Will the India variant (B.1617) take hold in the UK?

As an American living in Asia, I’ve written a surprising amount about UK politics in recent years. It started with a desire to understand the referendum that sent the nation towards the EU’s exits and mushroomed into a variety of related challenges.

I have a nearly completed book, The Dividing Kingdom, which followed matters from the time of the referendum into the Johnson era. I learned a lot about the PM researching that book. None of it was admirable or endearing in the least.

As Theresa May stepped down in summer 2019, I felt compelled to call out what I saw as a man that was clearly unfit for the job. I wrote multiple op-eds encouraging Britons to see him for what he was to no avail.

The UK's pandemic response

The current narrative around the UK’s response goes something like the following.

They started out poorly, not realizing the danger of the circumstances, and took too long to react to the first wave. The second wave was far worse as the Tories then waffled until the virus again forced their hands.

Once they had access to vaccines, they ramped up delivery. Johnson's administration took a chance on extending the time between people's first and second shots. This allowed the nation to get first doses to far more people than they would have under the standard vaccination regiment. Given the rapid decline in cases — the UK’s daily death toll recently dropped below fifty, after eclipsing 1200 for multiple days in January — the decision has been received as a brilliant maneuver. While many likely remain upset with their performance, the general mood is one of appreciation for what seems a path towards a return to normal lives.

The Johnson administration’s path ahead seems straightforward. Get vaccines out to the rest of the willing members of the public as quickly as possible and try to minimize transmission in the meantime. I’d vehemently argue for a Zero COVID approach that aimed for the total elimination of transmission. Unfortunately, Johnson’s team isn’t going for it yet. Setting the approach aside, I’m getting worried that the path ahead might not be as simple as it looks. For that, we need to look at the rise of variants.

Enter B.1617

When Prof Devi Sridhar went on the BBC yesterday to discuss the current circumstances, she claimed, “This is going to be the year of the variant.” News out of Brazil, the UK, Canada, and India all seem to align with this sentiment.

India is currently experiencing a horrific rise in cases, and while testing of variants is limited, several different ones have been found, and one (B.1617) appears to be taking off. Overall, the seven-day average caseload jumped from 143,000 a week ago to over 230,000 today. A month ago, the daily figure was around 40,000. A month before that, it was just 12,000 cases. The resulting curve is terrifying.

I don’t know enough yet to dig deep into the circumstances in India, but there's growing concern around a relatively new variant, B1617, that was discovered in India and has reportedly become the most common one there.

Update: The state of the pandemic in India creates a problem for vaccination efforts in many countries. I’ve written about the need to waive IP for COVID-19 vaccines and pursue national elimination efforts towards global eradication. The benefit of time has only deepened my belief in these needs.

A flight from Delhi to Hong Kong (Why are we still having international flights?) on April 4 (the last day in the above chart) has resulted in 47 cases. Dr. Karen Grépin shares the known details.

This is a relatively new story, so there are important unknowns.

• Were any of these people infected with the new B.1617 variant that’s spreading quickly through India?

• Did any of them get infected in quarantine after arriving?

• Were there any issues with pre-departure or arrival testing?

These questions are intended to help think through relevant possibilities. There’s no evidence that I’m aware of to confirm any of these things at this time.

In the UK, there have been growing calls to add B.1617 to the list of Variants of Concern and add India to its ‘red list’ of countries from which travel is temporarily banned. Boris Johnson had an upcoming trip to India canceled yesterday, and the UK.GOV site now shows that it will add India to the red list at 4 am on April 23. Shutting down such travel seems the right move, but is trouble already baked in?

More importantly, why is the UK allowing travel anywhere? It only takes one case to open the door to problems. How many cases of the B.1.1.7 variant — a recognized Variant of Concern — has the UK exported?

The UK has already had over one hundred cases of the B.1617 variant, so the red list ban won’t keep it out. It’s now a matter of things like how transmissible it is, but as Epidemiologist Dr. Mike Tildesley noted, not a lot is known about it.

Recap

The UK took a risk with spreading out doses that so far seems to have paid off. The new variant (B.1617) appears to have quickly become the dominant strain in India, where daily infections are off the charts. The UK has banned travel to and from India, but the ban doesn’t go into effect until Friday. The UK already has over one hundred cases of the B.1617 variant.

Prof Christina Pagel adds that the B.1617 variant has doubled every week in the UK (like B.117 did) and that it’s done so in more difficult circumstances. That said, it's still a small number of cases.

Those are the basic facts for the moment. Again, there are many unknowns, and the circumstances are quite different between the two countries, so there’s no reason to panic. But there does appear to be reason to keep a watchful eye on this and for people in the UK to continue to take precautions to avoid infection. (As should everyone everywhere.)

I assume we’ll learn a lot about whether this variant is being suppressed in the UK over the next few weeks. Let’s hope that’s the case. The UK is far ahead of India in terms of the percentage of the population vaccinated. Hopefully, that will make a big difference for them.

That said, I continue to worry about UK leadership. They’re planning to run multiple large events as ‘tests’ (Read here: tempting fate) over the next few weeks. A concert will require its 5,000 attendees to test negative to enter, but then they will not have to wear masks or practice social distancing in the event. And 4,000 people will be allowed to attend the upcoming FA Cup semi-final at Wembley Stadium. Boris Johnson can talk all he likes about encouraging people to “behave responsibly,” but these efforts suggest a ‘rip off the band-aid’ approach to reopening.

I don’t understand the rush. They’re a few months away from having the bulk of their adult population fully vaccinated. I’d want to get through that before considering anything beyond well-measured efforts to reopen.

A closing aside

I have a thorn in my side that I feel the need to address.

Since the advent of social media, it seems like every major news event spawns a collection of individuals clamoring for the limelight. The Trump campaign offered many vivid examples. Like carnival barkers jumping up and down on the TL, they clamor for attention with long Twitter threads that tend to paint the author as the central figure of the event or just sensationalize whatever is happening.

The pandemic has been a prime opportunity for such efforts. Zeynep Tufecki calls out an instance of such.

I’m trying really hard to recognize such efforts and avoid rewarding them. It’s not always easy, but the purveyors tend to regularly overplay their hands.

While I’m on the subject, this was an amazing subtweet of said alarmism.

So don’t let alarm farmers hit your panic button, but please do stay vigilant. We'll get through this.