For the last two weeks, the number of new cases of COVID-19 in the United States has been trending down. Which is good news … relatively. It’s only relatively good news, because the number of cases of COVID-19 in the United States remains staggeringly high. To get a sense of just how bad it’s been for how long, consider this: the daily case count first exceeded 100,000 cases in a day on November 4. It has not been below 100,000 cases on any day, not even a weekend, not even Christmas, since then. No other nation on the planet, no matter how large, has ever passed the 100,000 cases line.
Still, the daily count of new cases has fallen steeply in recent days. That change can be directly connected to what usually arrests rising case counts—implementation of new restrictions, often at the county/city level, for those areas experiencing an extraordinarily high level of COVID-19. That’s good. Deaths, as always, are lagging behind new case reporting. The best that can be said at the moment is that deaths have plateaued. And they have plateaued at a level that’s considerably worse than a 9/11 per day. So long as states and localities don’t react to the case count dropping to a level that is, by any rational measure, still extraordinarily terrible, and relax restrictions, it’s possible that the United States may actually press cases below 100,000 per day in the next two weeks.
We need that. Because on Monday the Minnesota Department of Health announced the first case of the Brazil P.1 variant in the United States. And there are reasons to be very concerned.
First the good news. The person who was detected with the P.1 variant in Minnesota had recently returned from Brazil. That means that this is essentially a primary case from the source. That’s much better than if this person had only been in contact with someone recently back from Brazil, and miles better than if it had been someone who had no idea how they had acquired this variant.
Still, this is a sobering reminder that the P.1 variant is coming. Not only did the spread of the original coronavirus remind the world of just how ineffective travel bans usually are when trying to restrict the flow of a virus, the situation is made much worse now because the symptoms of the SARS-CoV-2 P.1 variant are essentially the same as those of every other variant. To steal a little Kansas … it’s just a drop of water in an endless sea. Only genetic screening is likely to pick it out, and that screening is woefully inadequate. That’s especially true in (say it with me now) the United States, which has lagged behind other developed nations in instituting a system to regularly sample and sequence coronavirus.
Restrictions on travel to South America may slow the spread of the P.1 variant, but right now there are people who have traveled from Brazil, or have just met with someone who traveled from Brazil, who are carrying this variant. When the novel coronavirus first hit the United States, we made the huge mistake of not realizing that it was circulating widely in the population until patients began clogging ICUs. We shouldn’t make that mistake again: assume the P.1 variant is here. Assume it’s circulating “in the wild.”
Now, why is that a concern? Like recent variants in the U.K. and South Africa, the P.1 variant is thought to be more contagious than the original version of the virus in Wuhan, or the version that swept through Europe last spring and has largely dominated cases in the United States. While the U.K. government recently indicated that the variant first found there may in fact be more deadly than previous versions, there’s no direct evidence that this is the case for P.1.
What then makes it so scary? On a genetic basis, the P.1 has a cluster of changes. It shares one change to the spike protein in common with the South African variant, which is thought to make it less sensitive to vaccines (though Moderna recently indicated that their information suggests their vaccine is effective against both the U.K. and South African variants). P.1 also has other changes to the spike protein whose effects are not well understood.
The biggest cause of concern is how this variant has behaved in the small Brazilian city of Manaus. That city had already been on of the hardest hit in a nation where their own Trump-a-like, Jair Bolsonaro, has deliberately ignored the threat from the disease, spread disinformation, and flouted expert advice on social distancing. Brazil has the highest rate of COVID-19 deaths anywhere in the world except for (say it with me) the United States.
As a result of these poor policies, Manaus had seen its healthcare system come near collapse repeatedly over the summer and fall, and the level of infection there was thought to be extraordinarily high—over 75%. If there was anywhere on the planet that was testing the idea of “herd immunity,” it should have been Manaus.
Then the P.1 variant arrived and devastated the city all over again. The strain on the system was so great that a black market emerged in oxygen.
At least some of these cases of people infected by the P.1 variant are of people who were previously infected by some earlier version of the SARS-CoV-2 virus. The sheer viciousness of the outbreak in Manaus, and the prospect of reinfection, has raised the specter that the P.1 variant might have a particularly awful set of changes that renders it essentially a new disease—a potential pandemic within the pandemic.
Right now, we don’t know that to be the case. There have been a few documented cases of reinfection, but then, there had already been documented cases of reinfection going right back to Wuhan province. In addition, there’s another big difference between the pandemic now and the pandemic six months ago … six months. Those people with mild cases, or who for some other reason never developed a strong immune response during an initial case, might be much more prone to catching COVID-19 again at this point than they were in the 3-4 month period after their initial infection.
The way P.1 has swept through Manaus and come to dominate other variants in the region is frightening. It suggests a virus that’s more infectious. It may also be both more virulent and more capable of infecting people who had previously had COVID-19. That may not be the case.
But we had better act as if it is.