MUTANT ENEMY
South Africa Covid variant symptoms and where is the strain in the UK?
DOOR-TO-DOOR Covid-19 testers are hitting several UK hotspots - after 11 Brits caught the South African strain without having travelled there.
The variant was first found in the country in December and experts have warned that it can spread at a faster rate than other strains - but where has it been detected in the UK and how will you know if you have caught it?
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In December, two Britons tested positive for the “highly concerning coronavirus mutation”, and yesterday 11 more tested positive for the strain.
So far, there has been a total of 105 cases of the South African variant in the UK.
Scientists have warned the mutation, named 501YV2, is feared to be at least 50 per cent more contagious, with hundreds more undetected cases thought to be in the country.
Andrew Hayward, professor of infectious disease epidemiology at University College London and a member of SAGE, said: "This variant is identified through genetic sequencing and we sequence between five per cent and 10 per cent of all cases, so you can immediately tell from that that we have a big under-estimation of the number of cases.
"We would expect we're seeing the tip of the iceberg of community transmission."
What are the symptoms?
There is not yet any evidence to suggest that symptoms differ from the three Covid-19 symptoms already highlighted by the NHS.
The three main coronavirus symptoms are a new persistent cough, a high temperature and a loss of taste and smell (anosmia).
If you have any of these symptoms then you should isolate immediately and get a test.
However, people in eight areas across the UK are being urged to get a test even if they don't have the classic Covid-19 symptoms outlined by the NHS.
Today Universities Minister Michelle Donelan said the development was "deeply concerning" and urged people to stay at home.
She said: "Think again before you go about activities, even those within the rules such as essential shopping.
"Do you really need to go for that shopping or have you got enough in? Could you work from home, have that extra conversation with your employer?"
The Office for National Statistics (ONS) last week revealed that people with the UK variant of the virus displayed different symptoms, but the ONS has not yet released any research that suggests symptoms are different for people with the South African strain.
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Linda Bauld, professor of public health at the University of Edinburgh, said it may be possible for people to become infected with the South African variant even if they have had Covid-19 in the past.
She told BBC Breakfast: "That is something that is causing concern around the world.
"In Brazil where there is a different variant - which was badly hit in the first wave - there was a lot of reinfection there and that's what also seems to potentially be the case with this variant in South Africa."
Health officials said mass testing would help it to closely monitor any community spread of the new variant, and restrict further transmission.
Testing doesn't currently detect whether someone has the South African strain but they will be sent to the lab to be sequenced to identify any more cases of the particular strand in the area.
After the new strain was first detected, the WHO's technical chief, Dr Maria Van Kerkhove, said those infected with different variants had the same symptoms of the disease and there was no severity.
WHO's Executive Director Mike Ryan said the variant transmitted in the same way - through respiratory droplets from coughing or in the breath, and from infected surfaces.
Where in the UK is the new strain?
It includes parts of Surrey, London, the West Midlands, East of England, South East and North West.
Two positive cases of the strain - which have been worrying scientists - have been identified in people in Surrey with no links to travel or previous contact with those affected.
Ealing Council has also asked residents living and working in parts of Hanwell and West Ealing to get a Covid-19 test after a local resident tested positive for the South African strain, also with no travel links or previous contact.
In Kent, one case has also been identified with no previous links, meaning door-to-door coronavirus testing in the ME15 area of mid-Kent has now started.
Households within the ME15 area will be visited by staff from Kent Police, Maidstone Borough Council, Kent Fire and Rescue and other support agencies.
Mobile testing units (MTUs) will be deployed offering swab tests to people without symptoms, with additional home test kits available to people who are shielding.
People with symptoms are urged to book a test in the usual way.
What is the South African strain?
The South African variant is called 501.V2 and was announced by the government there on December 18.
Lawrence Young, a professor of molecular oncology, Warwick Medical School, said: “The South African virus variant emerged in a major metropolitan area in South Africa following the first wave of the epidemic and then spread to multiple locations.
“It has rapidly spread become the dominant virus variant in the Eastern and Western Cape provinces.”
Cases have now been detected in the UK, France, Finland, Norway, Switzerland, Japan, Austria and Zambia.
The first cases in the UK were discovered on December 23 and were thought to have been contacts of people who had recently been to South Africa.
Paul Hunter, a professor of medicine at the University of East Anglia previously said that it was “quite possible” there are undetected cases in the UK.
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Dr Simon Clarke, an associate professor in cellular microbiology at the University of Reading, said it is hard to track cases of the South African variant due to a testing issue.
He told The Sun: "On that standard PCR [the Covid test used gloablly], you will not be able to distinguish between the South Africa strain, and the strains that have been doing the rounds for months already.
"That's why its more difficult to track."
The only way to know how many cases of Covid are caused by this new strain is through genetic sequencing, a laboratory process which is used on only 10 per cent of tests for research purposes.
Dr Clarke said: "They would only pick it [the South Africa variant] up if someone goes for the normal testing procedure because they have symptoms, and they hit that one in ten chance of their strain being sent for sequencing. That is the only way the authorities would know about it."
What is being done to stop it?
Direct flights from South Africa have been suspended, and visitors arriving into the UK who have been in or transited through South Africa in the previous 10 days will not be allowed in.
And anyone who had visited South Africa prior to December 23 had to quarantine immediately.
Infectious diseases expert Dr Susan Hopkins, PHE, said health chiefs were “pretty confident” the measures will help to control the spread.
But some are in disagreement and warned that halting flights was not even to stop the new strain entering the UK.
Labour MP Yvette Coopet, the chairwoman of the Commons Home Affairs Select Committee, said: “Rightly, the Government has stopped direct flights from South Africa. But the first wave shows that is not enough.
“Genomic evidence quoted in our Home Affairs Select Committee report in August showed 34 per cent of imported Covid cases came into the UK from Spain, 29 per cent from France, less than 1 per cent came directly from China.
“The South Africa variant is already identified in France, Austria, Norway, Japan, Australia. And, currently, our border checks are weak and not taken seriously.”
Is it more dangerous?
The new strain might cause more severe disease in younger people, but this has not been investigated in detail yet.
South Africa’s health minister Zweli Mkhize tweeted there was "anecdotal evidence" of a "larger proportion of younger patients with no co-morbidities presenting with critical illness".
Dr Julian Tang, honorary associate professor and clinical virologist at the University of Leicester, said studies will assess whether young people are catching this variant more because of the way they behave.
It could be that they are not following Covid restrictions as tightly as they were previously, therefore catching the virus more often.
The strain from South Africa appears to spread faster, possibly more than the UK one, according to Health Secretary Matt Hancock.
This could be for a number of reasons - it may be because the mutations give it a biological advantage.
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Or it could be because people who have it have a higher viral load, which makes them more infectious.
People who have tested positive for the new UK and South African strains have had more viral particles on their swabs - indicating a higher viral load and therefore contagiousness - but this could just be a coincidence or because they were swabbed early in their disease.
How does it compare to the new UK strain?
The South African strain is “slightly different” to the UK’s one, according to Professor Neil Ferguson, a member of the UK Government’s NERVTAG group.
Dr Preston said: “The ’South African’ variant is distinct from the UK variant, but both contain an unusually high number of mutations compared to other SARS-CoV-2 lineages.”
A typical “new strain” might have a handful of mutations, but the British one has 17, while the South African variant has between 10 and 20.
“Some of these mutations change the S protein, which is cause for concern,” Dr Preston said.
The spike protein is on the outer surface of the viral particle. It is a focus for coronavirus vaccines, and so if it changes, it could affect how vaccines work.
Will it affect vaccines?
New strains may make vaccines less effective, because the immune system does not recognise the new variant when it infects the body.
Therefore, there is a theoretical risk the South African variant could escape the effect of the vaccine.
Sir Patrick Vallance discussed this possibility at the Downing Street press conference on January 5.
The Chief Scientific Adviser said: “There is nothing yet to suggest that’s the case. This is being looked at very actively.
“It’s worth remembering that when a vaccine is given you don’t just make one antibody against one bit, you make lots of antibodies against lots of different bits, and so it’s unlikely that all of that will be escaped by any mutations.
“But we don’t know yet.
“At the moment, you’d say the most likely thing is that this wouldn’t abolish vaccine effect. It may have some overall effect on efficacy but we don’t know.”
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The WHO said there were "no indications"; vaccines would not work against the South African strain.
"We have no indication that there's an impact on the vaccines that are being rolled out. That's very good news. That's the information we have so far, and studies are ongoing," said Dr Van Kerhove.
The mutations in this virus mean it's possible it can reinfect a person who has already recovered from Covid-19, according to Professor Peter Horby, who heads the Government’s New and Emerging Respiratory Virus Threats Advisory Group (NERVTAG).
Professor Horby told BBC Radio 4’s Today programme on December 24: “It’s got quite a lot of mutations in what we call the receptor binding domain, which is the part of the virus which is critical for infection and antibody responses.
“Those two reasons are why this virus is a worry, it may be more infectious and so make control difficult, and these three mutations in the receptor binding domain may have an effect on the ability of antibodies to neutralise the virus."
Generally, since the emergence of the British strain, health officials and scientists have said it is “highly unlikely” this will render the vaccines useless.
It is possible that in the future, we will need to adjust our vaccines so they are perfect against the strains in circulation.
This is how the flu vaccine is made every year.
Should we be worried?
Mutations are normal in any evolution of a virus over time. Already thousands have been found in SARS-CoV-2 within one year.
What makes the latest two from the UK and South Africa so interesting is the speed at which they became “prominent”, causing lots of cases and suddenly.
Mr Hancock said: “It is vital that we do all we can to stop transmission of this variant and I strongly urge everyone in these areas to get tested, whether you have symptoms or not.
"The best way to stop the spread of the virus – including new variants - is to stay at home and follow the restrictions in place.
"Until more people are vaccinated this is the only way we will control the spread of the virus."
Prof Young said: “Variants of SARS-CoV-2 have been around since the beginning of the pandemic and are a product of the natural process by which viruses develop and adapt to their hosts as they replicate.
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“Most of these mutations have no effect on the behaviour of the virus but very occasionally they can improve the ability of the virus to infect and/or become more resistant to the body’s immune response.”
Dr Anthony Fauci, director of the US National Institute of Allergy and Infectious Diseases, warned against overreacting to new coronavirus variants.
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He told BBC Radio 4’s Today programme: “RNA viruses mutate, we know that, they continue to mutate – they have mutated in the past and they will mutate in the future.
“The mutations that have been noticed in the south-eastern part of the UK and in South Africa... I don’t think that this is something that would require draconian changes in policy so we have to be careful that we don’t overreact to something that is the natural evolution of the virus that might not have any strong impact on how we handle the virus in any way.”
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