Dr. Roger Hicks: Vaccines versus the variants
The race is on. Can we get enough people vaccinated before more deadly variants emerge and make things worse? That is what doctors, epidemiologist and other medical experts across the country are asking. To answer this question, let’s review some basic facts.
The SARS-CoV-2 virus consists of a spherical shell made of proteins that protects a single strand of RNA, the genetic code of the COVID virus. RNA, or ribonucleic acid, is made of thousands of smaller molecules, called nucleotides, that are connected in a specific sequence. This sequence spells out the plans for making the virus’s 29 proteins. One of those is the spike protein, the part of the virus that attaches to our cells, enabling the virus to enter and multiply. Under a microscope, spike proteins on the virus look a bit like a crown; corona is Latin for crown, thus the name: coronavirus.
Vaccines stimulate our immune systems to make antibodies against the virus, so that if we are exposed, our defenses can quickly recognize it and respond to fight it off. The Pfizer and Moderna products are both mRNA vaccines, where “m” stand for messenger. The mRNA they contain is a fragment of the complete genetic code of the virus and gives our cells instructions on how to make a part of the SARS-CoV-2 spike protein. Messenger RNA is quickly digested by our cells and cannot affect our DNA, but our immune systems learn to recognize the spike protein as a foreign invader. Unlike a shot of gamma globulin, which temporarily gives us antibodies produced by someone else, vaccines allow our bodies to create our own immunity. They stimulate our immune systems to create antibodies to the virus and train our T-cells, a key type of white blood cell, to search for and destroy invaders.
Viruses hijack our cell machinery to make copies of themselves, creating billions of copies in an infected host. This can change, damage or kill the host cells, trigger the immune defenses- sometimes in excess- and make us sick. With so many copies being made, some aren’t perfect, and usually that doesn’t matter. But occasionally, one of the imperfections changes something in the virus that makes it harder for our immune system to recognize it as a foreign invader, or that makes it easier for the virus to invade our cells and replicate. Either of those situations give the imperfect copy – called a variant — an advantage. The more chance the virus has to multiply, the more chance there is for mutations to occur and variants to develop. That’s why the race is on around the world to vaccinate as many people as quickly as possible. The more people who are vaccinated, the fewer chances there are of the virus mutating.
Keeping track of the variants is challenging, partly because they have both a numeric scientific name and a common name signifying where they were first discovered. The ones getting the most attention are B.1.1.7, (the UK variant); B.1.351 (the South African variant); and P.1 (the Brazilian variant). Others have emerged in the US, including right here in California.
There is evidence that some variants can render certain vaccines less effective or rarely cause a second round of COVID in someone who was previously infected. In fact, we have one verified case of reinfection in Nevada County. Analysis of the viral RNA, called whole genome sequencing, showed the person’s second infection was caused by one of the California variants (B.1.427/B.1.429).
One of the advantages of the mRNA vaccines is that they are “plug and play” platforms. Both Pfizer and Moderna have said they could develop a booster shot against a variant in a matter of weeks by substituting a bit of the new mutant RNA for the original. The boosters would still need to be tested, manufactured, distributed and administered, but we are learning how to streamline all of those processes.
The pandemic will end, our schools and businesses reopen, and life will return to normal when enough of us have effective immunity to the virus. Some have suggested we get this community immunity – also called herd immunity- by just letting the virus run its course. That would come at a great price. Estimates show that there would be between 1 and 3 million deaths in the US alone. Many COVID-19 survivors would develop a wide variety of long-lasting symptoms. Many COVID-19 survivors are now called “long-haulers” – people who have had COVID and develop a wide variety of long-lasting symptoms such as chest pain, shortness of breath, cough, rapid heartbeat, abdominal pain, joint pains, and “brain fog”. Furthermore, current studies show that the immunity our bodies develop from any of the vaccines is more robust than immunity we acquire from being infected.
Nevada County now has one of the highest rates of new cases in the state. This is largely because a significant portion of our fellow citizens are ignoring the mask mandate and the advice to avoid gatherings with people not in one’s immediate household. Some say being told to wear a mask takes away their personal freedom. Yet our society has many laws and regulations intended to protect the common good. We have laws against driving while intoxicated because drunk drivers endanger not only themselves, but everyone else on the road near them. We have rules against smoking on airplanes and in restaurants because the smoke is harmful not only to the person with the cigarette, but to others who have to breathe it in. There are laws requiring us to wear seatbelts and drive on the right side of the road, yet no one claims these laws threaten individual freedom.
Wearing a mask in public demonstrates our concern for our fellow citizens and helps stop development of variants. It’s not that big a sacrifice, but it would make a huge impact on stopping the pandemic if everyone did it. Similarly, getting vaccinated not only protects you, it protects those around you.
I know everyone has pandemic fatigue and like me, is aching to get together once again with friends and family. You can do this safely when you and your family and friends are vaccinated. Until then, you know the drill: stay in place, keep your space, and cover your face.
Dr. Roger Hicks is the Medical Director for Yubadocs Urgent Care in Grass Valley and the founding president and current Director of the California Urgent Care Association.
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