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Should You Take Extra Precautions Against New Coronavirus Variants If You’re Immunocompromised or at High Risk for COVID-19?

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The rule of thumb is that even if you’re immunocompromised or living with chronic disease, you don’t necessarily need to take more or different precautions against the new variant — but it’s more important to follow the precautions you already know.

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This has been reviewed and updated as of January 29, 2021.

Coronavirus Variants

You’ve likely been hearing a lot about new COVID-19 variants lately, which can add yet another layer to your pandemic stress. However, understanding how new variants work and what they mean for your health and safety can help you know how to most effectively protect yourself.

A new variant of particular focus among the public health and medical community is the B117 variant, one of several variants that have occurred as a result of mutations to the COVID-19 virus. This variant emerged with an unusually large number of mutations and spreads more quickly and efficiently than others, per the U.S. Centers for Disease Control and Prevention (CDC).

First detected in the United Kingdom in September 2020, the B117 variant is now highly prevalent in London and southeast England and has rapidly spread throughout the world — including to the United States.

The B117 variant is believed to have mutated in an immunocompromised patient who was ill for a long time and then passed on the infection. (Read more here on the link between COVID-19 mutations and immunocompromised patients.)

Here’s everything you need to know about the B117 and other coronavirus variants, and whether or not you need to do anything differently to stay healthy and safe as the pandemic continues.

How Do Coronavirus Variants Occur?

A virus naturally replicates in your body — that’s how it survives and spreads to other people. But this replication process can contain errors. In fact, the RNA enzymes found in the coronavirus don’t “proofread” their work very well, so they make mistakes as they replicate. It’s kind of like how you might introduce a couple of errors if you were to re-type an entire report for school or work.

Sometimes, these mutation works out in the virus’s favor, giving it an advantage in being able to spread more easily to others.

“Whereas some mutations in the viral genome emerge and then recede, others might confer a selective advantage to the variant, including enhanced transmissibility, so that such a variant can rapidly dominate other circulating variants,” note the researchers of a January 15, 2021 report in the U.S. Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report (MMWR).

In other words, when a virus mutates in a way that helps it survive better, that version of it typically prevails — think “survival of the fittest.”

“A virus will always try to mutate and stay more infectious because that’s the nature of any microorganism,” says Aditya Shah, MD, an Infectious Disease Consultant at the Mayo Clinic. “By evolution, it will do whatever it has to do to survive, and that is what all other infectious diseases of public health significance in the past have done, including measles, smallpox, and polio.”

In this case, the B117 variant’s mutations are beneficial to the virus because they allow it to spread more easily. This variant is believed to be 50 percent more contagious than the strain that originated in Wuhan, China, according to the University of Minnesota Center for Infectious Disease Research and Policy.

It’s not certain what makes this strain more infectious, but experts have a few theories.

“The coronavirus uses a spike protein to bind to a receptor on the cell [in your body]. One hypothesis is that mutations in the spike protein allow the virus to bind more tightly and efficiently,” says infectious disease physician Amesh A. Adalja, MD, a Senior Scholar at Johns Hopkins Center for Health Security. “Another is that people with this variant have a higher amount of virus in their nose, which makes them more likely to shed the virus in higher amounts.”

Is This Coronavirus Variant More Deadly Than Others?

More research is needed to determine how the B117 variant affects the risk of death in those who have COVID-19.

British officials have said there is some evidence that the new variant may be associated with a higher degree of mortality, but it’s still too early to be certain. Chief Scientific Advisor Sir Patrick Vallance noted in a coronavirus news conference that if 1,000 men in their 60s were infected with the original variant, about 10 of them might die — but that number rises to about 13 to 14 with the new variant.

However, in discussing the risk of death with the new variant, he stressed that “these data are currently uncertain and we don’t have a very good estimate of the precise nature or indeed whether it is overall increased, but it looks like it is.”

The CDC states there is no evidence that the B117 variant causes more severe illness or a greater risk of death.

That said, even if the virus strain itself isn’t deadlier, the B117 variant may lead to more deaths by way of being more contagious. “The number of people who may die will be higher just because the number of people who get infected will be higher,” says Dr. Shah.

It may also lessen the protection that certain parts of the world have achieved over the past year.

More transmissible variants is “bad news, because that means some places that had already started to see protective effects become vulnerable again,” Caitlin Rivers, PhD, Infectious Diseases Epidemiologist at the Johns Hopkins Center for Health Security, told STAT.

Where Has the B117 Variant Been Found?

The B117 variant has been detected in more than 20 U.S. states, per the CDC. However, CDC experts told the Washington Post that it’s likely already in much of the United States.

As of mid-January 2021, the World Health Organization said that 60 nations have reported the B117 variant.

You won’t know from a typical COVID-19 test what variant of the virus you have — that requires additional testing. But based on the modeled trajectory of the variant in the United States, it could become the predominant variant by March, per the CDC’s MMWR.

Experts are concerned because a greater number of cases will strain health care systems and may lead to more hospitalizations and potentially more deaths. Greater compliance with prevention strategies — including vaccination, physical distancing, mask usage, hand hygiene, isolation, and quarantine — will be essential to limiting the spread of the virus.

That said, this won’t be the only new variant of COVID-19 that we see, and there are already others that experts are closely monitoring.

“It’s becoming a mutation-of-the-week game,” Stephen Goldstein, PhD, a coronavirologist at the University of Utah, told STAT.

For instance, another variant called B1351 has emerged in South Africa independently of the B117 variant, even though they share some of the same mutations. Meanwhile, a variant called P.1 emerged in Brazil, which contains an extra set of mutations that could affect its ability to be recognized by antibodies, per the CDC.

“It’s important to remember that there are going to be new variants that arise. The solution to these new variants is to decrease spread,” says Dr. Adalja. “It’s just more evidence that we need to rapidly accelerate vaccination processes.”

What New Coronavirus Variants Mean for Vaccines and Treatments

Public health officials are working to determine if new COVID-19 variants respond to medicines currently being used to treat people for COVID-19 or change the effectiveness of COVID-19 vaccines.

This information is changing rapidly, especially on data is reported from other COVID-19 vaccine trials around the world.

For example, Johnson & Johnson just issued a press release about the results of its phase 3 COVID-19 vaccine trial, which found that the efficacy rate against moderate to severe COVID-19 was higher in the U.S. (72 percent) than in South Africa (57 percent), where the new more contagious variant is driving most of the cases.

Novavax, which makes different kind of COVID-19 vaccine from Johnson & Johnson (and from the mRNA vaccines from Pfizer and Moderna) just issued data that showed its vaccine was nearly 90 percent effective in U.K. study (including in people with the new U.K. strain), but was only 49 percent effective in a study in South Africa.

This may sound alarming, but it underscores the importance of trying to get as many people vaccinated as quickly as possible and to slow transmission of the coronavirus by continuing to emphasize mask wearing, social distancing, and other prevention strategies, public health experts emphasize.

“We need to do everything we can now […] to get transmission as low as we possibly can,” epidemiologist Michael Mina, MD, PhD, of Harvard University told AP News. “The best way to prevent mutant strains from emerging is to slow transmission.”

The B117 variant may require 82 percent of the population to get vaccinated to control its spread, estimates a January 2021 preprint study from University of East Anglia. That’s compared to just 60 to 70 percent of the population achieving immunity, which is what the World Health Organization has said would be needed to break the transmission chain.

Vaccine makers are studying how their vaccines work against emerging strains and whether additional booster shots or formula tweaks will be needed. For example, the COVID-19 vaccine maker Moderna is currently developing two booster shots (one to combat the B1351 variant and one to more broadly fight against future potential mutations). Pfizer, which makes the other COVID-19 vaccine currently authorized in the U.S., says it might adjust its vaccine based on new variants, similar to how the flu shot is adjusted from year to years.

How to Protect Yourself If You’re Immunocompromised or at High Risk for COVID-19

If you live with a chronic illness, are immunocompromised, or have a higher risk for severe COVID-19, you may already be taking every extra step to prevent getting COVID-19.

In fact, 46 percent of patients living with rheumatic conditions like rheumatoid arthritis, ankylosing spondylitis, or psoriatic arthritis adhered to strict isolation measures compared to just 29 percent of healthy controls in an August 2020 study published in The Lancet Rheumatology.

That’s a good thing when it comes to the new coronavirus variants, because the rule of thumb is that even if you’re immunocompromised or living with chronic disease, you don’t necessarily need to take more or different precautions against the new variant — but it’s more important to follow the precautions you already know, says Dr. Shah.

“If you’re following the basic precautions and following them properly, you should be protected from any variant of the virus,” he adds.

The general guidance to follow is simple, yet not always easy to adhere to:

Maintain a social distance of six feet or more from people outside of your household whenever possible.

Wear face coverings when out in public and when you can’t be socially distant.

Wash or sanitize your hands frequently and disinfect commonly touched surfaces.

Avoid large groups or situations when it will be hard to be socially distant.

When spending time with others, being outdoors is safer than indoors.

“If you’re doing everything perfectly well, then the new variant is not going to be able to get to you,” says Dr. Adalja. “It’s not that because this is a more contagious variant, you have to wear your mask 50 percent more of the time or wash your hands for twice as long.”

“However, a more contagious variant will mean you have less forgiveness if you have a lapse, so you should be much better at washing your hands, much better at wearing face coverings, and much better at avoiding crowded and congregated places,” he adds.

In other words, now is a good time to reevaluate your prevention strategies and make sure you’re not just following recommendations to prevent getting COVID-19, but that you’re also following them correctly.

After all, a year of living through the COVID-19 pandemic may have caused many people to get more lax about certain strategies — without even realizing it. Here are a few things to keep in mind:

Upgrade your mask

If you’re using a flimsy cloth mask with one layer of fabric, now is the time to upgrade it to one that has two to three fabric layers.

The CDC still recommends against using surgical masks and N-95 respirators so they can be conserved for health care workers, but you may use a non-medical disposable mask. Some research has found that disposable medical masks can better protect you from infectious aerosolized particles than cloth masks.

When Vietnamese hospital workers were supplied with either two disposable masks daily or five cotton masks meant to be washed with soap and water and reused, the cloth mask wearers were 13 times more likely to get influenza-like illnesses than the disposable mask wearers, per an April 2015 study in the journal BMJ Open. The researchers note that poor filtration, moisture retention, and reuse of cloth masks may result in a higher risk of infection.

There is some discussion around doubling up on masks — wearing a disposable medical mask with a cloth mask on top of it — for even more protection. Infectious disease expert Anthony Fauci recently addressed this issue on Today, for example, saying that it’s just common sense that adding another layer of covering would be more effective. There’s no official guidance on this practice, but it might be something to consider if you must be in a crowded place where your risk of exposure to COVID-19 is much higher than usual.

Make sure your face mask fits properly

Wash your hands or use hand sanitizer before putting on your mask, put the mask over your nose and mouth, and fit it snugly against the sides of your face. If you have to continuously readjust your mask (so it doesn’t slip over your nose) or there are large gaps on the sides, it doesn’t fit properly and you need to find a new one, per the CDC.

Here are eight common mask mistakes you might not realize you’re making.

Tighten up your errands

If you’ve gotten more lax about browsing the grocery store or waiting in line at the bank or post office, now is the time to cut back on nonessential errands. The CDC recommends limiting your in-person visits to grocery stores and other stores selling essentials and ordering items online for home delivery or curbside pickup when possible. If you have to go inside a store, try to go during off-peak hours and always stay at least six feet away from others. Make sure to wash or sanitize your hands thoroughly after running errands.

Know where your close contacts have been

If you’re immunocompromised or at high risk for severe COVID-19, it’s especially important to know that any family or friends you see have been staying safe the same way you have so you can determine your own level of risk. Even if you think they’re trying to stay safe and avoid coronavirus exposure, always start by asking these five questions. Remember, the fewer people outside of your household that you come into close contact with, the better.

Reinstate Zoom or other virtual gatherings you had at the beginning of the pandemic. If you’ve let your guard down a bit over the past year when visiting with friends or family, remember that the CDC still recommends staying six feet apart from anyone outside your household and wearing a mask (even if it feels a funny, say, walking far apart from a friend during an outdoor stroll).

Rethink what’s ‘indoor’ vs. ‘outdoor’

Being outdoors is considered to be better for preventing COVID-19 spread, but not if the outdoor space actually resembles an indoor one. For example, some outdoor dining enclosures that are surrounded on all four sides likely have poor ventilation compared with being outside. Here’s more on the safety of outdoor dining enclosures if you’re at high-risk for COVID-19.

If you opt to dine outdoors at a restaurant, only do it with those who are in your household, and stay six feet apart from those who are not, per the CDC.

Let your disinfectants soak

Many people don’t know that most cleaning products should stay wet on a surface for at least one minute or up to 10 minutes to disinfect (that is, kill germs) before wiping it down, per UC Davis Health. The primary route of COVID-19 infection isn’t through touching contaminated surfaces, but it doesn’t hurt to be extra careful and make sure you’re getting the most out of your cleaners.

Sanitize your hands correctly

Don’t let your hands air dry when using hand sanitizer. For it to be most effective, you should rub your hands together until they’re dry, per UC Davis Health.

Continue to follow mitigation measures strictly even after you’re vaccinated

“A common issue I’m seeing now is that some people who get vaccinated are getting this false sense of security,” says Dr. Shah. “You may have up to a 95 percent lower chance of getting sick with COVID-19 than those who are not vaccinated — but that’s not 100 percent.”

The CDC notes that it’s important to continue using all mitigation strategies after you’re vaccinated as we continue to learn more about how the vaccines work in real-world situations: Wear a mask when around others, stay at least six feet away from those outside your household, avoid crowds, and wash your hands often.​

Here’s more on what to do after you get the COVID-19 vaccine.

The Bottom Line

Several new coronavirus variants emerging around the world are more contagious than the strain that originated a year ago in Wuhan, China, and experts are still exploring if they lead to more severe illness or greater risk of death. More variants will continue to emerge as the pandemic continues.

This is concerning, but if you continue to follow existing COVID-19 mitigation strategies, you’ll be protected from any variant of the virus you encounter.

“There’s nothing specifically different that you need to do because of the variant, but you need to do what we’ve been saying from the beginning with much better fidelity and be much more attuned to the risk,” says Dr. Adalja.

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