New and highly infectious strains of the coronavirus have not yet been detected in Hawaii, but the director of the state’s laboratory says the lab is actively searching for clues that would indicate a new variant is circulating among the islands.
One of the latest and highly infectious mutations of the virus that causes COVID-19 disease is circulating on the continental U.S. The variant, called B.1.1.7, was first detected in Britain and has since been discovered in states including California, Florida, Texas, Pennsylvania, New York and Connecticut.
“It’s probably a matter of time that we’ll see one of the new variants here,” Dr. Libby Char said at a press conference Tuesday. “To that end, the better we can isolate that variant and not let it get a widespread grip on our community the better off we’ll be.”
Asked what they could do if the variant was discovered, Char and other state officials repeated advice to distance from others and wear masks.
The latest variants are not necessarily more deadly, nor have they been shown to cause more severe illness. More research is needed. The threat they pose, national disease experts say, is that they could propel the disease more quickly, leading to exponential growth in hospitalizations and deaths just as vaccination efforts get underway.
The Hawaii state lab has the equipment to run the genomic sequencing to detect such new strains, but variants like B.1.1.7 could begin to circulate before the lab’s surveillance efforts confirm its presence. Like Char, Edward Desmond, the Hawaii State Laboratories Division administrator, said new variants entering the isles is inevitable.
“When these variant strains reach here … it might be awhile before we detect them,” he said.
The U.S. is behind on these tracking efforts, according to Marguerite Butler, a University of Hawaii professor who specializes in evolutionary biology and physiology.
The U.S. ranks 43rd in its surveillance efforts, testing only 0.3% of its population, the Washington Post reported, which is leagues behind other countries such as Australia, New Zealand and Taiwan.
The United Kingdom and South Africa were able to detect their new strains because they’re looking at more samples more closely, she said, but the U.S. doesn’t have the infrastructure to sequence samples at the same high rate.
Early research indicates the B.1.1.7 variant could be up to 70% more transmissible — meaning one person could transmit the virus to exponentially more people compared to the current strain. The more contagious version of COVID-19 could become the dominant strain in the U.S. by March, some experts say. As of Jan. 11, there were 72 confirmed variant cases in 10 states.
The timing is inopportune. Hawaii’s vaccination effort is underway — hundreds of kupuna, or elders, showed up for the state’s first mass vaccination clinic on Monday — but it is also lagging behind other states, federal data show.
Last week, Hawaii received about 59,000 doses of the vaccine, according to Lt. Gov. Josh Green. This week, the state received about half as many, and that shipment included both first and second doses. Both the Pfizer and Moderna vaccine require two shots given three to four weeks apart.
At Tuesday’s press conference, state officials blamed the slow rollout on lagging shipments from federal authorities.
“As we go forward, expect to see the vaccinations ramp up significantly, but it will ultimately be constrained by how much we get each week,” Green said. “We often don’t know until Thursday how much we’ll get for the following week.”
The efficiency of the vaccination program is crucial to addressing the threats new variants pose, Desmond said.
“Getting more vaccines into arms is probably our best way forward, but I also fear that B.1.1.7 may get ahead of our rollout of vaccines,” Desmond said. “I’m not the one to make decisions about more rigorous community mitigation measures, but I think that might be called for.”
At the Department of Health’s State Laboratory Division in Pearl City, four technicians are closely assessing 75 specimens per week, or about 300 specimens a month. It used to take the lab two-and-a-half weeks to complete genome sequencing, or analyzing all of the virus’ genetic information. Now it takes six working days, since the lab dedicated two more people to the effort.
The 75 samples per week is enough for a “pretty good sampling” of the Hawaii population, Desmond said.
That works out to about 5% of all positives collected in the islands. The U.K., by comparison, currently monitors about 10% of positive tests, which Desmond considered an “admirable” target.
“I’ve proposed a discussion with the state epidemiologist on the cost effectiveness of expanding our sampling, and whether they consider it to be a good investment to double the amount of sequencing and double the cost, or whether 5% of targeted sequencing is really adequate,” he said. “That’s a discussion we have not yet had.”
Desmond says Hawaii has one advantage that other states lack when it comes to detecting a new variant: cherry-picking specimens from patients with particular travel histories.
The current strategy is to sift through the samples that have the highest probability of being the B.1.1.7 strain by analyzing specimens from patients confirmed to have traveled out of state. In states where people can drive across state lines, it can be harder to detect new variants promptly. Earlier this month, the B.1.1.7 strain was found among American patients with no travel history, indicating it had circulated among the community for some time.
The Hawaii lab also collects specimens flagged by other private laboratories to have certain genetic characteristics hinting that they could be one of the new variants.
Labs across the state — including Kaiser Permanente’s and the laboratory owned by The Queen’s Health Systems, Diagnostic Laboratory Services — are collaborating with the state to find abnormalities in the virus’s genes, such as the spike protein gene the virus uses to enter human cells.
“Most of the testing performed at DLS’ Central Lab is using a kit that can detect an alteration in the spike gene,” said Piia Arma, a spokeswoman for Diagnostic Laboratory Services, by email.
If anything unusual stands out, DLS can conduct further analysis on its own or send specimens to the state.
As an extra safeguard, private laboratories are also holding COVID-19 positive samples for a week in case state lab technicians need to take a closer look. Extra analysis by the state lab is needed to determine whether it is a variant such as B.1.1.7. The lab is also analyzing community samples from all islands, Desmond said.
As a result of this work, local researchers have identified a Hawaii-specific strain, although none of its characteristics give cause for alarm, he said.
“This [Hawaii] strain has some mutations in it but the mutations are not associated with increased transmissibility, or they don’t have any worrisome links to functional changes,” Desmond said. “Nothing like increased transmissibility or vaccine resistance or anything like that.”
There is another option for Hawaii to redouble its efforts, according to Desmond. The state lab division could increase its specialized variant surveillance by contracting with an academic partner such as the University of Hawaii. It would cost $150 to $200 per specimen.
“We have to consider whether that’s a good way to expend public funds,” he said.
Butler says the places in Hawaii most likely to develop a stronger virus strain are settings where people live in close quarters, like the Oahu Community Correctional Facility, which has seen the largest outbreak in the state. The more cases, the more chances for mutations.
Butler thinks Hawaii could benefit by doing more specialized surveillance and that the University of Hawaii is eager to help.
“It would be great to do more, especially because it seems like we don’t have it here yet,” she said. “It is expensive and does take manpower, so it’s a matter of how many resources to put to these various efforts.”
Vaccination, as well as doubling down on distancing and hygiene measures, are among the only ways to really prepare for new strains, she said.
“If we remove the opportunity for the virus to replicate then we will eliminate possibilities of developing possible mutations,” she said. “It’s evolving because we are spreading it everywhere. We’re helping the virus, that’s the problem.”
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