Why the P1 Variant Poses So Great a Threat to BC

B.C. Premier John Horgan, in explaining the new pandemic restrictions, seemed to have chosen a health communication method also known as mule training: First, hit the mule between the eyes with a two by four. That’s to get his attention.

Horgan called on the 20-39s not to “blow it,” as if a whole demographic had been intent on a provincewide re-enactment of John Belushi’s Animal House. Social media erupted. CBC reporter Justin McElroy wondered why Horgan had picked on the young, essential but low-paid workers who’ve kept us going for more than a year. And in these pages, one of those workers gave Horgan a sharp response.

Horgan tried to explain himself in a couple of tweets: “My #1 concern is protecting people from this aggressive virus and getting through this last mile safely. I’m trying to catch the attention of the few who refuse to follow the public health restrictions.

“To the vast majority of young people doing everything they can: thank you. No question, most young people have made tremendous sacrifices to fight COVID-19. They're also more often working frontline jobs or living with roommates. Reports of more young people getting sicker due to new variants have kept us up at night.”

“New variants?” That caught my attention, because one new variant of COVID-19 looks seriously dangerous to us all, but especially to the 20-39s.

How the virus mutated

Full disclosure: As a retired science-fiction writer, I hate the very idea of “mutant viruses.” They’re the plot gimmicks of too many crappy pandemic medical thrillers and zombie movies. But I know that viruses do mutate. They don’t mean to: a mutation is a genetic typo, and when you’re making trillions of copies of yourself, you’ll make lots of typos. Most mutations self-destruct, some persist because they don’t slow the virus down, and some explode because they make the virus even more infectious than ever.

Brazil, thanks to its idiot president Jair Bolsonaro, offered the virus scores of quadrillions of chances to make typos while killing well over 300,000 Brazilians. One typo won the lottery, and that variant may buy British Columbia with its winnings.

The variant is called P1, and it seems to have emerged last winter along the Amazon River. Manaus, a city of 2.2 million that had seemingly gained herd immunity from its beating in 2020, found itself being beaten up yet again early this year. The P1 variant seemed to be the culprit, and soon it was all over Brazil.

Then, in the last week of March, Brazilian researchers posted a new study on the preprint site medRxiv, reporting a “sudden rise” in case fatality among young and middle-aged adults in Paraná, Brazil’s most populous southern state with 11 million people. The researchers looked at 550,000 cases in the state, over 8,000 of them fatal, and broke them down by age groups.

“All age groups showed either decline or stabilization of the case fatality rates between September 2020 and January 2021,” the researchers said. “In February 2021, an increase in CFR for almost all age groups could be instead observed. All groups above 20 years of age showed statistically significant increases in CFR when diagnosed in February 2021 as opposed to January 2021.”

Significant indeed. Younger persons around the world had seemed to escape the first wave or two of the virus. A very few fell ill, fewer still were hospitalized, and most who did catch COVID-19 were asymptomatic. They might infect others without even realizing it.

But in February, something happened. Young and middle-aged Brazilians caught the virus in increasing numbers, more were hospitalized and shockingly more of them died: “Patients aged 20-29 years experienced a tripling of their CFR, from 0.04 per cent to 0.13 per cent, while those aged 30-39, 40-49, 50-59 experienced approximate CFR doubling. Individuals between 20 and 29 years of age whose diagnosis was made in February 2021 had an over three-fold higher risk of death compared to those diagnosed in January 2021.”

The P1 variant was closely associated with this surge in fatalities. It was first identified in Paraná on Feb. 16: “As of March 3, 2021, surveillance data had indicated that P1 accounted for 70.4 per cent of tested samples that were screened for the new variant in Paraná.”

The researchers suspected that P1 had spread so rapidly for good reasons: “in addition to enhanced transmissibility and potential immune escape, it may be associated with enhanced virulence and pathogenicity.” That is, it spread more easily than earlier strains, it evaded more people’s immune reactions and it made its victims sicker. A very recent Brazilian study found that P1 is 2.6 times more transmissible than the original virus, and can reinfect many persons who’ve already recovered.

The researchers picked Paraná state not because it was a special case but because it was typical — a big state that by mid-March had counted over 780,000 of Brazil’s 11,363,000 COVID-19 cases. The P1 strain is all over the country, and by the end of March, Brazil’s case counts had risen to 12,748,747.

‘Sometimes they arrive at the ICU just to die’

However bad Bolsonaro’s policies have been for Brazil, P1 has made them worse. Doctors report that their ICUs are becoming crowded with young patients. One doctor in Brasilia, the capital, told BBC News last month: “In the last few months, we’ve seen more and more patients between 25 and 40 years old, which is scary — they’re my age, they’re young and are already serious, after waiting for [ICU] places in crowded emergencies…. They arrive in need of emergency dialysis, sometimes in shock. All of this makes their prognosis worse. Sometimes they arrive at the ICU just to die.”

A once-capable health-care system is now in collapse. On March 30, 3,780 Brazilians died of the virus, a new daily record. On March 31, the death count broke the record again with 3,869.

The second-biggest cemetery in the megacity of São Paulo has suspended operations because it has run out of space for graves.

That city also saw at least 230 suspected or confirmed COVID-19 cases die while waiting for a bed in an intensive care unit. Meanwhile, Rio de Janeiro hospitals have 1,300 idle beds and 1,000 patients needing them — but the hospitals lack the staff to support them.

‘The greatest health and hospital collapse in history’

On March 31, the newspaper O Globo reported that ICUs in 17 Brazilian states and the federal district are at least 90 per cent occupied. Another seven states are at 80 per cent or higher. And this is two weeks after the county’s major health institute, Fiocruz, declared that “Brazil is going through the greatest health and hospital collapse in history.”

The collapse may soon extend to the Bolsonaro government, which has seen a rapid turnover this past week in senior government ministers as well as the heads of the army, navy and air force — who all quit at once to protest the sacking of the defence minister. The media are talking about impeachment before Bolsonaro stages an “autogolpe,” a coup to give himself more power.

Finding a BC foothold

Public health officials and politicians around the world must be watching Brazil and taking detailed notes. What happens in Brazil, they know, doesn’t stay in Brazil. And while P1 was spreading through Paraná a few weeks ago, it was already finding a foothold here in B.C.

The B.C. Centre for Disease Control publishes weekly COVID-19 situation reports, including the number of variants found by testing. In epidemiological week 8 (Feb. 21-27), BCCDC reported 502 cases with the B117 variant, 33 with B1351, and 11 with P1.

Over the next three weeks, the first two variants grew steadily, but P1 grew exponentially: 11 cases in week 8, 21 cases in week 9, 84 in week 10, and 269 in week 11, which ended on March 20. At that rate, P1 could cause 6,859 cases by late April, and 168,000 by late May.

In its week 11 update, BCCDC also noted that “Adults 20-49 years of age comprised 58 per cent of all SARS-CoV-2 VOC [variants of concern] cases in B.C., and also comprised 1,066 (56 per cent) of the B117, 20 (42 per cent) of the B1351 and 211 (78 per cent) of the P1 variants that were detected.” So while B117 has so far caused more cases, P1 is already beginning to crowd it out.

And BCCDC’s update is already dated: On April 1, the Globe and Mail reported that “Whistler recorded 1,120 COVID-19 cases from the beginning of January to March 28, with 218 of them last week alone, driven by the P1 variant most commonly associated with Brazil. The majority of cases — 83.2 per cent — are in people aged 20 to 39.” The ski resort is now the site of the biggest P1 outbreak outside Brazil.

If John Horgan knows those numbers, and he certainly ought to, he might well worry about British Columbians between the ages of 20 and 39 — especially those exposed in the workplace. It’s not just that more will die, but that more will be hospitalized and more will require intensive care. As well, more will survive to become “long-haulers,” needing medical attention for months if not years and unlikely to be able to work or study in the meantime.

Worse yet, every new COVID-19 case gives the virus still more chances to make another lucky typo, perhaps one that’s even nastier than the current variants.

We now find ourselves in an arms race. Our new vaccines seem to work fairly well against the current variants, so every vaccinated Canadian is another barrier to their spread. But vaccination depends on logistics and sometimes the willingness of people to accept the vaccine. The virus isn’t so picky, and it can mutate just as easily in an anti-vaxxer as in anyone else. The consequences will be life-threatening for everyone: a collapsed health-care system can’t look after COVID-19 cases or anyone else, for that matter.

John Horgan tweeted that he was staying awake at night worrying about new strains, and he has good reason to. None of us should sleep soundly until everyone in B.C. — and on the planet — has been vaccinated. No one is safe until all are safe.