Opening up alongside B.1.617.2 — the so-called “India” variant

The day has finally arrived, May 17th, when we are finally allowed to hug and dine indoors and all sorts of other activities that have been off the menu for months on end. It’s the day we’ve all been waiting for — but you may have noticed a dark shadow hanging over us as we prepare to emerge from our long hibernation: a new, more transmissible variant — B.1.617.2 — has arrived on the scene. I thought I’d write a few words on what the implications of this might be.

First, let me get a little bugbear out of the way — I’m not going to call it the “India variant”. Yes, it first arose in India, who are having a terrible time of the pandemic at the moment. But this terrible time is not just due to B.1.617.2 — there are several variants co-circulating in India, including our very own highly transmissible B.1.1.7., which was home-grown by us in Kent and then helpfully exported all over the world. To my ears, calling B.1.617.2 “the India variant” is about as useful as Trump first calling Covid “the China virus”. Although I admit it’d be easier if these variants had slightly snappier names….

Second, let me quickly address another misconception: there’s been a lot of fearful talk about new variants “escaping” vaccines. There is very little evidence to suggest that B.1.617.2 will escape the vaccines we use in the UK. We very much think the vaccines will work against this variant. “In that case, why the worry?” I hear you ask. After all, our vaccination programme has been stonking along quite nicely, and millions of people have had at least one shot. Well, there are a few reasons for concern.

First of all, millions of people still remain unvaccinated. Included within these will be people who are vulnerable to severe illness, who have not been vaccinated either due to health conditions which preclude this, or because they just haven’t felt comfortable with the idea of being vaccinated (which, despite what some voices on Twitter might say, does not mean that they deserve to end up incredibly ill — vaccine hesitancy is complex and multi-factorial and nobody deserves to be harshly judged if they opt not to have the jab). Second, although the population who have so far not been vaccinated are younger and don’t have underlying identified vulnerabilities, that is not to say that getting Covid will necessarily be a walk in the park for them. We still don’t really understand Long Covid, for example, but we know that younger people can be susceptible. Third, no vaccine is 100% effective, so we can expect to see so-called “breakthrough infections” even in those who have had had both jabs. And lastly, many millions of us are only partially vaccinated. Some immunity is better than none, but it is also true that two jabs are definitely better than one. Taken together, it makes sense for us to keep infection levels as low as possible while we attempt to get a higher proportion of the population jabbed and double jabbed. Otherwise, Covid will find its vulnerable people; viruses always do.

Opening up and socializing is, of course, not going to help with keeping infection levels low. The virus circulates when people circulate; it transmits when it’s given the opportunity to do so. Covid loooooooooooves a bit of indoor socializing, it’s its dream come true. So, is lifting restrictions going to be a problem? The truth is, it’s hard to say. Scientists are by now pretty confident that B.1.617.2 is more transmissible than our old friend B.1.1.7., but there just aren’t enough data out there at the moment to know definitively just how much more transmissible it is; however, there is some evidence to suggest it could be up to 50% more transmissible. Modellers at Warwick have been hard at work trying to predict what effect loosening restrictions could have in differing scenarios of transmissibility, and have concluded that if B.1.617.2 is up there in the “30–40% more transmissible” stakes, then we realistically could see more people being admitted to hospital than we saw in the first wave. Then again, if it proves to be much lower than these figures, we’ll probably be OK. However, somewhere in between could mean that we can keep on top of Covid patients, but the NHS will have to pause its work to deal with the backlog of other health conditions that were put off being dealt with so that it can again pivot towards coping with Covid. Any one of these scenarios could happen — but there just aren’t enough data at the moment to pinpoint the transmissibility figure, so we don’t know exactly what we’re headed for.

Cause for concern, certainly. But before you start singing “It’s beginning to look a lot like Christmas” — remember, we’re in a far better situation than we were in December when B.1.1.7. raised its head and cancelled our festive plans. Millions more people have been vaccinated. We are starting from much lower prevalence levels. It’s spring, not respiratory viruses season. The entire population can access rapid Lateral Flow Device (LFD) tests for free to store in the their bathroom cabinet. So here is my advice on what we can do to prevent things going belly-up again while we learn more about this variant:

(1) If you’re unvaccinated or only partially vaccinated (i.e. just one jab, or <2 weeks after your 2nd jab), stick to outdoor socializing wherever you can for now. Beer gardens rather than indoors if possible. Preferably in smaller groups.

(2) Order some LFD tests to have at home. LFDs are a useful tool if (a) you are planning on going out socializing indoors, or with a large group of people, and (b) if you’re feeling under the weather, but don’t have any of the classic triad of fever/cough/loss of sense of smell or taste which would entitle you to a PCR test. In truth, many mild cases of Covid don’t have those symptoms at all — headache, tiredness, muscle aches, sore throat, diarrhoea, runny nose, can all be signs of infection. LFDs can be stored in your bathroom cabinet, done in the comfort of your own kitchen, and results are available in 30 minutes! Note: they a red-light test rather than a green-light test, i.e. you can potentially test negative even if you’re incubating Covid; however, if it tests positive you’ll know for sure you are likely infected (and should get a PCR test to confirm).

(3) If you’re going to spend time indoors with other partially vaccinated/unvaccinated people, make sure the room is as well ventilated as possible. This is probably the single best thing that you can do to prevent infection. Open the windows, throw wide the doors, get that fresh air circulating. Don’t be afraid to ask the pub owner to do so.

(4) Download the NHS COVID-19 app and be sure to check in to any venues you go to. This will mean it’ll be easier for Test & Trace to find you if you’ve been potentially exposed to a positive case, so they can interrupt chains of transmission.

(5) Get a PCR test if you have fever/cough/loss of sense of smell or taste, and isolate yourself.

(6) Keep up the hand hygiene, and masking/social distancing where feasible. Sitting very close to somebody for a long period of time is more risky than giving them a hug hello or goodbye.

(7) Last but not least — GET VACCINATED. Your absolute best defence against Covid is vaccine-induced immunity. When you reach the point that you’re two weeks after your second jab, you can really start to relax about all of the above and begin to live your life with the pandemic behind you. And how fantastic that will feel?!

Some references for further reading:
SAGE minutes 13 May 2021; PHE technical briefing; Warwick modelling paper

I’m an infectious disease epidemiologist with special interest in zoonoses, new & emerging infectious, One Health, and interdisciplinary public health research