Q&A: COVID Variants Pose a Deadly Threat

Willpower. That’s what’s missing, says Kevin Kavanagh, MD, a member of Infection Control Today®’s Editorial Advisory Board. “We have the technology to do it,” Kavanagh tells ICT®. “We just don’t have the willpower. I mean, we know how it spreads, we know how to kill it, we should be able to stop it cold in its tracks.” And because of that lack of willpower among the public, there’s a real danger that the variants of coronavirus disease 2019 (COVID-19) that have cropped up will stop being variants and become commonplace, warns Kavanagh. More alarmingly, there’s evidence that children may be more vulnerable to at least one of the variants. “There is a very high concern that they may affect children more than the previous version,” he says. “That doesn’t mean that children are going to be affected more than adults. But that this version or these variants may be able to affect children more.” He believes that if the United States had locked down completely in the beginning of the pandemic, the country would be well on its way to being normal in the pre-COVID sense. But now? “We may not ever get out of this because, again, this virus is not only endemic in the human population, but it’s also in animals. And if we keep spreading this virus around, it’s going to slowly devastate both our population and our economy.”

Infection Control Today®:So, the COVID-19 variants: Exactly how much of a danger do they pose in your opinion?

Kevin Kavanagh, MD:Well, I think they pose a significant danger. They’re very problematic. There’s initial data that shows that they have increased infectivity. And also, they may also have increase in fatalities, especially the UK variant, which we have the most data on. But what’s very distressing about the South African and the Brazilian variants is that they’ve mutated enough that it appears that they can evade our monoclonal antibody therapeutics. And they may be moderately resistant to the vaccines. And so, at this point, Moderna is even trying to change their formulation of their vaccine or modify it. So that will have a booster out for some of these more obscure variants. And when I say obscure, that means they’re obscure right now. If we continue to spread the variants, they will become commonplace. Already, we have one area of our nation that up in Minnesota that has had an infection from the from the Brazilian variant. And this is very

Kevin Kavanagh, MD

worrisome because, as I said, these variants can possibly avoid vaccines. But remember, our natural immunity, our testing, our vaccines, monoclonal antibody therapies, are all based on the same scientific underlying fact. That is the spike protein is the virus’s underbelly. That’s what it needs to be is very lethal and very infectious. And that’s also what the vaccines need to attack. And if that changes, then it affects everything. And with the Brazilian variant, there appears to be enough of a change that reinfections may be occurring. There’s one city in Brazil in the Amazon area called Manaus. I’m sure I mispronounced that. But in that city, they had an initial infection of COVID-19. They had 76% of the population, by some estimates, becoming immune. They felt they had reached herd immunity, and the infections waned. Now with this new Brazilian variant, the infections are just raging and they’re undergoing a wave now, which is far worse than the first wave. Overrunning their hospitals and they’re running out of oxygen, and just really horrific stories coming out of that region. And so, this variant is extremely worrisome, and this underscores the fact why we need to be wearing masks. If you notice the White House has upped their advisement, to wearing if possible surgical masks and they’re even going to be wearing N95 masks. And the national Defense Production Act is going into effect, whereby there’ll be cranking up N95 mask production. And I would suggest that the public starts wearing those, especially if you’re going to be in an area that you’re going to have high contact with other people. Because these variants are much more infectious.

ICT®:You’ve been on this broadcast a number of times and I think you said once that with modern technology you can basically print out a new vaccine that would be adjusted to the variance. Am I paraphrasing you correctly?

Kavanagh:Yes, and it’s definitely the case. And that is absolutely the big plus on the type of technology we’re using. It’s a huge statement to our technological ability. The problem comes in re-vaccinating everybody or giving everybody a booster. Look at the problem we’re having now. So manufacturing, distribution, re-vaccinations, and making sure that getting a booster which would be your third shot, doesn’t give you very serious side effects. All of that needs to get done. It’s not as simple as just coming up with the vaccine. You then have to re-vaccinate the world. And if we keep having these variants coming about every six months, because we’re spreading this virus like wildfire, it’s going to be very problematic. Now, you had mentioned once about close-downs in the introduction, and I’d like to address that. I think in some aspects that’s a false narrative. Because every area of our country now is under different rules. Some have more closures than others, but no one is under a hard lockdown. In Kentucky, we haven’t been that way since earlier in the year. The same thing in Arizona. But yet businesses are absolutely devastated. I do not think that you’re going to have a resurgence of the economy, regardless of what the mandates are, until this virus is under control. And the question is, is if early on if we would have had a hard lockdown for a few weeks, similar to what they did in Australia, our economy now probably would be much, much more robust. And we’d be going about our lives in a near normal state. This concentration on what the feds do or what the state does, that’s really a false narrative. It’s what the virus does. If you have deaths as high as we’re having now, of commonly now over 3000 deaths a day, sometimes over 4000 deaths a day, with a more infectious variant, you’re not going to have people going to small stores. They’re going to continue to order online, continue to get delivery, continue to get pick-up at restaurants. And granted, the restaurant industry’s been devastated. But other restaurants have adapted. There was one article in our paper that last year we had 40 restaurants close in Lexington, Kentucky. But there was another 40 that opened. Same quality? Same type? Probably not. But nevertheless, there’s still a market there. You have to adapt. The idea of putting your head in the sand and hoping that this virus goes away just isn’t a good idea. It’s not going to happen. We’re going to be dealing with variants of this virus, getting boosters, getting yearly shots, probably now for many, many years to come. We may not ever get out of this because again, this virus is not only endemic in the human population, but it’s also in animals. And if we keep spreading this virus around, it’s going to slowly devastate both our population and our economy. So, if people are worried about a paycheck, I mean, if you opened up everything to the way that it was people still wouldn’t be complying, because the vast majority of people now are going to be following public health advice. And unless it’s safe for people to enter into a business, they’re not going to readily do that. And a business is going to suffer economically. And I think that needs to be underscored. I don’t see any difference in the economy and states that have laxed rules versus states that have severe rules. The thing that is different though, is in states like Arizona, they’re absolutely getting eaten up by this virus with a tremendous amount of deaths and cases.

ICT®:I looked up the number of people who died in America in the 1918 flu epidemic, and it was 675,000. Now we’re up to 425,000 with COVID-19. And that’s with taking a totally modern approach to medicine and to prevention. And yet, we still have 425,000 deaths. What does that say?

Kavanagh:Well, it says to me that in the last year, maybe we should have had a hard lockdown that everybody went along with and then had everybody start wearing surgical masks. And to de-politicize this. It was known early on that this virus was probably aerosolizing, was very infectious, that you had to wear masks, that you needed to look at airflow and air sanitization. I’ve talked about that for months on this network and in various publications. And this advice has largely gone unheard and unheeded by a number of our population and leaders. Even now you have coronavirus deniers. Our science is only good if we take advantage of it. If we don’t do that, we’re going to suffer like we did back in the 1800s. Now, of course, our population has tripled since then. And that’s a sign that, well, maybe we’re doing a little bit better. But we’re only halfway through this pandemic. The 1918 flu stats are for two years. So far, we’re one year into this. And the 1918 flu stats, a lot of those were based on expected deaths. They didn’t have the reported cases like we now have. Back then they didn’t even know what a virus was. They thought it was caused by a bacterial infection. That’s how Haemophilus influenza got its name. They thought that was a causative organism. But it wasn’t. It was a secondary infection. Of course, nowadays, you’d have a lot of people saying, Well, if 90% of the people died of 1918 flu actually had bacterial infections in their lungs, we don’t count those as those deaths. You know, it just goes on and on. But if you look at excess deaths, I think by the time we’re out of this pandemic, we're going to be very similar to the 1918 flu, unless everybody embraces the vaccine and gets vaccinated and starts to slow down transmission, then we can snuff it out. We have the technology to do it. We just don’t have the willpower. I mean, we know how it spreads, we know how to kill it, we should be able to stop it cold in its tracks. It’s just people worried about themselves, rather than worrying about the community. And I know it’s very hard to lose a business or a practice. Over a decade ago, I was a surgeon. I had severe arthritis. I could still operate but it was risky for my patients. I had to quit. And at the time I quit, I had no guarantee of any financial security. That took six months before that started to come in. And I was able to adapt. I know what it’s like. But you have to make sure that your patrons are safe. And that’s the responsibility of every business holder there is.

ICT®:As you often do, you sent me an email with some information before our talk. And one of the things I found most alarming in what you emailed me—and probably a lot of people find it alarming—is that children seem to be getting more infected by COVID-19. Or at least they seem to be more vulnerable to it. Am I paraphrasing correctly?

Kavanagh:Well, that’s these variants. There is a very high concern that they may affect children more than the previous version. That doesn’t mean that children are going to be affected more than adults. But that this version or these variants may be able to affect children more. And that’s concerning, because when you change that spike protein, you change the way it attaches to the cells a little bit. Maybe you’ll get differences in that. Now, it is questionable, because you started to see this spike in this in the UK at the time when the variant was changing, and they were getting a new variant, but they were also opening schools at that time. So, it may be because they were opening schools. But it’s going to have to be something that we closely watch and follow with caution. And I think that when you open schools, there’s been encouraging reports. And of course, you will hear people saying, well, schools are the safest place in the world. They’re safer than out in the community. Well, but being out in the community isn’t very safe. They’re not the safest place in the world, that’s in your home. And when they opened up schools, they did it following public health advice. Everybody wore masks, they social distanced. You want to make sure you pay attention to proper ventilation, air sanitation, have enough complete air exchanges. They did small class sizes and bubbling. Class sizes around 12. And that very much fits with a hybrid schedule. And I hate to say this, but sports took a backseat to the education of our students. Sports are important. But contact sports, especially indoors, are very problematic to spreading the virus. We need to get our children educated safely. And so, I would really advise against indoor contact sports in schools. If you can’t wear a mask, it’s probably a sport that you shouldn’t be doing at this point.

ICT®:Basically, your message to infection preventionists has been that their main job should be educating the public. Is there anything else they should be doing? They’re in the hospital. How can they spread the message further?

Kavanagh:Well, definitely. But they also have to spread the message in the hospitals that with this new variant, it spreads more easily. And they really haven’t outlined how it spreads more easily. They don’t really know. It may be that it aerosolizes more. It may be that it lives longer in the environment. And so, they really need to make sure that they are pushing for N95 masks. Some people are wearing two masks. Wear goggles. And they have to articulate this also to the patients. Make sure that the patients are coming into the facility with masks, whenever possible. Do not have a waiting room. Have a patient being called in from the outside. If you have to have a waiting room, keep patients far apart. The six feet was for droplet precautions. It was not for aerosolization of the virus. And don’t put a chair within six feet of a doorway or a walkway where people are commonly walking. That defeats the purpose. You want to really look at minimizing visitors. All of this needs to be done. They need to heighten the precautions they’re doing because this virus is much more infectious. And that is the main message and they also need to be articulating this on social media, to their friends, and to society in general.

This interview has been edited for clarity and length.