CDC chief presents plan of attack for COVID variants

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Rochelle Walensky, MD, MPH, director of the Centers for Disease Control and Prevention (CDC), on Wednesday described a multi-agency attack plan to stop the spread of three variants of COVID-19.

As a member of Journal of the American Medical Association’s (JAMA’s) Q&A series with JAMA Editor-in-Chief Howard Bauchner Walensky referred to the plan she co-wrote with Anthony Fauci, MD, the nation’s leading infectious disease specialist, and Henry T. Walke, MD, MPH, of the CDC, who was published Wednesday in JAMA Network.

In the viewpoint article, they explain that the Department of Health and Human Services created the SARS-CoV-2 interagency group to improve coordination between CDC, National Institutes of Health, Food and Drug Administration. (FDA) of the United States, the Biomedical Advanced Research and Development Authority, the United States Department of Agriculture, and the United States Department of Defense.

Walensky said the first goal was to increase vigilance over public health mitigation strategies to reduce the amount of virus circulating.

As part of this strategy, she said, the CDC strongly urges avoiding non-essential travel.

Additionally, public health officials are working on a surveillance system to better understand the variants of SARS-CoV-2. This will require accelerating the sequencing of the SARS-CoV-2 virus genome and ensuring that the sampling is geographically representative.

She said the CDC is partnering with state health labs to get about 750 samples each week and is teaming up with commercial labs and academic centers to get an interim target of 6,000 samples per week.

She acknowledged that the United States “is not where we need to be” with sequencing, but that it has come a long way since January. At that time, they were sequencing 250 samples every week; they are currently sequencing thousands of them every week.

Data analysis is another concern: “We need to be able to understand at a basic science level what information means,” Walensky said.

Researchers are unsure how the variants might affect the use of convalescent plasma or monoclonal antibody treatments. 5% of people vaccinated against COVID-19 are still expected to contract the disease. Sequencing will help determine whether those people who have been vaccinated and subsequently contract the virus are among that 5% or whether they have been infected with a variant that escapes the vaccine.

Speeding up vaccine delivery around the world and in the United States is essential, Walensky said.

As of Wednesday, 56 million doses had been administered in the United States.

The three main threats

She updated the numbers for the three biggest threat variants.

Regarding B.1.1.7, from the UK, she said: “So far we have had over 1,200 cases in 41 states.” She noted that this variant is likely to be around 50% more transmissible and 30% to 50% more virulent.

“So far, it appears that this strain has no real decrease in sensitivity to our vaccines,” she said.

The South African strain (B.1.351) has been found in 19 cases in the United States.

The P.1. a variant, originating in Brazil, was identified in two cases in two states.

Outlook for March and April

Bauchner asked Walensky what she plans for March and April. He noted that public optimism is high in light of the continued reduction in the number of COVID-19 cases, hospitalizations and deaths and as the weather warms and more vaccinations are on the horizon. .

“While I really hope what might happen in March and April,” said Walensky, “I really know it could go wrong so quickly. We saw it in November. We saw it in December.”

CDC models have projected that by March the most transmissible B.1.1.7 strain will likely be the dominant strain, she reiterated.

“I’m afraid it’s spring and we’ll all have enough,” Walensky said. She noted that some states are already relaxing mask mandates.

“By this time, life will look and feel a little better, and the motivation of those who might be reluctant to get the vaccine may be diminished,” she said.

Bauchner also asked him to consider whether a third vaccine, from Johnson & Johnson (J&J), could soon gain emergency use clearance from the FDA – and if its lower expected efficacy rate could result in a system multi-level vaccination, with populations at higher risk. receive the most effective vaccines.

Walensky said more data is needed before this question can be answered.

“The data may very well tell us the best populations in which to use this vaccine,” she said.

In phase 3 data, the J&J vaccine was shown to be 72% effective in the United States for moderate to severe disease.

Walensky said it’s important to remember that the projected effectiveness of this vaccine is greater than that of the flu vaccine as well as many other vaccines currently in use for other diseases.

She said it also has several advantages.

The vaccine has less stringent storage requirements, requires only a single dose, and protects against hospitalization and death, although it is less effective in protecting against disease.

“I think a lot of people would choose to get it if they could get it sooner,” she said.

Marcia Frellick is a Chicago-based freelance journalist. She has previously written for the Chicago Tribune and Nurse.com and was an editor for the Chicago Sun-Times, the Cincinnati Enquirer, and the St. Cloud (Minnesota) Times. Follow her on Twitter at @mfrellick.

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