The pandemic wars — vaccines vs. variants

Viruses mutate all the time, especially single stranded RNA viruses like influenza.

John Barry, renowned historian and author of the international bestseller, “The Great Influenza: The Epic Story of the Deadliest Plague in History,” told me in a recent interview that the infamous “second wave” of the 1918 Spanish Flu was likely due to a variant. This second wave was far worse than the first wave and, overall, the Spanish Flu killed over 50 million people worldwide at a time when the world had 1.9 billion people. 

The current coronavirus pandemic has killed 2.5 million people, a much smaller number at a time when the world population is four times what it was in 1918. There are other significant differences. For one thing, the death rate of COVID-19 is much lower, approximately 0.4 percent (or lower) compared to 2.5 percent for the Spanish Flu. For another, we have a highly effective safe vaccine, whereas, according to Barry, back in 1918 not only was there no effective vaccine but people didn’t even know what a virus was and many mistook the flu for a bacteria. 

Perhaps the greatest difference between the two ferocious pandemics is that influenza, without the proofreading mechanism of a coronavirus, mutates much more frequently and spins off new strains more easily which are sometimes far more virulent, as occurred in 1918. Still, variants are a concern now too — both escape variants that may occur from the vaccine as well as native variants that occur simply because there is so much of the virus still around. Though most variants ultimately don’t threaten us or change the course of the illness, some do. Perhaps no variant is more concerning than the so-called Brazilian P.1 variant, which has caused a resurgence of cases and hospitalizations in Brazil despite a high seropositivity rate from previous outbreaks. Reinfection is clearly a problem. 

One important caveat is that the number of people vaccinated in Brazil remains quite low — less than 300,000 people. This slow rollout has left the door open for this new dangerous variant to emerge and pre-dominate. In fact laboratory studies show that the Pfizer vaccine is effective against the Brazilian variant as well as all the other prominent variants including both the UK and the South African variant. 

It may not be too late to shut down travel to and from South Africa and Brazil in order to slow the spread of these variants here while we vaccinate as much of our population as possible, though it is already too late to slow the spread of the UK variant.

In the real world laboratory, the UK’s B.1.1.7 variant has exploded in Florida, now responsible for over 50 percent of the cases. But largely because the vaccine covers the variant, a majority of those over 65 have now been vaccinated and there is already a substantial amount of natural immunity presenting a barrier to spread, the numbers of cases, hospitalizations and deaths continue to drop. 

Variants will continue to emerge and those that are more easily transmissible will continue to have a survival advantage. Continued mask wearing and distancing and limiting gatherings in areas of high spread can help to slow the virus to buy us time until the vast tracts of the population are vaccinated. But lockdowns are ineffective. State by state comparisons between stay-at-home California and open Florida, or lockdown Rhode Island versus wide open South Dakota, states of similar population and similar numbers of COVID-19 cases and deaths, reveal that lockdowns don’t add anything except hardship and suffering. 

It is a race against time, vaccine against variants and these highly effective safe vaccines will win if a large majority of the world takes them. Any variants that are truly resistant to the vaccine can be overcome by a retooling of the vaccines, which can be accomplished in a matter of weeks both with the MRNA vaccines (Pfizer and Moderna) as well as the adenovirus vector vaccines (Johnson and Johnson).

The COVID-19 pandemic will never reach the magnitude of the 1918 Spanish Flu, not because we are smarter or more compliant now than they were back then, but simply because science has provided us with an incredible weapon against the virus that they didn’t have. This weapon has joined with a weapon as old as the hills, the natural immunity you gain from having experienced and overcome a disease, to slow the virus down. 

Marc Siegel, M.D., is a professor of medicine and medical director of “Doctor Radio” at NYU Langone Health. He is a Fox News medical correspondent and author of the new book, “COVID: the Politics of Fear and the Power of Science.”