The Impact of COVID-19 Virus Mutations
COVID-19 has continued to pose a problem worldwide. Until the end of January, there were already over 100 million cases in the world, with more than 2 million deaths.
COVID-19 has continued to pose a problem worldwide. Until the end of January, there were already over 100 million cases in the world, with more than 2 million deaths. Data in Indonesia also shows a persistent increase.
Our new cases have surpassed 14,000 per day and the positivity rate is also more than 20 percent, even close to 30 percent in some areas. This indicates a high degree of infection, which demands caution and thorough handling.
We are aware that the increasing number of cases in the country may be due to the impact of year-end holidays. The condition may also result from pandemic fatigue, in which health protocols are loosely implemented. It’s also likely that an insufficient number of people have been tested and involved in contact tracing so that the situation is as yet uncontrolled. Apart from that, it’s also necessary to observe the possibility of ongoing mutations.
Also read: Vaccination and Threat of Virus Mutation
We’ve learned that COVID-19 is caused by the SARS-CoV-2 virus. Viruses can indeed mutate from time to time. We know there’s the D614G mutation of the COVID-19 virus already identified in February. This mutation is said to be more contagious than what was originally discovered in Wuhan, China. Over time, the D614G mutation spread over various regions of the world and became part of the pandemic throughout 2020.
In December 2020, the British government reported a new variant now known as B.1.1.7. The British government’s report to the World Health Organization was incorporated in the International Health Regulation (IHR) because the mutation this time was apparently more serious than the previous one. In December 2020, various COVID-19 virus mutations were also reported, and the most worrying ones were B.1.351 and E484K, as well as 501.V, which arose in South Africa.
Two men look at a globe in front of the London School of Economics in London, Tuesday, Jan. 19, 2021. The globe designed by Mark Wallinger is called \'The World turned Upside Down\'. The U.K. is under an indefinite national lockdown to curb the spread of the new variant, with nonessential shops, gyms and hairdressers closed, most people working from home and schools largely offering remote learning.
Infection, virulence and PCR
A mutation or change in parts of a virus will produce a virus of a new variant.
In general, four things are now connected with COVID-19 virus mutations. First, as generally agreed upon by experts, national leaders and international organizations like the WHO and others, the new variants of the COVID-19 virus are in fact more infectious. It was even reported that their contagion was 70 percent higher.
Also read: Vaccines: Some Successful, Others still Awaiting Results
Several countries reported that the new variant might cause a spike in cases, such as Vietnam. As is known, the B.1.1.7 mutation variant has been found in a number of our neighboring ASEAN countries other than Vietnam, like Singapore, Malaysia and the Philippines.
The WHO director general has also stated that mutations causing the emergence of new variants would raise the number of cases and could heavily burden hospitals with patients. It means that if a surge in cases occurs in a country, such mutations should be taken into account as one of the triggering factors.
The second is whether mutations affect the severity of the disease. Existing scientific evidence actually doesn’t indicate that such mutations make new virus variants more virulent and the disease more severe. However, with infections on the rise, people in their advanced age and with comorbidities will most likely be infected — and we are aware that COVID-19 in these groups can be very serious a have higher likelihood of ending in death.
Also read: Covid-19 Vaccine, Between Euphoria and Fear
On the other hand, with the higher surge in cases, hospitals can be overwhelmed in their handling of patients so that the situation will likely affect mortality.
The third factor also discussed is the impact of mutations on the accuracy of PCR testing. So far, experts have still concurred that the changes in mutations do not yet affect the accuracy of PCR testing in a significant way. We can still rely on PCR test results to determine whether or not somebody is a confirmed COVID-19 patient.
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The Gambir Community Health Center conducted a polymerase chain reaction (PCR) swab test in the Duri Pulo area, Gambir, Central Jakarta, Monday (18/1/2021). The test was carried out as part of tracking positive cases of Covid-19.
Impact on vaccines
The most widely discussed question is whether mutations that create new variants will have an impact on the effects COVID-19 vaccines now beginning to be used worldwide.
When the mutations in Britain and South Africa were first reported in December 2020, experts agreed that the available vaccines would remain capable of giving immunity against the new variants. It’s because the mutations only involved one or a few spikes of the coronavirus, while the vaccines will overcome a number of spikes at the same time, so the inoculations will still be effective for disease prevention.
Yet experts at the time also said that the virus seemed to have shown signs of going through changes that might be more extensive in the future.
Novovax’s efficacy in the small-scale clinical trial in South Africa declined to below 50 percent.
Some new data became available in January. On Jan. 28, for instance, the Novovax vaccine reported an efficacy rate of almost 86 percent in its clinical trial in Britain involving the new variant of that country. But it turned out that Novovax’s efficacy in the small-scale clinical trial in South Africa declined to below 50 percent. Nearly all the sick volunteers in the South African clinical trial were linked with the new COVID-19 variant mutating in that country, and it was believed to cause the sharp drop of the vaccine’s efficacy in Novovax’s clinical trial in South Africa.
Phase 3 Novavax coronavirus vaccine trial vaccine volunteer Franklyn Howe is given an injection at St George\'s University hospital at in London, Wednesday, Oct. 7, 2020. Novavax Inc. said Thursday Jan. 28, 2021 that its COVID-19 vaccine appears 89% effective based on early findings from a British study and that it also seems to work — though not as well — against new mutated strains of the virus circulating in that country and South Africa.
Another example is the Johnson and Johnson vaccine, which on Jan. 30 presented its clinical trial results. It reported that the efficacy of this single-dose vaccine varied in several countries, listing 72 percent in the United States, 66 percent in Latin America and 57 percent in South Africa. The relatively low efficacy in South Africa supposedly had to do with the fact that the 95 percent of the cases joining this research were affected by the new COVID-19 virus variant, B.1.351, which might make the virus less reactive toward the immunity response of antibodies, possibly including the antibodies produced by vaccination.
Meanwhile, several other vaccine producers have maintained that their vaccines are quite effective against new variants, but no valid evidence has yet been provided. Some also indicate that if mutations are going on, their vaccines can be modified within several weeks so that they remain effective. Other vaccine producers are still observing current developments and will take measures if needed later on.
Prevention and anticipation
What becomes important now is certainly how to prevent or detect whether such mutations and new variants have been present in Indonesia.
Also read: COVID-19 in 2021
In terms of international air traffic, there’s indeed a regulation on whoever is allowed and forbidden to enter Indonesia. But it should be noted that there are reports from other countries, such as that in South Carolina, US, that there was a case in which one’s body carried a virus of the South African variant while in fact the person concerned had no travel history. So, the infection might have originated in the person’s own area.
We are also aware that some laboratories in Indonesia have conducted genomic sequencing examinations and so far, no new COVID-19 virus variants have yet been found. It will be better if this activity can increase the number of people examined and the coverage of patients; ideally, of course, in the form of systematic and properly structured genomic surveillance on a national scale.
Tjandra Yoga Aditama
It is surely our hope that the new variants will not enter Indonesia, and if they have entered, they can be immediately identified so that steps can be appropriately made and the COVID-19 problem in the country will not be further encumbered.
Tjandra Yoga Aditama, Postgraduate director of Yarsi University; professor, Medical School of the University of Indonesia; former director of WHO SEARO; former director-general of disease prevention and control, and head of the Health R&D Agency.
This article was translated by Aris Prawira
