Viewpoint: South African Variant Could Spur a New U.S. Surge

I must admit, I was somewhat taken aback watching yesterday’s spat between Anthony Fauci, MD, and Senator Rand Paul. As predicted, it drew abundant media attention, and the news coverage could cover nothing other than the wearing of masks. But overlooked in the exchange was information of profound importance. Fauci stated: “In the South African study conducted by J&J they found that people who were infected with wild type were exposed to the variant in South Africa the 351. It was as if they had never been infected before. They had no protection.”

Which means if you had COVID-19 and do not obtain the vaccine and become infected with the South African variant you may well develop severe COVID-19. About 40% of these cases are in South Carolina and it has been reported it has approximately 2 to 3 times the transmission. The avoidance of natural immunity is largely driven by the E484K escape mutation. The same mutation is found in the variant in Brazil but more disturbingly it is found in the New York variant.

Kevin Kavanagh, MD

The New York variant also contains a mutation which helps the virus bind more efficiently to cells along with another mutation which helps it escape immunity. All-in-all, this is a very worrisome virus, and it is fast becoming the dominant strain in New York. The strain is causing more severe illnesses and as of last week it accounted for 39% of infections in New York City.

The California variant which overran the that state, has the L452R mutation. This strain is 19% to 24% more transmissible and is more lethal, infecting the lungs 40% more often.

Both the California and New York variants appear to be able to evade at least some of the monoclonal antibody therapies. The Food and Drug Administration has stopped shipment of the Eli Lily monoclonal antibody product (bamlanivimab) to California, Nevada and Arizona.

If one does the math, if a third of our population is vaccinated, which means they may be protected from severe illness but can become infected and spread the virus, it places those not vaccinated at grave risk. If these variants are more infectious and deadlier than last year’s, D614G, then we may be headed for another major surge. Those offering reassurance based on the upcoming warm weather have forgotten last year’s lessons and the major summer surges. The best advice is to get vaccinated and follow strict public health advice.