Wednesday, 19 May 2021

A Scottish perspective on the Indian variant

It was always predictable that the so-called Indian variant of the coronavirus was going to enter the UK. There are now fears that this new variant will cause a “third wave” resulting in an increase in hospitalisations and the suspension of the much anticipated loosening of lockdown restrictions. One question that many have is how new variants of the virus arise. This is an example of evolution in action. So first, a quick lesson in viruses.

To simplify things considerably, a virus is just a piece of DNA and an associated protein coating. A virus cannot reproduce by itself. Instead , the coronavirus, like other viruses, hijacks the mechanisms of the cells in the body of an infected host and forces those cells to make copies of the virus. Typically during the course of an infection many millions of copies of the virus will be churned out. Every time the virus is copied, there is a chance of an error taking place in the copying process and the virus not being copied correctly. The overwhelming majority of times, the virus is copied correctly, however because so many copies of the virus are made during the course of a typical infection, there’s a high probability that some faulty copies will be created.

Most of these faulty copies - the mutations - will be less effective at doing the virus’s two jobs of hijacking cells in the body and of being transmitted from one host body to another. These mutations will soon die out. Many other mutations will not be any better or worse at these jobs. However a small minority of these faulty copies will be more effective at hijacking body cells in the infected person and more effective at being transmitted from one person to another. These mutations have a competitive advantage over other less effective variants, and will preferentially spread. This is what happened with the so-called Kent variant which is now the dominant strain of the virus in the UK. This variant was more effective at being transmitted than the variants existing at the time, so eventually it crowded out the others.

Because millions upon millions of copies of the virus are made in each one of the millions of people who have become infected, new virus mutations are constantly being produced. There is concern that eventually one of these virus mutations might cause more serious illness or that it could be resistant to the vaccines currently in use.

New variants of the virus crop up constantly. The more restrictions there are on foreign travel, the easier it is to keep novel and potentially risky variants out of the country. Of course this must be balanced against people’s right to travel freely. It seems that in reaching a decision on this, the Scottish Government has given more weight to public health considerations than the Conservatives at Westminster, who appear to put more weight on the commercial interests of the travel and transport industries. Since the Scottish Government has no control over foreign borders, in this respect Scotland is at the mercy of UK government decisions which can undermine decisions made by the Scottish Government. The UK government delayed putting India on the red list of countries for over three weeks after concerns were raised about the spread of a new variant of concern there. Travellers arriving in the UK from India were allowed to self isolate at home instead of having to go into supervised hotel based quarantine.

The good news is that there is no definitive evidence - yet - that this new Indian variant is resistant to the vaccines that we currently have. Neither is there any evidence to suggest that this new variant causes more serious illness in those it infects. The other good news is that if a vaccine resistant variant was ever to arise, scientists would not have to go back to square one and develop an entirely new armoury of vaccines from scratch. It should be possible to “tweak” existing vaccines so that they’d be effective against a resistant strain.

However there is concern that this new Indian variant may be more effective at being transmitted from one person to another, although it’s not yet clear just how more effective it might be. If it’s more effective at being transmitted this means that the new variant is more likely to infect people and to cause more cases of serious illness simply because there are more people who are being infected. If the virus is able to infect more people more rapidly and to reach more people who are vulnerable to serious illness, the incidence of serious illness increases even though the variant does not in itself cause a more serious illness. That could cause a significant rise in hospitalisations among those who have not yet been vaccinated. This possibility is what alarms Scottish public health authorities and has led to the loosening of lockdown restrictions being paused in Glasgow.

The big problem that the Scottish Government faces is that it has to fight the virus with one hand tied behind its back. Scotland is in the position of trying to bail out a leaky boat with a Westminster shaped sieve. Decisions made in Scotland can all too easily be undermined by decisions made at Westminster.

Without control over international borders, Scotland was left in the ridiculous position of demanding hotel-based quarantine for the tiny number of international travellers who flew directly into Scotland from “red list” countries, but the far larger number of travellers who arrived in the UK-Ireland common travel area from abroad but whose flights first took them to England or Dublin where they then caught connecting Scotland were able to organise their own unsupervised quarantine at home. The UK Government continued to allow travel from India even after it became clear that the situation in the country was spiralling out of control.

It is not unreasonable to assume that if the far stricter supervised hotel based quarantine had applied universally to everyone arriving in Scotland there could have been a chance that the entry of the new variant could have been prevented and we might not now be in the position of having to delay Glasgow’s exit from lockdown amidst concerns that the new variant of the virus is getting a foothold in parts of the city. But that’s hypothetical. We are where we are, more concerning is that even though there is clear evidence of community transmission of the new variant in parts of England, and concerns are being raised about a possible third wave, Johnson is not pausing the loosening of lockdown restrictions in England. A surge in infections in England will have an inevitable knock on effect in Scotland.

Hopefully this new variant will not prove to be markedly more efficient at transmission but if it is, and there is a third wave, it will once again highlight how Scotland’s efforts to contain and control the pandemic are being undermined by a Conservative government which prioritises financial and economic concerns above public health.

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