for nearly seven weeks in the fall due to an adverse reaction in a UK participant.

The second is that AstraZeneca’s initial trial results in November puzzled many experts. The company combined data from its Brazil and UK groups, even though they had different sample sizes and demographics. It also averaged the results of two different dosing regimens, one of which was administered by mistake.

Now, scientists hope that results from AstraZeneca’s US trial will clear up much of the world’s confusion. The findings are expected to be released to the public within the next month.

Currently, the US data is being reviewed by an independent monitoring board. If the vaccine is found to be safe and effective, the FDA could authorize it for emergency use in April, Reuters recently reported.

The US trial has more than 30,000 participants

Even if AstraZeneca’s global trials had been free of inconsistencies, the FDA would most likely still have wanted to see the results of the US trial before authorizing the shot.

The US trial is larger than its predecessors in other countries. The study involves up to 32,000 volunteers – roughly the same number as the clinical trials done by Pfizer and Moderna. And it’s only testing one regimen: two full doses.

“The US study is the one that’s going to be the definitive study to tell us how this vaccine works against severe, hospitalized COVID and symptomatic COVID,” Anna Durbin, a vaccine researcher at Johns Hopkins Bloomberg School of Public Health, told STAT.

AstraZeneca CEO Pascal Soriot
Pascal Soriot, executive director and CEO of AstraZeneca, testifies before the Senate Finance Committee on February 26, 2019.

The trial could also shed light on how the vaccine performs among older people. Nearly one-quarter of the US trial participants were over 65, according to Biopharma Dive. Meanwhile, just 12% of participants in AstraZeneca’s UK and Brazil trials were over 55.

Murky data from the UK and Brazil

The FDA requires coronavirus shots to prevent disease in at least 50% of vaccine recipients.

In November, AstraZeneca reported that its shot was 62% effective at preventing COVID-19 among nearly 9,000 volunteers in Brazil and the UK. Those participants received two full doses, but about 2,700 others accidentally got a half dose followed by a full dose. Among that smaller group, the vaccine’s effectiveness rose to 90%.

AstraZeneca averaged the two results, stating that the vaccine was 70% effective.

“To people looking in from the outside, that doesn’t make a whole lot of sense,” Dr. Johan Bester, director of bioethics at the University of Nevada, Las Vegas School of Medicine, told Insider last month. “We’re either going to give half doses or full doses to people and it will either be one effectiveness or the other.”

AstraZeneca’s shot may be less effective against the variant found in South Africa

In the months since AstraZeneca revealed its global trial results, subsequent analyses have found even more variation in the shot’s effectiveness.

A February analysis that hasn’t been peer reviewed found that the vaccine was 55% effective when doses were given less than six weeks apart, but 82% effective when doses were given at least 12 weeks apart. The results were based on trials in Brazil, South Africa, and the UK with more than 17,000 volunteers in total.

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AstraZeneca COVID-19 vaccines in storage in Copenhagen, Denmark on February 11, 2021.

Another study that’s still awaiting peer review indicated that the vaccine was just 22% effective against mild and moderate illness caused by B.1.351, the variant first identified in South Africa. As a result, South Africa halted its distribution of AstraZeneca’s vaccine. But that study was small, with roughly 2,000 participants.

When it comes to two other prominent variants – B.1.1.7, initially spotted in the UK, and P.1, first identified at a Japanese airport among travelers from Brazil – preliminary data shows AstraZeneca’s vaccine has the same efficacy: between 60% and 90%.

The US trial may not give any more clarity about how well the vaccine works against these three variants, since it’s not yet known how many volunteers wound up getting exposed to those strains during the study. But the fact the trial is happening later than Pfizer’s or Moderna’s means there’s a greater chance that participants in this one were exposed to new variants.

Even in the worst-case scenario, Bester said, the shot will probably be effective enough to meet FDA standards.

“What we’ve seen is promising,” he said. “It is a moderately to very effective vaccine that is cheaper than the other alternatives and gives us another tool in our arsenal to stop people from dying.”

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People infected with the coronavirus variant found in the UK are up to 64% more likely to die than those with other strains

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Medical workers bring a patient out of an ambulance outside Royal London Hospital, in London, January 15, 2021.

The data is in: People infected with the coronavirus variant first discovered in the UK have a higher risk of dying from COVID-19 than those who get other versions of the virus.

New research published Monday in the journal Nature found that among cases involving the variant, known as B.1.1.7, patients had a 55% higher chance of death within four weeks following their positive test.

The study authors examined roughly 2.2 million people who tested positive in England between September and mid-February, then compared the number of deaths among those with B.1.1.7 to those who were infected with other strains.

After controlling for variables including a patient’s age, sex, ethnicity, and living arrangement, the researchers found that with the original virus, about six out of every 1,000 people in their 60s who test positive might be expected to die. But this number rises to about nine out of 1,000 with B.1.1.7.

“In spite of substantial advances in COVID-19 treatment, we have already seen more deaths in 2021 than we did over the first eight months of the pandemic in 2020. Our work helps to explain why,” Nick Davies, the lead author of the study and an epidemiologist at the London School of Hygiene & Tropical Medicine, said in a press release.

In January and February, 42,000 people in England died of COVID-19.

Mounting evidence shows the B.1.1.7 variant is more deadly

B.1.1.7 was discovered outside London in September, but initial evidence suggested the strain wasn’t more lethal. Then in January, UK Prime Minister Boris Johnson announced the variant was likely associated with higher mortality.

Research published last week in the journal BMJ confirmed that. It found B.1.1.7 to be deadlier than other strains – and even more deadly than the Nature study results suggest.

The BMJ researchers examined nearly 55,000 pairs of people in the UK. Within each pair, one person had tested positive for B.1.1.7 while the other had tested positive for a different coronavirus strain (including the variants from South Africa and Brazil). The members of each pair had similar ages, ethnicities, and geographic locations, and got their positive test results between October and February.

The study found the B.1.1.7 variant was 64% deadlier than the other strains within the four weeks following a positive test.

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UK Prime Minister Boris Johnson.

Johnson’s January announcement was based on research collected by the UK’s New and Emerging Respiratory Virus Threats Advisory Group, which found that on average, people infected with B.1.1.7 in the UK had a 30% higher mortality rate than those with the original virus.

A follow-up analysis from Public Health England analyzed data collected between late November and early January, and found that B.1.1.7 was 65% deadlier than other strains. Researchers from the University of Exeter, meanwhile, looked at samples collected between October and late January and found that people infected with the variant were almost twice as likely to die.

Higher mortality could be related to higher viral loads

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A COVID-19 patient is wheeled into an ambulance in London.

The strain’s increased lethality could be chalked up to the fact that people infected with B.1.1.7 have higher viral loads on average, meaning they produce more viral particles when they’re infected. Higher viral loads, multiple studies show, are associated with a higher risk of death and more severe disease.

“That was the first thing that certainly came to my mind,” William Schaffner, an infectious-disease expert at Vanderbilt University, previously told Insider. “It would make very good sense.”

It’s also possible that the strain’s increased transmissibility simply gives the virus a better chance of infecting more people who are at higher risk of severe illness. A more transmissible strain means people are more likely to get infected if exposed; B.1.1.7 is between 50% and 70% more contagious than the original version of the virus.

This higher transmissibility could be due to several mutations in the genetic code for the virus’ spike protein, which it uses to invade cells. These tweaks may make it easier for the B.1.1.7 variant to spread.

“It may simply be a matter of a more contagious virus getting to more vulnerable people who are older or have underlying health problems like diabetes or lung disease,” Schaffner said.

Yet another possibility is that the variant’s increased transmissibility indirectly contributed to a higher mortality rate due to the stress it put on the UK’s healthcare system. The number of daily COVID-19 cases there skyrocketed in the four months following B.1.1.7’s discovery, jumping from 3,899 new cases on September 20 to more than 68,000 cases on January 8.

The spike in cases strained UK hospitals and healthcare resources, which may have hurt patient outcomes.

“If your cases get out of control, your deaths will get out of control as your health system comes under pressure,” Mike Ryan, executive director of the World Health Organization’s health emergencies program, said in January.

Existing vaccines work against B.1.1.7

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A woman receives a COVID-19 vaccine in Wales.

B.1.1.7 has been found in 94 countries, including the US.

But in recent studies, both Pfizer and Moderna found that their shots held up well against the variant. Other vaccines, including those from Johnsen & Johnsen and AstraZeneca, protect people from B.1.1.7, too.

But these shots seem less effective overall against the variant first discovered in South Africa, B.1.351, and the strain found in Brazil, named P.1.

That’s likely because those two variants share a mutation that can prevent the antibodies generated in response to the original virus from recognizing them. This genetic tweak is mostly missing in B.1.1.7, though UK researchers did find 11 cases of B.1.1.7 with that mutation in a set of more than 200,000 samples.

Studies have not found either B.1.351 or P.1 to be more lethal than the original virus.

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California healthcare workers didn’t know they were fighting a new variant this winter. Their trauma should be a warning.

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Chaplain Kevin Deegan places his hand on the head of a COVID-19 patient while praying for him at Providence Holy Cross Medical Center in Los Angeles on January 9, 2021.

  • Southern California’s winter surge of COVID-19 infections overwhelmed hospitals.
  • A new variant of the virus became dominant there, which may have partially spurred the surge.
  • Four healthcare workers in San Diego and Los Angeles share their stories from the winter.
  • Visit the Business section of Insider for more stories.

Shawna Blackmun-Myers grasped her patient’s hand, called the woman’s family, and held up the phone. As everyone said their goodbyes on the other end, the patient couldn’t respond: A tube down her throat was feeding oxygen from a ventilator into her lungs.

Blackmun-Myers, an ICU nurse at the Jacobs Medical Center in San Diego, told Insider that the woman was in her 50s and had been bubbly when she came in weeks earlier. Normally in the ICU, Blackmun-Myers said, “people are so sick that that energy and that light is dimmed, but even her being in that situation, she was still just such a bright light.”

“We were dancing and listening to music, and we were watching some soap opera drama stuff on TV and, you know, talking tea about everybody,” she added.

But the woman’s condition worsened quickly. Hospital staff readied a ventilator.

“She’s crying and telling me, you know, ‘I just don’t want to be alone. And I just know that once this tube goes in, I don’t think it’s coming out. I think this is going to be it,'” Blackmun-Myers said.

“I did my best to let her know, you know, obviously she’s not alone. I was there with her. I had her back,” she added.

Then the virus brought heart and kidney problems. The woman went on dialysis. Eventually, there was nothing more the hospital could do to restore her quality of life, and her family knew she wouldn’t want to live this way.

In January, Blackmun-Myers oversaw the woman’s death as hospital staff disconnected the ventilator. The sound of crying family members echoed through the phone.

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Chaplain Kristin Michealsen holds the hand of a deceased COVID-19 patient while talking on the phone with the patient’s family member at Providence Holy Cross Medical Center in Los Angeles on January 9, 2021.

It was the middle of winter in Southern California. Coronavirus cases were at an all-time high, and ICUs were above 90% capacity. Blackmun-Myers’s unit was losing multiple patients every day.

“I ugly-cry, and then I get angry, and I accept the fact that I did everything I could,” she said. “And just move on so I can take care of the next person and their family.”

Blackmun-Myers didn’t know it at the time, but a new coronavirus variant had been overtaking the region.

The CAL.20C variant was first identified in Los Angeles in July, then disappeared from the record until October. But by January, it accounted for 44% of Southern California coronavirus samples in one study, and more than half of California samples in another.

Several other factors contributed to Southern California’s winter surge – holiday travel, crowded housing, pandemic fatigue – but many researchers think the variant played a role.

Two studies that aren’t yet peer-reviewed suggest that the variant is more infectious than the original virus strain. The research also found it to be associated with a higher incidence of severe illness and partially resistant to antibodies developed in response to the original virus or vaccines.

Although California cases have dropped from a peak of about 40,700 per day in late December to about 4,000 now, experts warn that CAL.20C or other variants could still change the course of the pandemic.

“Now is not the time to relax the critical safeguards that we know can stop the spread of COVID-19 in our communities,” Dr. Rochelle Walensky, the CDC director, said at a White House briefing last week.

“Please hear me clearly,” she added. “At this level of cases, with variants spreading, we stand to completely lose the hard-earned ground we have gained.”

Blackmun-Myers and three other Southern California healthcare workers say what they saw this winter should serve as a strong warning.

Struggling to be heard

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Kristine Chieh during a COVID-19 shift, with marks on her face from wearing protective gear.

The ICU was loud. Given the influx of coronavirus patients, the Sharp hospital network in San Diego had to jerry-rig negative-pressure systems to prevent virus particles from wafting out of patients’ rooms. The makeshift tubing roared overhead, so nurse Kristine Chieh had to yell over it – and through several layers of PPE – for patients to hear her.

Chieh isn’t normally an ICU nurse, but in January, the COVID floors needed all the help they could get. Two days before her first ICU shift, Chieh’s friend, a man in his late 40s, died from COVID-19 after more than two weeks in the hospital.

“I walked through the ICU, looking at the windows, and I swear I see my friend over and over and over again in those beds,” she said.

Chieh recalled stopping to help a man video chat with his family. A mask covered his face, pumping oxygen from a BiPap machine. Chieh lifted the mask for short intervals so he could speak to his family. After a few seconds, he would run out of breath, and Chieh would put the mask back down. Family members would speak up to fill the silence.

“There’s all kinds of people on that iPad, like he must have a large family,” Chieh said. “They thought it was so awesome to be able to hear his voice, and I think he was really excited to use his voice.”

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A healthcare worker places a BiPAP machine on a COVID-19 patient at United Memorial Medical Center in Houston, Texas, December 28, 2020.

She spent about half an hour like that, lifting and lowering the mask.

“The other ICU nurse was in the process of intubating somebody at the same time that this is happening, so there’s no way she would have been able to do that for him,” Chieh said. “I clocked out for the day and I don’t know what ever happened to him, long term. Hopefully he made it out okay.”

‘It almost overtook my vocabulary and my mind’

Chieh works as a float nurse across three locations in the Sharp hospital network, going wherever she’s needed. Typically, she works in progressive care units – the level before intensive care. But during the winter, even the COVID-19 patients there were severely ill. Chieh would dash from room to room, changing in and out of protective gear to help patients who suddenly found themselves struggling to breathe.

“Throughout my shift, I’ll get patients who are off and on just being like, ‘I can’t breathe, I can’t breathe.’ And then I go in and I do breathing exercises with them. I adjust their oxygen. I have the respiratory therapist come in, do breathing treatments, whatever is needed,” Chieh said.

They would calm down and be fine for about an hour, she said, before it happened again.

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Kristine Chieh, in full PPE, stands in front of a negative-pressure room for COVID-19 patients.

Robert Bang, a floor nurse in Los Angeles, spent his winter days the same way. Alarms were constantly sounding through the computer system, he said, to alert him that a patient’s oxygen levels had dropped too low. He would rush to the patient’s room, sometimes to find that they didn’t even realize they were losing oxygen.

“If you’ve been short of breath for so long, you just start developing fatigue from breathing so hard. So it might be like your new normal,” Bang told Insider.

Even when he went home, Bang said, he would still hear the alarms in his head. Work followed Chieh home, too.

“My husband gave me this feedback: I talked about COVID too much at home. Talked about math too much, talked about every news article,” she said. “It almost overtook my vocabulary and my mind.”

That hasn’t fully subsided – Chieh said those winter days still haunt her.

“I feel like I can remember every single COVID patient,” she said. “I imagine what it must be like to have this astronaut person come into their room to work with them. They must be terrified.”

‘I’ve never seen something infect people so easily’

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Dania Lima, right, helps fellow nurse Adriana Volynsky put on personal protective equipment in a COVID-19 unit at Providence Holy Cross Medical Center in Los Angeles, December 22, 2020.

Many of Dr. Kenny Pettersen’s patients in Los Angeles live in crowded homes with a combination of parents, kids, grandparents, or cousins under one roof. That made it difficult to make quarantine plans for the COVID-19 patients who weren’t sick enough to stay at the hospital.

In spring and summer, he told Insider, “when someone in the household would have COVID, usually like half or less of the rest of the household would get COVID.”

But this winter, Pettersen, said “it was almost universally 100%.”

Pettersen is a primary-care physician at Olive View-UCLA Medical Center. The change in LA’s outbreak was so noticeable to him during the winter that he assumed the virus itself must have changed.

“I’ve never seen something infect people so easily,” he said. “I felt like I was almost wasting my time talking to patients about the prevention of household transmission.”

More research on CAL.20C is still needed to confirm his suspicions, though, since the initial studies of the variant haven’t been peer reviewed, and the spike-protein mutation that characterizes it has not been thoroughly investigated.

Relief and grief after the surge

Pettersen’s grandmother died of coronavirus in August. Many of his patients died, too, and some left behind young children. One family is losing their home after the coronavirus-related deaths of two family members.

“Practically every one of my patients, either they’ve been infected, or many of their family members have been infected, they know somebody very well who has died or gotten severely sick,” Pettersen said. “I think the cumulative toll that takes on my patients is just really profound.”

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Nurse practitioner Nicole Monk, 44, receives a coronavirus vaccination at the Los Angeles Mission homeless shelter on Skid Row, February 10, 2021.

Still, he said, the mood among his coworkers is more upbeat now. There are even days at the hospital when nobody dies of COVID-19.

“I think that we can start to breathe with a little bit more confidence,” Pettersen said. He and his wife have both been vaccinated.

Bang and Chieh say they feel safer these days, too. The volume of COVID-19 patients is much lower. They’ve been vaccinated, and more people are getting shots each day. But the winter memories persist. Some healthcare workers are now nervous about other variants. And there’s a strong possibility they or their colleagues will develop PTSD.

But Pettersen, at least, said he was finally able to go to an outdoor restaurant for sushi with his wife recently.

“We can, you know, be optimistic for the first time in about a year,” he said.

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