Health officials in Arkansas are awaiting results from samples sent out of state for genetic sequencing to determine if a more contagious strain of the coronavirus that federal health officials warn will be the dominant strain in the United States by March is present in Arkansas.
"I think the variant is probably here and circulating," said Dr. Jennifer Dillaha, the state's chief epidemiologist. "We need to operate on that assumption."
In recent months, more transmissible variants of covid-19 emerged in the United Kingdom, Brazil and South Africa. Those strains, also called variants of concern, are genetic mutations of the virus and are much more effective at infecting people, health experts say.
In a report published on Jan. 15, the U.S. Centers for Disease Control and Prevention said a covid-19 strain called the B.1.1.7 variant, first reported in the U.K. in December, "exhibits rapid growth in early 2021, becoming the predominant variant in March" in the U.S.
Arkansas sent a number of virus specimens collected from individuals who tested positive for covid-19 that "are suspicious" to the CDC and to Yale University for genetic sequencing to determine if they are the new variant, Dr. Jose Romero, the state's health secretary, said during a weekly news conference Tuesday.
As of Friday, four of the nine specimens submitted to the CDC have come back negative, while results for the remaining five are still pending, according to the Health Department. Those nine samples were submitted after a machine, owned by the Department of Health and housed at Baptist Medical Center-Little Rock, detected some type of mutation in positive test results.
Results for the other four samples sent to Yale by Natural State Laboratories, which partners with the Health Department, have not come back.
Additionally, the state's Public Health Lab submits 19 samples every other week for genetic sequencing as part of a CDC national strain surveillance program. So far, none have been positive for a new strain, the Health Department said.
As of Friday, out of the 195 confirmed cases in the U.S. caused by the U.K. variant, the CDC reported zero in Arkansas. At least 20 states, including neighboring Texas and Louisiana, have confirmed presence of the variant.
"The virus will get here," Romero said. "It is just a matter of time."
ALWAYS MUTATING
Viruses are constantly mutating.
As viruses replicate inside humans, the process by which they create genetic copies is imperfect, lacking the ability to correct errors as new virus is produced.
Think of a copy machine where every page that is printed has a few letters in a sentence that are different. Like the copy machine, the virus is not able to correct these differences, or mutations, resulting in the emergence of new variants.
Just as the copy machine is not aware that it is making mistakes, neither is the virus.
Sometimes these errors are advantageous, and sometimes they are not, said Dr. Robert Hopkins, a professor and division chief of internal medicine at the University of Arkansas for Medical Sciences.
"There is not an editor, so as you make new copies of that genetic material, the material in the cells of people who are infected, there are going to be errors," Hopkins said. "Many of the errors, when they happen, are going to make the virus function less well than the original virus."
Sometimes "we get what is called an enhanced function," he said, of which the result is these more contagious strains.
"They spread faster because they either attach more easily to human cells or they attach more firmly and inject their genetic material into those cells to replicate the virus more than what we would consider the standard [covid-19] virus," Hopkins said.
There are likely countless new strains of the coronavirus emerging, many of which die off and some, like the U.K. variant, that survive because of a mutation that turned out to be advantageous.
"Mistakes don't always result in bad things," he said. "It is a mistake that is good for the virus and bad for humans."
MORE EASILY SPREAD
Rising case numbers could be an indication that the variant is in Arkansas, experts say.
On Jan. 1, the state reported more than 4,300 new covid-19 cases, its largest single-day increase of positive cases since the pandemic started in March.
"I don't know whether it's the U.K. strain or whether we have a slightly different strain that is more successful," Hopkins said. "It just seems we are getting much easier spread than we did before."
During a news conference Friday, British Prime Minister Boris Johnson said that, while still uncertain, some data indicates that the U.K. strain could be deadlier than the original strain.
In December, Baptist Health detected a mutation of covid-19 in patients who tested positive for the coronavirus, Dr. Amanda Novack, Baptist Health's medical director of infection prevention, said via email. Those positive results were from patients who were tested at one of Baptist's testing sites or were submitted for analysis by the Department of Health.
Baptist identified the mutation using the Department of Health's machine, called the TaqPath by Thermo Fisher Scientific, that the health care provider houses in Little Rock.
That machine amplifies genetic material of the virus, Novack said.
The machine detected differences in the structure of certain samples. However to determine the specific variant patients are carrying, the samples are sent out of state, she said.
Novack and other experts studying the variants say there is, so far, no indication that they make a patient sicker than the original strain that caused the nation to shutdown in March.
"These specific patients are not sicker than our normal covid patients, but they are much more contagious," she said. "There are certainly a lot of implications."
WORRISOME IMPLICATIONS
Those implications are what are worrying health care professionals.
The more people who become infected, the more people will become seriously ill, increasing pressure on hospitals that are already at, or are nearly at, full capacity.
"We know our health care systems are stretched to their limits right now," Hopkins of UAMS said. "If we are seeing increased spread of disease, that means we will have more people in the proportion of folks who are going to get severe disease and need to be in a hospital and need to be on a ventilator."
"I am worried about our ability to meet that demand," he said.
At Baptist Health, patients potentially carrying the new variant represent less than 5% of the patient population with covid-19, Novack said, adding that Baptist hospitals, so far, "haven't seen that we need to do anything differently in the treatment of these patients."
It appears that the Moderna and Pfizer covid-19 vaccines are still effective with the variants, though the CDC said on Jan. 15 that scientists are still studying "how these variants affect existing therapies and vaccines."
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"So far, the science is proving that covid vaccines being distributed are protective against the popular strains you hear about," Novack said. "It is still extremely important to wear a face mask, socially distance and take the vaccination when it is available."
"The less chance we have of spreading the virus, the less chance it has the opportunity to mutate," she said.
Should there be significant mutations, there could be a scenario where a modified vaccine would have to be produced, Dillaha said.
"It would not be difficult to modify the vaccine to protect against a variant," Dillaha said. "I don't think it is likely this variant will escape the immune protection the current vaccines offer."
State officials say that if the U.K. strain or other variants emerge in Arkansas, there are no plans yet to enact further restrictions to curtail spread.
"Our main limitation is the rollout of the number of [vaccine] doses we are receiving," Dillaha said. "That limitation would not go away if the variant showed up in Arkansas."
"It would increase the urgency of the situation," she said. "Right now, I think we are moving just about as fast as we can."
Hopkins said state officials should not rule out more restrictions.
"We clearly are now at health care capacity, and with predictions of seeing no peak [in virus cases] for months ahead, if we don't do a better job, we are going to have to lock down further," he said. "I know that is a difficult situation for many people, but we are talking about saving lives."