COVID-19 mutation raises more questions than answers

*Experts say UK variant is already in Nigeria but may not make current vaccines less effective
*Academy says benefits of vaccination far outweigh risks but discourage use in pregnant women

Worried about concerns over the use of COVID-19 vaccines, the emergence of mutant strains in United Kingdom (U.K.) and South Africa as well as the commencement of second wave of the virus with attendant spike in new cases and deaths, medical experts have made recommendations of how best to contain the situation.

Former Commissioner for Health and Permanent Secretary, Lagos State Ministry of Health, Dr. Jide Idris, told The Guardian: “Yes, there are reports of the emergence of mutant strains of covid-19 virus. To me, the public health efforts for containment (non-pharmaceutical interventions) should continue, more so since the knowledge is still evolving and we don’t fully know what effects the new vaccine would have on it.

“I am very much concerned since we do not know what the real characteristics of the new strain is. Yes, it is more transmissible; it could be more lethal and the protection we seemingly have here may or may not be effective.”

On the chance of spread of the mutant strain to Nigeria, Idris said: “Chances are high and that is if it is not here already. I am aware of the report of a study, which supports the existence of a similar variant strain here.”

On the issue of genetic make-up, he said they also do not know as there are many other factors involved including environmental factors etc. Idris, however, said there are many studies being carried out by scientists globally.

Idris added: “The research activities should and will continue until the real answers are found, and I strongly believe these are the things we should be involved in, especially to study our peculiar situation here. Government should support and fund these activities. We have researchers here who can do this.”

A consultant public health physician and Executive Secretary, Enugu State Agency for the Control of AIDS (ENSACA), Dr. Chinedu Idoko, told The Guardian: “If indeed this nationally observed current wave of COVID-19 is indeed of more virulent mutant strains then it calls for a more aggressive approach to safety protocols and preventive measures.

“Reports have it that in a number of facilities in Nigeria, confirmed COVID-19 patients appear turning out with more severe presentations in many instances requiring oxygen and breathing support as against previous experience in the first wave. If this is the true reality then the re-awakening to COVID-19 has to be more of an emergency and widespread.”

Idoko said the implication of the said mutant strains cut across COVID-19 vaccine production/ delivery as well because the varied strains come with it more challenges to combating it.

He further explained: “It is an issue of concern. For us in Nigeria I think this demands a change in strategy. The less severe presentations of the COVID-19 in Nigeria have been variously attributed to either a strain of lower virulence presenting in this part of the world or probably some sort of derived immunity as a result of the commonly prevalent and endemic diseases we more frequently suffer and recover from here in the developing world. Whichever it is, it seems obvious we may this time around be dealing with a different ‘kettle of fish’.

“We obviously therefore need to step up on our health promotion, preventive and treatment approaches to combating this virus. The wearing of face masks should go beyond an aesthetic statement or for entry/ passage purposes, the hand wash/ sanitizers should be engraved in our consciousness and everyday living. Social distancing should become the norm while especially health professionals should exhibit high index of suspicion.

“Furthermore our constituted authorities need to show more than a passing interest in encouraging indigenous vaccine production.”
A consultant public health physician and leader, Lagos State COVID-19 team, Prof. Akin Osibogun, told The Guardian: “Yes, a variant strain of the Severe Acute Respiratory Syndrome Coronavirus Type 2 (SARS-COV-2) virus has been reported in the United Kingdom (UK). While it may not necessarily be more virulent, it is said to be more infective with a capacity to spread faster.”

Osibogun, who is also the immediate past Chief Medical Director (CMD) of Lagos University Teaching Hospital (LUTH), said the strategy for control may not change but definitely needs to be intensified. “Face masks, hand washing, physical distancing, avoidance of crowd events and now the deployment of the approved vaccines once they are available. It is very important for us in Nigeria to intensify public education on non-pharmaceutical interventions mentioned above as the vaccines may still take a couple of weeks or months before getting here,” he said.

Director General of Nigerian Institute for Medical Research (NIMR) Yaba, Lagos, Prof. Babatunde Salako, told The Guardian: “Viruses often mutate forming new strains which may be different from the initial one however, only significant mutations lead changes in virus behavior and its ability to become more virulent or more infectious as seen in the UK/SA mutant strains.”

Salako said the implications include the need to be more proactive in surveillance in order to detect early other mutations. “More people may also contract the disease since this is more infectious although yet to be seen to cause more severe clinical symptoms. We are still studying the situation. Again, a change of strategy may be necessary especially in terms of Non Pharmacological Interventions (NPIs), social distance and lockdown,” he said.

Salako added: “One should naturally be concerned as Nigerians have jettisoned the use of NPIs and some don’t even believe that COVID-19 is real. The UK strains is already in Nigeria and we are trying to see how much of it do we have around.”

England’s health secretary, Matt Hancock, had on Monday told parliament that a new variant of COVID-19 had been identified and might be driving infections in the south east, leading to headlines about “mutant COVID.”

According to the British Medical Journal (BMJ), “this new Severe Acute Respiratory Syndrome Coronavirus type 2 (SARS-CoV-2) variant has been snappily named VUI-202012/01 (the first “Variant Under Investigation” in December 2020) and is defined by a set of 17 changes or mutations. One of the most significant is an N501Y mutation in the spike protein that the virus uses to bind to the human ACE2 receptor. Changes in this part of spike protein may, in theory, result in the virus becoming more infectious and spreading more easily between people.”

Will the current vaccine still work? According to experts analyses published in the British Medical Journal, “The new variant has mutations to the spike protein that the three leading vaccines are targeting. However, vaccines produce antibodies against many regions in the spike protein, so it’s unlikely that a single change would make the vaccine less effective.

“Over time, as more mutations occur, the vaccine may need to be altered. This happens with seasonal flu, which mutates every year, and the vaccine is adjusted accordingly. The SARS-CoV-2 virus doesn’t mutate as quickly as the flu virus, and the vaccines that have so far proved effective in trials are types that can easily be tweaked if necessary.

“With this variant there is no evidence that it will evade the vaccination or a human immune response. But if there is an instance of vaccine failure or reinfection then that case should be treated as high priority for genetic sequencing.”

Also, medical experts under the aegis of the Academy of Medicine Specialties of Nigeria (AMS), on Monday, in a unified statement made available to The Guardian by President, African Fertility Society (AFS) and Joint Pioneer of IVF in Nigeria, Prof. Oladapo Ashiru, said: “We believe that the vaccine trials and the United States Food and Drug Administration (FDA) and the Advisory Committee on Immunisation Practices (ACIP), a committee within the United States Centers for Disease Control and Prevention (CDC), data evaluation process have been robust and transparent. In other countries across the world, regulatory bodies have also endorsed the vaccine, and similar processes will be followed globally to evaluate each upcoming candidate vaccine.

“We await the arrival of a vaccine in Nigeria that would be suitable for our climate. It is our collective opinion, after closely monitoring this situation, that the benefits of COVID-19 vaccination far outweigh the risks. We endorse vaccination for all eligible health care workers, patients, and our society at large, including populations who are disproportionately impacted by COVID-19 or complications from the disease, in consultation with their physicians or health care professionals.”

AMS said it is especially important that certain eligible patient populations, including pregnant women, consult with their trusted physicians when considering whether to take the vaccine. “Since the beginning of the pandemic, various medical bodies urged that pregnant and lactating people be included in the vaccine trials and research; unfortunately, they were not. While a conversation with a clinician may be helpful and is encouraged, it should not be required prior to vaccination as this may cause unnecessary barriers to access. We support additional data collection and research to continue to inform recommendations for these populations,” it noted.

The Academy believes that as vaccination becomes available that both preventing the spread of existing COVID-19 infections and widespread vaccination are essential to control the pandemic and save lives.

The AMS said the Lagos State Government has rolled out regulatory protocols to put the current second wave of pandemic in check and the United Kingdom has report a more virulent new wave of COVID-19 that spreads rapidly.

The Academy said ongoing public health measures such as distancing, masking, hand hygiene, and appropriate personal protective equipment for healthcare personnel are critical in minimising spread of existing COVID-19 infection and protecting healthcare providers around the globe. “Vaccination is the key to prevention of new infections,” it said.

The Academy further explained: “Following the approval of the Pfizer vaccine for use by the UK Government, on December 11, 2020, the U.S. Food and Drug Administration (FDA) authorized the Pfizer/BioNTech COVID-19 vaccine for emergency use in the United States. On December 12, 2020, the Advisory Committee on Immunization Practices (ACIP) approved the recommendation to use this vaccine in the indicated population under FDA’s Emergency Use Authorization. The Moderna vaccine has also been approved for emergency use in the US. Russia and China also have their own vaccine as there are many candidate vaccines being developed all over the world.

“On December 16th the Lagos State Government issued a release that concerts, carnivals and street parties are banned in Lagos State until further notice. Also all places of worship to have no more than 50 percent of their capacity…”

The Academy endorsed the Lagos State guidelines and recommended that similar guidelines be observed nationwide.

AMS therefore highlighted below the safety measures it cannot over emphasise:
1. Wear a mask (and a face-shield) when physical distancing is not possible. Masks can help prevent the spread of the virus from the person wearing the mask to others. Face-shields can help protect the eyes from aerosols or droplets of infected people but are not a replacement for masks. Masks alone do not protect against COVID-19 and should be combined where possible with face-shields, physical distancing and hand hygiene.
2. Clean your hands often. Use soap and water, or an alcohol-based hand rub.
3. Maintain a safe distance from anyone who is coughing or sneezing.
4. Do not touch your eyes, nose or mouth.
5. Cover your nose and mouth with your bent elbow or a tissue when you cough or sneeze.
6. Stay home if you feel unwell.
7. If you have a fever, cough and difficulty breathing, seek medical attention.
8. Calling in advance allows your healthcare provider to quickly direct you to the right health facility. This protects you and prevents the spread of viruses and other infections.
9. Follow the advice provided by your local health authority.
10. Test and self isolate if positive
11. We now have a second wave. Take good care of yourself and keep safe.
12. We recommend the use of multivitamins and supplements to boost immunity.

The AMS said in addition to the above for Nigeria in particular pending the arrival of vaccines it encourages the use of treatment protocols to have been found to reduce the mortality and morbidity of the disease. “They include the use of anti-inflammatory drugs, such as steroids e.g. dexamethasone, non-steroidal anti-inflammatory drugs example Colchicine, and the experimental drugs like ivermectin. These treatments are inexpensive and they are well suited for our environment where cost is a major issue,” it noted.