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COVID mutations, vaccines, chronic disease -- things you need to know

Infection rates and vaccine failures - some points to ponder

We have been seeing the headlines about the COVID tragedy in India as hospitals turn patients away and the nation runs out of oxygen as people are literally dying in line waiting to refill oxygen tanks. India faces a historic crisis and you probably imagine the densely packed cities and poverty are the cause. But wait, what about the REST OF THE STORY?

If you or someone you care about has a chronic disease, there are things about the story of India that will likely affect you in coming months. I've written about COVID variants before, click here for a review. The UK strain has become the dominant variant in the US and it has done that because it is about 50% more infectious than the Wuhan original. The University of British Columbia recently released an actual image of the UK variant spike protein which helps us understand that. The image is an amazing science story about how they could take this picture but a story for another time.


The blue part is the spike protein and it has attached to not one, but two ACE2 receptors. This is the mutation that made the B.1.1.7 UK variant so much more infectious. There are thousands of known mutations of the virus but most don't have any effect on us that we know of yet, but from time to time one does, such as the mutation that produced the UK variant.

New research by Victor Grubsky with the University of Southern California has shown that the India strain, which is labeled B.1.617.2, has a shocking transmissibility, a measure of infectiousness, of 3.19. You will want to think about that number.

Here is a table showing the most important variants circulating today. Click on the table for a larger view but note the India strain at the bottom. It is estimated to have arisen in December 2020. It is currently crushing India and is already an estimated 10% of UK cases. It is probably coming to a town near you.

Variant analysis takes time and this table just lists a few of the thousands that are known to exist but it is important to understand that the India strain looks like it is 4 times as transmissible as the original Wuhan version. If you think you can skip getting the vaccine and let herd immunity protect you it is likely a fools errand.  Very few people will escape uninfected and unvaccinated over time.

So I'll assume you are vaccinated.  What does that mean if you happen to suffer from chronic disease?  My community is focused on NAFLD/NASH so liver is front and center. Since the liver plays a role in several immune system functions, we are part of the immune compromised community.  If your immune system isn't in top condition COVID is particularly dangerous for you.

Transplant patients and others taking immune system suppressing drugs like RA or lupus patients may be vulnerable even with vaccination. We don't really have the data yet. It is important to understand that being vaccinated does not mean that you can't become infected. It just gives your body tools with which to fight the virus and if your body does it well the infection is defeated and you may not even know you were at risk.  Even in a healthy population, the vaccine is not perfect.  A 90% effective vaccine still means that 10% of those infected suffer a break through and become ill.  It may be less severe than an infection without the vaccine but people will still die.

If you have a compromised immune system or chronic disease it is important that you remember that these vaccines are not a get out of jail free card for us.  As you re-enter society you will do well to keep these risks in mind. You can be sure that those controlling your media are well aware of the India situation and in coming weeks the story will be put forward as they try to get ahead of it without scaring people more.  If you are hesitant to get the vaccine, I suggest you think about it very carefully. If you have been vaccinated, until you have a test for the actual presence of a good antibody population you would do well to remain cautious about exposure as summer events start to happen.

Remember this study which showed the odds ratio of infection, before the new strains came along, with NASH risk 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 as the virus has mutated the relative hazard has only increased.

Our best to you and yours and may the vax be with you.