Loosening restrictions too early increases risk of vaccine-escaping mutants

Failure to contain COVID-19 amid new strains could allow virus to replicate and mutate further

(Getty Images)

We all want to reopen. With cases dropping, is it finally time?

For Gov. Jared Polis, the answer is a partial yes. As of last Friday, the governor oversaw yet another revamp of the state’s pandemic dial, moving the goalpost to allow many counties to enjoy looser COVID-19 restrictions. Still, many experts remain hesitant.

This isn’t the first time Polis has found himself at odds with the public health sector. In Nov. 2020, the governor refused to enact a firm “Stay at home” policy, a move that frustrated his own party and was a prelude to the largest spike in cases the state has seen. Later, Polis unexpectedly announced loosened restrictions, again frustrating local health officials who said they weren’t consulted. The strong sense of being ignored eventually led to Jefferson County’s interim public health director and medical director, Dr. Mark Johnson, to go on record with Colorado Public Radio as saying, “My sense is that the governor listens to his business colleagues and business interests more than he does to his public health interests.”

Alas, if cases are declining as Polis says, why do public health experts remain hesitant to reopen?

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The devil is in the details.

While Colorado has, indeed, been declining in cases from our most recent peak, the 3- and 7-day averages of cases today still remain greater than those of the first two peaks in 2020. This essentially establishes our new baseline as the height of our old peaks, a potential sign of reopening prematurely. Similarly, although death rates and hospitalizations have declined, these numbers do not adequately reflect the toll of moderate to severe — and in some cases potentially permanent — symptoms of COVID-19.

Yet concerns of reopening too early run much deeper.

To date, only about 13% of the state’s population has been vaccinated, with roughly 9% receiving only one of the required two doses. This remains well below estimated herd immunity levels required to contain community spread, suggesting Colorado may not be able to vaccinate quickly enough to outpace another deathly peak — particularly given our increased baseline. Even more concerning, weekly reports show nearly 45% of Colorado’s recent outbreaks were traced to general categories of education, dining and entertainment, retail and office settings — the very places that could see restrictions relaxed.

Dr. Richard Pang moments before injecting the COVID-19 vaccination into a willing arm at the UCHealth mass vaccination clinic in the Coors Field parking lot January 30, 2021. UCHealth partnered with the Governor’s office, Colorado Department of Public Health and Environment and the Colorado Rockies to administer the COVID-19 vaccine to 10,000 qualified and registered people of two days. (Andy Cross/The Denver Post, pool)

But most notably, although stay-at-home measures have been largely sold to the public as a means to lower death rates and conservation of critical resources — both accurate — there was always more to the story. Reducing cases also meant limiting the risks of selectively advantageous mutations that could give rise to exponential case growth or evade vaccines.

To appreciate how a reduction of cases translates to a lower incidence of mutations, consider that viruses require a host — you — in which to replicate, mutate and spread. Without hosts, mutations and transmission can’t occur. Although mutations in viruses are normal — particularly for RNA viruses such as SARS-CoV-2 — not all mutations are harmless. Some mutations make a virus more deadly, more transmissible or even vaccine-resistant, any of which would greatly hamper ongoing recovery efforts for COVID-19.

To this end, several concerning mutations have already been identified amid rampant worldwide cases. These include the better known B.1.1.7 lineage, as well as new strains emerging in South Africa, Brazil and more. While much remains to be seen, a growing body of evidence suggests these convergent mutations are increasing transmission, this time possibly including children. For example, in April 2020, only 1.7% of COVID-19 cases were found in those under age 17. As of Feb. 4, 2021, this has increased to 12.9% according to the American Academy of Pediatrics. This might be a reflection of testing lags, but early theories suggest it may be related to mutations that appear to have favored stronger binding of the virus for human transmission.

Given increased transmission relates to exponential — not linear — growth, experts project the B.1.1.7 strain in particular could become dominant by as early as March or April. The United States is currently estimated to be doubling B.1.1.7 cases every 10 days. If we loosen restrictions amid a largely unvaccinated population, we risk continuing to exponentially increase the number of available hosts, and subsequently the ability of the virus to replicate and mutate further.

In viral outbreaks, our best defense is a good offense. While another push to stay home sounds beyond dreary, it could mean slowing the development of mutations, including a potentially vaccine-evading one. As one theory points out, the evolutionary pressure for SARS-CoV-2 to mutate has largely been lacking, due to an immunologically naive population. However, as we continue to introduce a partially immune population — whether naturally acquired or through vaccination — the pressure to mutate may increase. This is also why accelerating vaccination delivery is paramount.

In Polis’ defense, the genie may already be out of the bottle. In failing to clamp down on viral spread early on, we already gave carte blanche to a deadly, prone-to-mutate virus. Several newspapers already detail COVID-19 as endemic, marking a reality of viral perpetuity. Even still, if a vaccine-evading mutation were to present before we could restabilize, it could jeopardize our gains to date. In this light, now is the time to tighten the reins — not loosen them — precisely because we don’t know what is to come.

To quote Dr. Carlos del Rio of Emory University, “The more rapidly we can stop transmission and vaccinate people, the less likely the virus is going to be mutating.” That’s in everyone’s best interest, now and in the future.

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