With input from Dr Monica Vasudev

1330:  Minutes of Virtual Meeting of CMAAO NMAs on “New UK and Brazil Strains”

23^rd January, Saturday, 9.30am-10.30am

Participants: Member NMAs

Dr KK Aggarwal, President CMAAO; Dr Yeh Woei Chong, Singapore Chair CMAAO; Dr Ravi Naidu, Malaysia; Dr Alvin Yee-Shing Chan, Hong Kong, Treasurer, CMAAO; Dr Marthanda Pillai, India, Member World Medical Council; Dr Debora Cavalcanti, Brazil; Dr Marie Uzawa Urabe, Japan Medical Association; Dr Md Jamaluddin Chowdhury, Bangladesh Medical Association; Dr Qaiser Sajjad, Secretary General, Pakistan Medical Association; Dr Prakash Budhathoky, Treasurer, Nepal Medical Association

Invitees: Dr Russell D’Souza, Australia UNESCO Chair in Bioethics; Dr Suresh Mittal; Dr S Sharma, Editor IJCP Group

Key points from the discussion

• Whenever there is a surge in cases and the second peak/wave is bigger than the first, think of new mutation.
• The UK Prime Minister has said that the new UK strain is 30% more dangerous than the original strain. It causes three additional deaths for every 1000 deaths.
• The terms “variant,” “strain,” “lineage,” and “mutant” are synonymous.
• There is a need to study genomics: to identify the virus causing the disease, develop diagnostics and vaccine, to track transmission and to identify re-infection.
• The new variants have the ability to spread more quickly in humans, cause either milder or more severe disease in humans, evade detection by specific diagnostic tests (S gene target failure) and evade vaccine-induced immunity. They are also less susceptible to therapeutic agents such as monoclonal antibodies.
• Unlike the SARS-CoV-2 virus, the influenza virus lacks proof reading activity; no proof reading means more mutations.
• The D614G strain is the dominant strain all over the world.
• The mutation in Nigeria P681H (proline replaced by histidine) is a single mutation occurring at 681 (near the S1/S2 furin cleavage site). This is a virus favorable mutation, but not the best for the virus. It died out as it was an isolated mutation.
• A mutation named N440K (asparagine to lysine) has been detected in India. This mutation is in the receptor-binding motif (RBM). It is found in Andhra Pradesh (34% of genomes analyzed) and also in Karnataka, Maharashtra and Telangana.
• In India, two more mutations - C1240Y and P84T - have been seen in the state of Kerala. These are not in the receptor-binding domain (RBD) or RBM and hence this mutation will die out.
• Another mutation is in Australia - S477N (serine to asparagine); this is in the RBM. But, this mutation also died out.
• Cluster 5 mutation from Denmark had 69/70 deletion. Since it was an isolated strain, it died out. But, this was adopted by the UK strain. This deletion may change the shape of the spike protein.
• N501Y mutation was seen in immunocompromised individuals. This mutation increases the spike protein’s binding capability.
• The UK variant VOC 2020-12/01 adopted 681 from Nigeria, 69/70 deletion from Denmark strain and N501Y from the immunocompromised persons. There are 23 gene mutations in this variant. It is now said to be also more lethal.
• The South Africa variant 501.V2; there are three mutations (two are in RBD and one in RBM). N501Y is the main substitution; it also has two other mutations of concern: K417N lysine with asparagine and E484K glutamic acid with lysine. The new variant is much more contagious than the UK strain.
• A new mutant has also been detected in Japan. According to the National Institute of Infectious Diseases, the new variant includes mutations N501Y, E484K and K417T. This variant of the virus belongs to the B.1.1.248 strain and reached Japan from Brazil. It is different from the strains in Britain and South Africa.Two new variants have been identified in Brazil P.1 and P.2. The P.1 strain carries the E484K mutation along withN501Y and K417T. The P.2 strain is not yet of particular concern to scientists.
• In Israel, 6.8% of people who have taken the vaccine (Pfizer) have already become positive and symptomatic. The efficacy of the Pfizer vaccine in Israel is said to be much lower than was expected.
• The 33 deaths in Norway indicate that the elderly frail individuals were not able to tolerate the mild reactogenicity of the vaccine.
• Three mutations of concern are the UK strain, South African strain and the Brazil strain. This virus is further going to mutate.
• The only answer will be vaccine to be taken every year similar to flu vaccine.

Dr KK Aggarwal

President CMAAO, HCFI and Past National President IMA