So my hope was the situation would develop a little bit around a new variant first sequenced in South Africa, but headlines are running wild to the point that I, and I am sure you, am waking up to calm, rational, measured and sober discussions of what is known about this new variant.

I am -already- reading articles about how to trade the lockdowns that must surely be coming. The UK is apparently already banning air traffic from affected African countries. Belgium has already identified a case of this new variant. Etc. Etc.

Alright, so what do we actually know?

This new variant was, as mentioned, first identified in South Africa. It will almost certainly officially be designated the “Nu” variant, if it has not already been so by the time you are reading this. So that’s what we will be calling it once that goes official. More formally it is the B.1.1.529 variant. This variant does indeed have a shocking number of mutations in the spike protein, including a few that like delta have been more resistant to antibodies generated by the vaccines in particular.

So why the worry? The worry is with this many changes to the spike protein, it is possible that vaccine and prior infection antibodies will not recognize all of these changes easily, if at all. The worst case is that this mutant has such a bizarre looking spike protein that it’s basically a new virus to the immune system. There are some computer models that show that this spike protein may not be as well recognized by T-cells generated by vaccines or prior immunity.

Despite the headlines, though, we have no idea if that is true, and why I was trying to wait until we knew what any of those mutations actually meant.

There has been no in vitro, petri dish testing to see if the antibodies from vaccines and previous infection still bind and disable this virus (which is far better data than computer models of T-cells). BioNTech, Pfizer’s vaccine partner, is in the office this morning and has already said it will take a few weeks to generate that data. We have no idea if this variant is more, less, or equally as infectious as say, delta. We have no idea if it hospitalizes people at the same rate. We have no idea -if- it breaks through vaccines and natural immunity how often that happens, and how severe it is when it does.

It will take a few weeks to learn all of this, and right now, my guess is A) we find this variant is already widespread across the globe and B) has probably been spreading for at least a little bit. Part of the early concern is that there are anecdotal reports that some of the first South Africa cases identified are breakthrough, but no details on how many and severity. The variant is also the majority of cases in the Johannesburg province where the identification of the Nu variant was made. That is spurring a lot of initial WHO concern, but keep in mind that there is not a whole lot of COVID activity in South Africa right now, and there are only about 100 identified cases so far. Total.

So the best case is that this variant just happens to be the low simmer strain in that part of South Africa at the moment, and is the majority of cases there not because it is out-competing other strains by being more infectious, but because none of the other strains happen to be around in significant numbers. The odds of the good outcome actually go UP if they are finding more of this worldwide, especially if they go BACK a few months and discover the Nu variant was circulating then too. Remember too that while more mutations in the spike protein make it more likely that the immune system will not recognize it as a COVID spike protein it already knows, they also INCREASE the chance that the new, different spike protein will NOT bind the ACE receptor as well. As an example, in long term HIV patients, the low simmer of HIV in their bloodstream are defective viruses. They have mutated to survive the HIV drug cocktail, and so persist in HIV patients, but the mutations they had to get to do that mean they don’t replicate very well at all. They survive only because they can do juuuuuust enough to grind out a few new copies of themselves to keep a barely detectable level of infection going.

The odds of this are more probable than the headlines would make it seem, because again, the general trend of viral evolution is to become less severe over time. More contagious, if possible–but there is a limit to how much alteration of the spike protein SARS-CoV-2 can do and still bind the ACE receptor it needs to in order to actually infect human cells.

Lastly, what every article I have seen so far is uniformly NOT mentioning is that the recently approved Merck and Pfizer acute COVID treatments. They show 80%+ reduction of hospitalizations and even greater reduction in mortality when started early enough into treatment–and do NOT depend on the spike protein at all. Nu can have all the spike protein mutations it wants–if it doesn’t have other mutations in the actual targets of these drug, there is every reason to suspect they will continue to work. And there is NO information at the moment, or reason to suspect, Nu is resistant to these drugs. Or the anti-depressant which showed strong promise in Phase 3 randomized studies in the setting of severe COVID (likely by modifying the Ah-nold response, which depends more on choices your immune system makes, and not on spike protein mutations). Or even ivermectin, if ivermectin works at all (again, slight trend at best in the largest, best run Phase 3 studies, and odds right now are ivermectin is not especially effective against COVID). The only treatments that ARE affected by changes in the spike protein are the vaccines and the monoclonal antibody treatments (again, thank you for your understanding on the latter).

Again, no one has any idea if Nu is resistant to the vaccines and/or the monoclonal antibody treatments (and which ones) yet.

We will know more in the coming weeks.

So the TL;DR summary is Nu has some worrisome features, but there is a LOT we don’t know about it, and headlines seem a little ahead of what we do know so far. They are also VERY vaccine focused in their interpretations thus far, and again, we have MORE than vaccines, and with those treatments, actually hit more targets than just the spike protein right now. That realization and its implications have not hit the mainstream media or, I would argue, much of the public consciousness just yet.

We will obviously follow this story closely over the next several weeks when all of these important details will be filled in.

Until then, continue to enjoy your weekend and your holidays, and you can safely regard the headline panic like so:

If those details warrant the drama, we will provide the drama then.

<Paladin>