Problematic variants that can’t grow as fast as Delta will be only a limited problem. When we read about a Mu (0.1%) being a problem for vaccines, if it can’t outcompete Delta, it won’t take hold. 8/
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So Delta, oddly, is defeating variants that would be more challenging for vaccines (and also monoclonals). And until a variant that causes problems for the vaccine also spreads faster than Delta, it won’t become dominant. 9/
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As an aside, Delta causes some problems for the vaccine but in a different way— because it replicates more virus so quickly that w/ lower antibody levels, immune response often isn’t fast enough to prevent symptoms. Cellular immunity does kick if to prevent hospitalizations. 10/
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So why hasn’t a variant come along that has both negative characteristics? Will it? The answer to the first question is largely randomness. There’s no reason why both types of mutations can’t exist in the same virus variant. 11/
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The more opportunity, the more random things will happen. So it’s also the length of time of the pandemic, the spread & the too slow, too low vaccination rates that increases the odds. 12/
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Will it happen? We don’t know but we do know that vaccinating the globe and the US more quickly will reduce the odds. In the scheme of viruses Delta already replicates very fast. Not close to measles, but arguably comparable to chicken pox. That’s a tall order for a mutant. 13/
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So we could expect to see a lot of “problematic” mutations for the vaccines that never amount to much because Delta crushes them. But what happens if we do see one that’s vaccine evasive that Delta doesn’t outcompete— or at least leaves room for it in some regions? 14/
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There are a few key ingredients that must be ready: surveillance, vaccine development, regulatory & scaled manufacturing/distribution. 15/
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We’ve taken a big step forward in surveillance with the CDC’s new forecasting center. Genetic sequencing need to occur however in many more regions of the US than it does now. Countries around the world are also improving their ability to spot variants quickly. 16/
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Once we identify a new variant, we can test its effectiveness against vaccines in the lab. If one is an evasive mutation, within 100 days we should have the capability to develop a new specialized booster. By that time we should know if the variant is outcompeting Delta. 17/
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why haven’t we gotten a booster through that even encodes the long dominant d614g mutation? something is broken in the chain here, i fear
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