19 May 2021

How the Indian variant threatens recovery

By refusing to adjust the roadmap is Boris Johnson repeating past mistakes?

(Photo By Christopher Furlong/Getty Images)

Imagine you are a front seat passenger. The driver has promised to get you to your destination by a specified time. He has a certain raffish charm, an abiding tendency to be over-optimistic, and a truly awful track record as a motorist. He has twice involved you in major crashes, both of which caused the airbags to deploy. In the distance you can make out a jumble of stationary vehicles. Some have their hazard lights on. Far from slowing, or even maintaining the current speed, your driver presses the accelerator. “Mustn’t be late,” he says, nodding at the melee on the horizon, “though we may have to brake if it hasn’t cleared by the time we get to it.”

The driver, of course, is Boris Johnson and his cabinet. The car is the UK – or at least England. The potential hazard that has just come into view is B1.617.2, a variant of Covid-19 that was first identified in India. And the front seat passenger is the majority of UK expert scientific opinion, which is collectively starting to feel sweat prickle its skin.

What do we know about this new variant? In India it outcompeted other circulating strains – including B.1.1.7, the Kent variant, which is currently dominant in the UK – and drove that country’s devastating second wave.

B1.617.2 is now seeded in the UK, particularly England, and time-lagged data showed it to be rising rapidly in the north-west, London and the south-east from the beginning of May. Absolute numbers are still low, but at the moment its trajectory is mirroring that of the Kent variant in November and December last year, which went on to cause the appalling wave in January.

That, however, is essentially all we know. Sage, the government’s scientific advisory group, currently estimates B1.617.2 to be 50 per cent more infectious than B.1.1.7. It has added caveats to that opinion – some of the apparent transmission advantage might simply reflect the numbers of international travellers bringing it to a particular area – but whatever the Indian variant’s absolute infectivity, it is higher than our current dominant strain.

This matters because England’s roadmap out of lockdown is based on the transmissibility of the Kent variant. Plug in different measures of infectivity and you get a very different set of possible outcomes, including surges and hospitalisation rates akin to the UK’s first and second waves – and these models do try to take account of the current progress of the immunisation campaign.

Vaccines are a key variable: we know they reduce transmission as well as serious disease, but the size of these effects against B1.617.2 are currently unknown. The UK has given first doses to around 70 per cent of the adult population, more than half of whom have also had second doses. There are still a lot of unprotected people but they are the younger, fitter cohorts less likely to develop severe disease or die.

The UK data currently available shows the Indian variant taking off in children and young adults, but not the older age groups where vaccine coverage is high. This could be an indication that immunisation is strongly protective but, equally, when the Kent variant began to take hold last winter, it also spread horizontally through more youthful cohorts before transmitting vertically to older people.

Vaccine coverage among the most vulnerable is excellent, but not universal. The higher the overall case load in the community, the higher the numbers of hospital admissions and fatalities among the partially or completely unvaccinated, or those whose immune systems have failed adequately to respond to jabs. Furthermore, the UK continues to pay scandalously scant attention to the huge number of younger patients left struggling with chronic health problems as a result of Long Covid after our first and second waves.

The risks posed by greater contagiousness would be amplified were the Indian strain to possess any degree of vaccine escape. It lacks the mutation known to be associated with partial vaccine resistance yet it is too early to be sure it will be as responsive to current immunisations as B.1.1.7.

Both nationally and internationally there are documented cases of hospitalisation among fully vaccinated individuals who have contracted the Indian variant. The numbers are too small at present to be able to tell if these are simply what would be expected from good yet imperfect vaccines, or whether they point to the Indian variant having some degree of resistance.

The first wave taught us the impossibility of protecting our borders by focusing control measures on travellers from countries we deem arbitrarily to be “high risk”. And even our flawed “traffic light” system is only as good as those operating it. There is a widely held view that India was placed on the “red list” weeks too late, a decision possibly skewed by post-Brexit trade considerations.

The other lesson we really should have learned by now is the imperative to act early. Pandemics spread exponentially. This means that really serious trouble always looks trivial when it first gets under way – small numbers, very little noise. Act decisively at that stage and you avert a whole heap of grief just a few weeks further on. But if you wait until it is plain that a crisis is developing, you will be too late; it will engulf you. Lockdowns – the pandemic equivalent of airbags – will be the only option left.

Is the advent of the Indian variant the start of a UK third wave? Perhaps, perhaps not. But the thing to do when you see a hazard on the road ahead is take your foot off the accelerator and hover it over the brake. That is why the bulk of UK scientific opinion, including many voices on Sage, wanted the government to delay this week’s further easing of lockdown by at least another fortnight. Gather more information; vaccinate still more people. Johnson has repeatedly shown himself to be a reckless risk taker. In refusing to adjust the roadmap, he has rolled the dice again.