There are issues with the COVID virus and its mutations that are important if you have comorbidities and you can't get the information from headlines. As you re-engage with society a little information can help you decide what you will do.
We have all seen these picture of the coronavirus with all the spikes sticking out of the surface. The virus is really a remarkable construction. We all know that the molecules of life can change or mutate which can alter the way the various elements can react to their environment. The spikes of the corona virus are its key to infection. If one of them connects with an appropriate cell in a host it can attach and infect that cell. An important fact is that conceptually, all of those spikes could be different. In practice they are not but each could harbor a mutation and in the case with COVID we are seeing mutations that make it even more infectious. A short summary of what we know. Keep in mind that things are changing fast.
As of January 31st there were 2021 known mutations of which four have been shown to be of concern because they either make the virus more infective or allow it to be less sensitive to the current vaccines. They all start from the Wuhan strain and we know them by where they were first identified.
B.1.1.7 United kingdom
B.1.1.351 South African
B.1.1.28 Brazilian
B.1.1.248 Manaus
There are at least 10 mutations in these various strains that have biological importance. The South African and Brazilian have more variants that the UK strain which has so far been the dominant variant in most of the world. It is estimated that the strains that have the additional mutations are up to twice as infective as the original Wuhan strain. Some variants have been shown to reduce the effectiveness of the current vaccines, though none are known to totally evade them.
The variants work by increasing how easily a spike connects to the ACE2 receptor or by making it easier for the virus to penetrate the cell wall and actually invade the cell. The extreme efficiency of infection of the variants is shown by the fact that by January the UK strain had already been identified in 40 countries. The Brazilian strain has already been identified in Guatemala, El Salvador, Belize, and Mexico and is assumed to be in the US. The most concerning sub version of the UK variant contains an unprecedented 14 substitutions of amino acids which illustrates the risk that some newly dangerous version might arise.
Lets look first at those spike proteins. Calling them spikes makes a headline that editors like but they are really more like deformed little mushrooms. They may look like modest structures but they are actually complex chains of molecules that fold up and create what are really small bundles of active chemicals which have the ability to defeat the defenses of our cells.
So why am I bothering to tell you all this? The virus can only mutate if it is infecting a cell. No host, no replication, no disease, no problem. We have a vast pool of infection right now and the vaccines are our best shot at containing this. So my first concern is when I hear of people who don't think they will get the shot. While it is true that they might not become ill or die they might be the person who breeds the next lethal version. I'd prefer they not take that risk.
More importantly, for people with significant comorbidity it is vital to understand the math. Assume the vaccine is 95% effective. That is great, but who are that other 5%? None of these are perfect and there will be people who are vaccinated who are unlucky and still get infected. If you have a serious risk you should keep that in mind as we rebuild our social interactions.
Remember this study which showed the odds ratio of infection, before the new strains came along, with NASH at 14 times that of a healthy person. That relative risk didn't change just because we have a vaccine. Our situation is vastly better with the vaccine but it isn't a get out of jail free card for people with elevated risk.
Our best to you and yours and may the vax be with you.
