Greek Reporter spoke to the Greek-American medical professor from Stanford University, regarding his insights on this unsettling new mutation of the virus and what he believes should be done at this stage in the global fight against the pandemic.
Asked if he believed that the existing RNA-based vaccines will fight effectively against this new strain, called B.1.1.7, he cautioned against panic, but remarked that the increased transmissibility of the virus is cause for special concern.
“The new strain B.1.1.7 has become very common in the UK,” he notes, “but it has also been documented in several other countries and there it did not become very prevalent, at least to date. I suspect it must have already reached also several countries where routinely surveillance has not picked it yet, but this does not mean that it is not already there.”
Ioannidis noted that the US may be one of these countries as well, but at this point that is an unknown. He then added that actual evidence regarding the higher ability of B.1.1.7 to spread “is not very conclusive,” noting that “To date, there is no evidence that this variant changes clinical severity and fatality.”
More infections still means more fatalities
However, he says, “scientists do need to check these issues very carefully, because, even if a new strain is not more lethal, a higher transmissibility means that more people need to be infected (or vaccinated) before an epidemic wave stops. Even with equal fatality risk per infection, more infections would translate to more total deaths.”
Like all other viruses, the medical professor says, the coronavirus, officially named SARS-CoV-2, does change through mutations, and there are “many such mutations that have been documented” already.
After the emergence of the new UK strain, he explains, there were other variants, including one from South Africa and one from Nigeria, that have caused experts to speculate about the possibility of higher transmissibility.
“Of course,” he says, “the scientific community will check all these very carefully, but it would be wrong to have the public panic, trying to follow in the news every single new variant that emerges.
Mutation in new coronavirus strain appears slower than annual flu
“We have to be careful to diminish exposure,” he cautions. “This is a simple, clear message and we should not confuse it with overly technical and ever-changing information about mutations and strains.”
On a very positive note, the eminent professor says that, if anything, the rate of mutation for the coronavirus appears to be “substantially lower than the respective rate of change of influenza.”
The public, of course, is already very familiar with the fact that the annual flu strain that the globe deals with every winter changes annually, prompting scientists to create a new flu vaccine each and every year.
“We have no evidence so far,” he says, “that the available COVID-19 vaccines will be affected by that specific mutation,” but that scientists are studying the issue carefully and will continue to do so.
“We do possess the technology to do this”
He acknowledges that “there is some preliminary evidence that I cannot exclude the possibility that at some point (not now, but perhaps in a more distant future) that the existing vaccines would have to be modified in the same way as we do for influenza.”
He declares with finality, however, that “We do possess the technology to do this.”
Overall, the noted medical educator calls for calm, stating that the development is “an interesting scientific observation, but not something for the general public to get over-excited about at the moment.”
“Blind, draconian lockdowns not the best solution”
Greek Reporter asked Dr. Ioannidis about the wisdom and efficacy of lockdowns, imposed to some degree throughout Europe and in some states in the US in the course of the past year — and recently reimposed after spikes in the virus in the past several months.
“I continue to believe that blind, draconian lockdowns are not the best solution, and they become less and less viable as a reasonable solution when they are further prolonged for longer periods of time,” he states emphatically.
The professor then adds that “Analyses for lockdowns in the first wave have shown that these draconian measures did not do much to curtail the number of cases, as we show in a paper that has been accepted in the European Journal of Clinical Investigation.” This most recent scientific paper should be online soon.
“Similarly,” he says, “lockdowns did not do much to curtail the number of deaths in the first wave, as shown in the study here. In the second wave, they also seem to have largely failed to add incremental value beyond more simple measures like distancing, masks, and banning large events,” he declared.
“However,” the professor added, “we will wait to analyze the full picture when data are complete.
“Given the nature of the data, one cannot exclude small benefits of lockdowns over more targeted measures in some countries or locations, but then these benefits would be too small to match the harms of draconian lockdowns.”
Immense social, economic and psychological effects of lockdowns
The professor, who previously showed in studies that the economic, social and psychological fallout from the decade-long Greek economic crisis resulted in the death of many thousands of Greek citizens, believes that “some models suggest that lockdowns even do harm in terms of the spread of the virus and the resulting fatality burden in the population.”
This is because, he explains, “they shift the infections away from those who are at lower risk and towards those who are disadvantaged and at higher risk. Called “inverse protection,” the professor has also performed studies on this effect, as seen here.
Additionally, he cautions, “the availability of effective vaccines should be one more reason that policy leaders can invoke to avoid the blind perpetuation of lockdowns.
“Psychologically, policy leaders should feel reassured that now we have tools to deal with the virus, including both better drugs (e.g. dexamethasone and monoclonal antibodies) and several vaccines,” Ioannidis says.
“Unfortunately,” he adds, “many policy leaders interpret this the wrong way and they think that if they continue or intensify the lockdowns, this will be beneficial since vaccines will be distributed soon, in a relatively short period of time.”
Vaccines must be accepted by large proportion of population
Unfortunately, Ioannidis explains, “this reasoning is flawed for two reasons. First, as I discussed, lockdowns do not seem to save lives and more likely they kill and devastate lives.” In addition, he says, even if done for what most view as a relatively short time, that would be a misconception. “Vaccines will unfortunately take a long time to be distributed to a large segment of the population, even if we do our best.”
Perhaps most chillingly, Ioannidis declares that simply expecting the vaccines we have now to offer herd immunity by themselves “may take until the fall of 2021 in most countries — and in some countries this may be well into 2022.
“If they are not widely endorsed by the population, vaccine-induced herd immunity may never be reached,” he warns. “Moreover, several countries like India had 60% seroprevalence already by November, which means that they have pretty much reached herd immunity already.
“The same may be true for some hard-hit locations even in the USA and Europe (e.g. locations in Northern Greece) where, sadly, the virus has already spread very widely,” he cautions. “Continuing hard lockdowns for another 4-12 months or even over a year — while waiting for 70% of the population to be vaccinated — can be devastating.
“Vaccines are a fantastic development, but we should not use their availability as an excuse for disastrous decision-making.”
Masks and social distancing still important
Greek Reporter asked if the masks that most of us continue to use will work against this more virulent strain, which some say spreads 70% more easily than the original strain of the virus.
“We are still calibrating the exact potential of B.1.1.7 and of other strains that may have higher transmissibility,” Ioannidis answers. “Nothing has changed regarding masks so far. It is always important to avoid being in crowded places. Masks can help when it is unavoidable to meet other people and be in crowded places for reasons that are beyond one’s control (e.g., some types of work for essential workers).
“However,” he warns, “trusting that a mask will 100% protect you in a crowded place is erroneous, regardless of what viral strain is circulating.”
Many across Europe and the US have recently decried the lag time between the vaccines’ approval by the different countries’ regulatory agencies, resulting in decisions being made weeks apart, appearing to lead to people suffering needlessly in the interim.
For times like these, with infections raging across the planet, shouldn’t there be a universal vaccine standard that countries could agree to beforehand?
Lag time between regulatory agencies’ vaccine approval
Asked about the feasibility of combining regulatory agencies to eliminate the weeks between the beginning of inoculation campaigns across the nations of the western world, Ioannidis makes several important points.
In fact, even though information now moves — and is shared — at the speed of light, there are multiple advantages to having separate agencies all over the world charged with approving medicines and vaccines.
“There have been efforts in the past to synchronize the work and decisions of regulatory agencies around the world,” he explains. “The truth is that for most products, licensing decisions are aligned across different agencies and the decisions are reached at about the same time.
“The same seems to be true also in the case of COVID-19 vaccines; the timing has had very little difference across agencies. There is also a very serious counter-argument against eliminating all these agencies and creating just a single global one: the availability of multiple agencies allows for more independence in the evaluation and there are more eyes who view these licensing applications and the evidence that they procure in support of the specific products.”
Adding that there is already pressure for a “domino effect” once one agency has approved a product, he admits that “others feel increased pressure to do the same. I think it is important to maintain as much some independence which allows extra layers of careful scrutiny.
Ioannidis maintains “Vaccines need to be widely used, but also carefully regulated and monitored for long-term effects and for safety in the community while they are widely used. Dismantling or weakening regulatory agencies would not help that purpose.”