By Yoshitha Perera
The Covid-19 virus has already mutated into different variants and experts say we can expect more. The Department of Immunology and Molecular Science of the Sri Jayewardenepura University is currently conducting extensive research and carefully monitoring some other new genetic types of the pandemic virus that may be able to spread easier or overpower vaccines. Understanding new variants of the Covid-19 virus could help the Government regulate future vaccination programmes and keep the spreading of the virus under control.
In an interview with The Sunday Morning, Sri Jayewardenepura University Department of Immunology and Molecular Science Head Prof. Neelika Malavige shared some important views on Covid-19 in Sri Lanka, different variants, and the mutation of the new variant. She also highlighted certain important health precautions and potential to curb the spreading of the virus.
Following are excerpts of the interview:
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"No vaccine protects you the day after you get it. Some vaccines provide some protection about 21 days after getting the first dose. But some vaccines only give protection from 14 days after the second dose. So, we can’t expect immediate protection soon after getting a vaccine" Prof. Neelika Malavige [/caption]
What are the Covid-19 variants found in the country so far?
There are hundreds of variants of the SARS-CoV-2 virus that causes Covid-19. The majority of these variants are of no significance. Only a few are more dangerous because of increased transmissibility, increased disease severity, or causing infection of those who have got the vaccine or who have had a natural infection.
The World Health Organisation (WHO) has named four variants of concern – B.1.1.7 (UK variant), B.1.351 (South African variant), P.1 (Brazilian variant), and most recently the Indian variant (B.1.617.2).
In Sri Lanka, we are now seeing the B.1.1.7 in the community, and it is this variant that is responsible for the ongoing large outbreak. The Indian variant has not been detected in the community so far.
How fast has the virus mutated? How differently do these various strains behave?
The SARS-CoV-2 virus mutates very slowly, but as all viruses, it does mutate. When the transmission is high, the mutation rate is also higher. Most of the mutations are unfavourable for the virus. But sometimes, the viruses acquire mutations that help the particular virus transmit faster or re-infect.
How many more such mutations can be expected?
The higher transmission of the virus can help the virus to mutate fast. So, it actually depends on human activities as well. We should reduce virus transmission by vaccination and also by limiting its spread by changing our behaviours. The virus will of course mutate, as it is a common thing to all viruses and it is not something unique.
What is the best precaution we can take?
Right now, it is to reduce the virus spread. Vaccination is the best option in the long run, but it takes a long time to immunise a sufficient proportion of the population (80% at least). Also, no vaccine protects you the day after you get it. Some vaccines provide some protection about 21 days after getting the first dose. But some vaccines only give protection from 14 days after the second dose. So, we can’t expect immediate protection soon after getting a vaccine.
How important is vaccination, especially given the multiple strains that have been detected in the island?
Right now, most vaccines protect against the detected dangerous variants. The protection is less against the South African, Brazilian, and also possibly against the Indian variants. Although the protection is less, almost all vaccines do prevent severe disease with these variants. So, at present, it is a satisfactory thing.
How much have we developed our research capacity since last year and what more could be done?
Our genomic sequencing capacity and the facilities for the research that we are currently doing were established before the Covid-19 pandemic. If we didn’t have these technologies established, we would have been in a very difficult position right now without knowing what is going on here.
We actually do have very high-end state-of-the-art equipment to carry out cutting-edge research in our laboratory. We do have human resources as well. However, funding is lacking but it is understandable given the situation of the current pandemic.
What is your idea on the technology and expertise to locally manufacture vaccines? Does Sri Lanka have sufficient resources and the infrastructure to locally manufacture vaccines?
We do have the technology and expertise, but it’s the infrastructure that is lacking when it comes to manufacturing vaccines. I think now it’s too late to establish this infrastructure and then develop vaccines for Covid-19. That’ll take at least another two years.
But I think it’s important to develop these facilities, as it is clear to many scientists/infectious diseases specialists/immunologists in the world, that Covid-19 is not the last pandemic we will be seeing in our lifetime.
The changes that are happening due to climate change, intense travel between countries, people going to very remote areas in the world, and the clearing of forests and thereby encroaching on the habitat of other animals, have created the ideal environment for more viruses to emerge, causing more pandemics. So, we have to prepare for the future.
According to reports, an ultra-infectious new Covid-19 strain was detected in Sri Lanka and can remain airborne for up to 60 minutes. Is there any research being conducted on this?
This statement is terribly wrong, and I think what I said in a press conference has been misunderstood and misquoted. This new strain I was talking about is the UK variant, B.1.1.7 – it is new to Sri Lanka and as we can see, is causing havoc.
It is not airborne for 60 minutes. Emerging evidence has shown that the SARS-CoV-2 viruses causing Covid-19 can spread by airborne transmission. This was recently accepted by the WHO and the Centres for Disease Control and Prevention (CDC) (of the US).
However, this airborne transmission only happens in certain circumstances, such as in poorly ventilated, closed, overcrowded areas. In such environments, it has been shown that the virus may be airborne for several hours.
This is why such environments should be avoided and all doors and windows should be opened. Airborne transmission is highly unlikely to play any role in outdoor environments such as parks and beaches. It is important to wear masks indoors because of this reason.
Do you feel new health guidelines are necessary, given the present situation, or do the guidelines we have at present suffice?
The guidelines highlight the importance of social distancing, hand hygiene, wearing masks, avoiding gatherings, and staying away from others if you have respiratory symptoms. These are the important things to prevent infections. The principles haven’t changed.
How is the spread being monitored?
The spread is being monitored by carrying out PCRs or rapid antigen tests on those who are symptomatic and their contacts to identify infected individuals.
What is your idea on mixing and matching Covid-19 vaccines?
Mixing the AstraZeneca vaccine with the Pfizer vaccine is carried out in many countries, especially in younger people. Many European countries have advised younger people who took AstraZeneca as the first dose, to take an alternative vaccine as the second dose.
Scientifically, mixing certain vaccines should be alright. However, clinical trials are currently being carried out in other countries about mixing and matching vaccines, and the data will be available soon.
With the spreading of the new variant, is there any research on how to modulate the immune response to boost its protective action and decrease immune-mediated damage to organs, especially for those who cannot get the vaccine?
There are several drug trials going on to see if use of certain drugs can modulate the immune system to prevent severe Covid-19. One of the effective drugs is dexamethasone, which was found to be effective in those with pneumonia, but it had no benefit in people with mild illness.
There are other drugs (cytokine receptor blockers), which are also given to patients with severe Covid-19. Many other trials are ongoing to see if severe Covid-19 can be prevented altogether.
What is your idea on making priority lists to administer the vaccine in the current state?
The first aim I think is to reduce or prevent mortality. All vaccines have shown that whatever the variant, they do significantly (> 95%) prevent death. Therefore, it is important to give vaccines to those who are more likely to die from Covid-19 or develop severe disease, such as older individuals (> 60 years of age) and those with comorbidities (diabetes, kidney disease, cancers, etc.).
For vaccines to be effective in reducing transmission, at least 60% or more of the population have to be immunised. Immunising a small proportion of the population will not stop or reduce transmission. Therefore, if vaccines are limited, it’s important to use them to prevent or reduce deaths and severe disease.
"No vaccine protects you the day after you get it. Some vaccines provide some protection about 21 days after getting the first dose. But some vaccines only give protection from 14 days after the second dose. So, we can’t expect immediate protection soon after getting a vaccine" Prof. Neelika Malavige [/caption]
What are the Covid-19 variants found in the country so far?
There are hundreds of variants of the SARS-CoV-2 virus that causes Covid-19. The majority of these variants are of no significance. Only a few are more dangerous because of increased transmissibility, increased disease severity, or causing infection of those who have got the vaccine or who have had a natural infection.
The World Health Organisation (WHO) has named four variants of concern – B.1.1.7 (UK variant), B.1.351 (South African variant), P.1 (Brazilian variant), and most recently the Indian variant (B.1.617.2).
In Sri Lanka, we are now seeing the B.1.1.7 in the community, and it is this variant that is responsible for the ongoing large outbreak. The Indian variant has not been detected in the community so far.
How fast has the virus mutated? How differently do these various strains behave?
The SARS-CoV-2 virus mutates very slowly, but as all viruses, it does mutate. When the transmission is high, the mutation rate is also higher. Most of the mutations are unfavourable for the virus. But sometimes, the viruses acquire mutations that help the particular virus transmit faster or re-infect.
How many more such mutations can be expected?
The higher transmission of the virus can help the virus to mutate fast. So, it actually depends on human activities as well. We should reduce virus transmission by vaccination and also by limiting its spread by changing our behaviours. The virus will of course mutate, as it is a common thing to all viruses and it is not something unique.
What is the best precaution we can take?
Right now, it is to reduce the virus spread. Vaccination is the best option in the long run, but it takes a long time to immunise a sufficient proportion of the population (80% at least). Also, no vaccine protects you the day after you get it. Some vaccines provide some protection about 21 days after getting the first dose. But some vaccines only give protection from 14 days after the second dose. So, we can’t expect immediate protection soon after getting a vaccine.
How important is vaccination, especially given the multiple strains that have been detected in the island?
Right now, most vaccines protect against the detected dangerous variants. The protection is less against the South African, Brazilian, and also possibly against the Indian variants. Although the protection is less, almost all vaccines do prevent severe disease with these variants. So, at present, it is a satisfactory thing.
How much have we developed our research capacity since last year and what more could be done?
Our genomic sequencing capacity and the facilities for the research that we are currently doing were established before the Covid-19 pandemic. If we didn’t have these technologies established, we would have been in a very difficult position right now without knowing what is going on here.
We actually do have very high-end state-of-the-art equipment to carry out cutting-edge research in our laboratory. We do have human resources as well. However, funding is lacking but it is understandable given the situation of the current pandemic.
What is your idea on the technology and expertise to locally manufacture vaccines? Does Sri Lanka have sufficient resources and the infrastructure to locally manufacture vaccines?
We do have the technology and expertise, but it’s the infrastructure that is lacking when it comes to manufacturing vaccines. I think now it’s too late to establish this infrastructure and then develop vaccines for Covid-19. That’ll take at least another two years.
But I think it’s important to develop these facilities, as it is clear to many scientists/infectious diseases specialists/immunologists in the world, that Covid-19 is not the last pandemic we will be seeing in our lifetime.
The changes that are happening due to climate change, intense travel between countries, people going to very remote areas in the world, and the clearing of forests and thereby encroaching on the habitat of other animals, have created the ideal environment for more viruses to emerge, causing more pandemics. So, we have to prepare for the future.
According to reports, an ultra-infectious new Covid-19 strain was detected in Sri Lanka and can remain airborne for up to 60 minutes. Is there any research being conducted on this?
This statement is terribly wrong, and I think what I said in a press conference has been misunderstood and misquoted. This new strain I was talking about is the UK variant, B.1.1.7 – it is new to Sri Lanka and as we can see, is causing havoc.
It is not airborne for 60 minutes. Emerging evidence has shown that the SARS-CoV-2 viruses causing Covid-19 can spread by airborne transmission. This was recently accepted by the WHO and the Centres for Disease Control and Prevention (CDC) (of the US).
However, this airborne transmission only happens in certain circumstances, such as in poorly ventilated, closed, overcrowded areas. In such environments, it has been shown that the virus may be airborne for several hours.
This is why such environments should be avoided and all doors and windows should be opened. Airborne transmission is highly unlikely to play any role in outdoor environments such as parks and beaches. It is important to wear masks indoors because of this reason.
Do you feel new health guidelines are necessary, given the present situation, or do the guidelines we have at present suffice?
The guidelines highlight the importance of social distancing, hand hygiene, wearing masks, avoiding gatherings, and staying away from others if you have respiratory symptoms. These are the important things to prevent infections. The principles haven’t changed.
How is the spread being monitored?
The spread is being monitored by carrying out PCRs or rapid antigen tests on those who are symptomatic and their contacts to identify infected individuals.
What is your idea on mixing and matching Covid-19 vaccines?
Mixing the AstraZeneca vaccine with the Pfizer vaccine is carried out in many countries, especially in younger people. Many European countries have advised younger people who took AstraZeneca as the first dose, to take an alternative vaccine as the second dose.
Scientifically, mixing certain vaccines should be alright. However, clinical trials are currently being carried out in other countries about mixing and matching vaccines, and the data will be available soon.
With the spreading of the new variant, is there any research on how to modulate the immune response to boost its protective action and decrease immune-mediated damage to organs, especially for those who cannot get the vaccine?
There are several drug trials going on to see if use of certain drugs can modulate the immune system to prevent severe Covid-19. One of the effective drugs is dexamethasone, which was found to be effective in those with pneumonia, but it had no benefit in people with mild illness.
There are other drugs (cytokine receptor blockers), which are also given to patients with severe Covid-19. Many other trials are ongoing to see if severe Covid-19 can be prevented altogether.
What is your idea on making priority lists to administer the vaccine in the current state?
The first aim I think is to reduce or prevent mortality. All vaccines have shown that whatever the variant, they do significantly (> 95%) prevent death. Therefore, it is important to give vaccines to those who are more likely to die from Covid-19 or develop severe disease, such as older individuals (> 60 years of age) and those with comorbidities (diabetes, kidney disease, cancers, etc.).
For vaccines to be effective in reducing transmission, at least 60% or more of the population have to be immunised. Immunising a small proportion of the population will not stop or reduce transmission. Therefore, if vaccines are limited, it’s important to use them to prevent or reduce deaths and severe disease.