Thread by @MonicaGandhi9

Let's talk B117 and why I don't think this variant is going to deter our progress. What are 3 things you worry about with a variant? 1) Increased transmissibility; 2) Increased virulence; 3) Can escape immunity from your vaccine (or natural infection). Let's take them 1 at a time

1) Increased transmissibility: There is lab data showing higher viral loads with this variant in nose so could be more infectious. However please look at epidemiology on world stage and in U.S. to make your decisions. UK tamped down virus with vaccines with 90% of their strains

being B117 and never saw their dreaded surge once vaccine roll-out started; 2) Israel started rolling out vaccine with 80% of strains being B117, saw surge as we are seeing in some states here (will get to that in min.) but then tamped down with vaccine
pfizer.com/news/press-rel…

3) And here in US, as I just tweeted, 5 US states have nearly 50% of cases (NY, MI, Fl, PA, NJ) but those states do not overlap cleanly with the states that have the highest prevalence of B117 or other variants of concern in the US (CA, CO, MN, MI, NH, FL)
abcnews.go.com/amp/Health/wir…

as shown to us by this CDC map (cdc.gov/coronavirus/20…). So, not that simple and each state's cases probably reflective of their natural immunity (high in CA, TX after 3rd surge; low in MI as not as large surges) + vaccination rate

Okay 2) Increased virulence: The cleanest way to look at this in US is to look at states with highest prevalence of B117 and see if "hospitalization per case" rate has gone up. Meaning, if virus is more virulent, more cases will end up being hospitalized. Will call this ratio H/c

Let's look at H/c ratio for some of our states with highest prevalence of variants per CDC (FL, MI, MN, CO) - we don't want to be here all night so won't even bother with CA with such low cases/hospitalizations; effect of variants here is pretty obvious (eg. nil). Ok, here goes

MN (again, your H/c should go up if variants more deadly as variants spread from 2/25/21-4/6/21)
4/6/21: H/c 4.5% (Last 7 Days Cases 11,209; Last 7 Day Hospitalizations, 505)
4/1/21: H/c 3.9% (cases 10,988; Last 7 Day Hospitalizations 430)
3/25/21 H/c 4.6% (cases 8579; H 390)

3/18/21 H/c 4.4% (cases 6949; H 304)
3/11/21 H/c 3.9% (cases 6579; H 257)
3/4/21 H/c 4.8% (cases 5589; H 269)
2/25/21 H/c 4.9% (cases 5546; H 273)
GET THE PICTURE? Hospitalizations/case not going up. Let's do few more states with high variant prevalence

MICHIGAN:
4/6/21 H/c 6.6% (cases 45192; H 3000)
4/1/21 H/c 6.0% (cases 39801; H 2379)
3/25/21 H/c 6.3% (cases 26,271; H 1653)
3/18/21 H/c 5.9% (cases 17,707; H 1039)
3/11/21 H/c 7.3% (cases 11810; H 859)
3/4/21 H/c 7.4% (cases 9492; H 706)
2/25/21 H/c 7.8% (cases 8,498; H 661)

Same true of FL (3,191 B117 cases sequenced) where hospitalization/case ratio has reduced from 8% on 2/25/21 to 6% this week. Same true of CO (894 B117 cases sequenced) where hospitalization/case ratio has decreased from 4% on 2/25/21 to 3% last week. Increased virulence not seen

3) And final concern- variants (B117) will evade our vaccines? Hope I addressed this yesterday (thread). So, here is a thread on why B117 or variants are not deterring progress with these amazing vaccines & should not signal lockdowns/school closures
threadreaderapp.com/thread/1379294…

@ThreadReader unroll

@threadreaderapp unroll

And to finish off this LONG thread - please read this article - "The course of the UK COVID 19 pandemic; no measurable impact of new variants". Variants had nothing to do with transmission or mortality. Phew, seems prudent for us to move on.
medrxiv.org/content/10.110…

One other concern I have seen raised about B117 is whether it is causing more severe disease in the US among children. Fortunately, no evidence of increased hospitalizations among children over time in areas with B117 (like Michigan) from data: healthdata.gov/Community/COVI…

And here is the hospitalization data from Pennsylvania and Florida also showing no evidence of increased virulence over time of the virus (as B117 prevalence increases) in children

And here is the data from Minnesota. So happy we have the ability (with publicly-available data) to test our concerns (e.g. B117 more virulent in children) and, thereby, relieve us of them. All of this data publicly available from HHS/ CDC, etc.

Good news. New papers today in Lancet journals showing B117 doesn't cause more severe disease. 1st in Lancet Public Health. Analysis covered 13 full weeks in England over the period when the proportion of B.1.1.7. grew most notably Sept 28-Dec 27, 2020
thelancet.com/journals/lanpu…

Traditional NPIs worked against B117. No statistically significant associations between proportion of B.1.1.7. within regions & the type/duration of symptoms people experienced, no more severity or hospitalizations. More transmissibility (Ro 1.35x with B117).

2nd paper here from Lancet ID between Nov 9 & Dec 20, 2020. Authors compared illness severity in people with and without B.1.1.7 & calculated viral load. No evidence of an association between the variant and increased disease severity (hospital, death.)
thelancet.com/journals/lanin…

But also found higher viral loads in nasal swabs with B117 than non-B117 indicating likely higher transmissibility. So not more virulent (doesn't cause more severe disease), more transmissible, traditional non-pharmaceutical interventions work, crushed in England by vaccines.