Why Are the New Strains of COVID-19 More Contagious? Here's What We Know So Far

Just when things were starting to look up on the pandemic front, with a rollout of vaccines underway across the US and in several other countries, the latest news about COVID-19 has reminded us that we've still got a long way to go. A more infectious strain of the virus, identified first in the UK and known as B.1.1.7, has been confirmed in at least 33 countries and five states (California, Colorado, Florida, New York, and Georgia).

Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases, said it's likely that the B.1.1.7 strain has already spread to other states. "I think it's pretty clear that if it's in places like California, and New York and Colorado… that pretty soon it's going to be in several more states," Dr. Fauci told Newsweek in a January 6 article.

Meanwhile, another newly identified strain, linked to a surge in COVID-19 cases in South Africa, is believed to also be more infectious than previous strains. This new second strain, named 501.V2, hasn't been confirmed yet in the US, but Dr. Fauci told Newsweek on January 5 that he believes it's already here. The 501.V2 strain has also been found in the UK, France, Finland, Zambia, Switzerland, Japan, and South Korea, per Newsweek.

Right now, experts do not believe the UK and South African COVID-19 strains are making people sicker or are more deadly, and it's not clear if they will impact the effectiveness of the new vaccines. Here's what experts are saying about the UK-evolved variant that's currently infecting Americans, why potentially dangerous viral strains evolve in the first place, and what this means when it comes to staying safe.

Why are the new strains more contagious? 

First, keep in mind that any microorganism (like a virus or bacteria) can mutate, and there can be no replication without the chance occurrence of such errors, Charles Bailey, MD, medical director for infection prevention at Providence St. Joseph Hospital and Providence Mission Hospital in Orange County, California, tells Health. The more a virus replicates, the more it mutates.

"A mutation is a change in the viral RNA, which may cause a change in the structural proteins of the virus," Supriya Narasimhan, MD, chief of infectious diseases at Santa Clara Valley Medical Center in San Jose, California, tells Health. Viruses mutate because they're carried by different host cells, she says. Being exposed to vaccines also puts pressure on the virus to adapt in order to survive. (Basically, they're trying to stay one step ahead of our efforts to kill them.) But not all mutations are meaningful—some may have no effect on the fitness of infectivity of the virus, while others may actually be detrimental to the virus.

The B.1.1.7 strain may enter host cells more easily, causing infection

Occasionally, however, a mutation emerges that gives the new virus an advantage over the original version—such as the ability to escape detection, greater infectivity, or less susceptibility to vaccine, Dr. Narashimhan explains. B.1.1.7 falls into that category. This variant has 17 mutations in its genome, some of which are in the Spike protein, which is what the virus uses to bind to receptors in human cells.

A mutation to the spike protein may theoretically allow the new strain to more easily enter host cells, thereby triggering infection. "Some estimates have calculated an approximately 50% increase in infection," Dr. Bailey explains. "in other words, 15 new infections from the mutated strain versus 10 from the current COVID-19 strain."

One such mutation is N501Y, which is in the receptor binding domain (RBD) of the Spike protein of the virus. Scientists believe that this mutation may cause it to bind more tightly to the human angiotensin-converting enzyme 2 (ACE2) receptor. Other changes in the Spike protein may allow this mutation to evade detection by certain PCR (polymerase chain reaction) methods, Dr. Narashimhan adds. "It is postulated that the combination of the tighter binding and, perhaps, the failure of some test methods, make it more contagious," she says.

The more contagious strains aren't making people sicker

Dr. Narasimhan confirms that more severe illness hasn't been seen with the new variant. But she points out that if more people get infected, it follows that more will get sick and need hospital care—and a subset of those will not survive. Even if the new variant is not more lethal, the fact that it can spread faster and more effectively may translate to a higher death and disability toll. "To put it another way, a small percentage of a very big number can easily be much, much bigger than a big percentage of a small number," she says. "This is one of the main reasons we are concerned."

The B.1.1.7 strain also seems to have spread farther than experts initially thought—even before it had been identified as a new variant. "This also happened in early 2020 when the virus was well inside the US and beyond China even before we knew it," Dr. Narasimhan says.

Speed of spread doesn't just increase infection numbers; it can also decrease the effectiveness of contact tracing. "The faster any virus spreads, the more people may have been infected by the time an infected individual is first identified, and attempts to contain its spread through separation of susceptible family members or contact tracing can even begin," Dr. Bailey explains.

Here's what to do to lower your risk

Basically, take all the preventive steps we've been told to do for months—wash our hands, stay six feet away from others, and wear face coverings when it's not possible to physically distance. And when a vaccine is available to you, get it. Still, Dr. Narasimhan warns that we don't know yet if those measures are as effective against B.1.1.7 as they were in an identical scenario with the regular strain of COVID-19. "We may need to amp up these measures at a time when society is already fatigued of them."

She adds that we simply won't know all the answers about B.1.1.7 for some time, and that goes for any other emerging new strain. "As health care workers and scientists, we were just seeing a light at the end of the pandemic tunnel with the vaccine rollout and this uncertainty is unsettling," she admits.

The information in this story is accurate as of press time. However, as the situation surrounding COVID-19 continues to evolve, it's possible that some data have changed since publication. While Health is trying to keep our stories as up-to-date as possible, we also encourage readers to stay informed on news and recommendations for their own communities by using the CDC, WHO, and their local public health department as resources.

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Low-dose aspirin administration helps in reducing preterm birth risk

Low-doses of aspirin on a daily basis can help reduce preterm birth risks among first-time pregnancy. The medication can be administered from the 6th week until the 36th week.

The clinical trial, which involved more than 11,000 women in several low-and-middle income countries, found that women taking daily low-dose aspirin were 11 % less likely to deliver before the 37th week of pregnancy, compared to those given a placebo.

Research study suggest that low-dose aspirin therapy in early pregnancy could provide an inexpensive way to lower the preterm borth rate in 1st-time mothers, said the study author.

Preterm birth is the most common cause of infant death and the leading cause of long-term neurological disability in children. According to the study authors, advances in newborn care have improved survival for preterm infants, but this care is limited or unavailable in many parts of the world.

Earlier studies have suggested that low-dose aspirin may reduce the risk of preterm birth and preeclampsia, a potentially life-threatening blood pressure disorder of pregnancy. However, these studies were not large enough to statistically determine the therapy's effectiveness in reducing preterm birth.

The researchers enrolled 11,976 women with a 1st time pregnancy from 7 sites in India, Pakistan, Zambia, Democratic Republic of the Congo, Guatemala and Kenya. Roughly half were assigned at random to receive 81 mg of aspirin daily, the other group received a daily placebo.

Preterm birth ( before 37 weeks) occurred in 11.6% of the women who took aspirin and in 13.1 % of the women who took the placebo. Similarly, birth before 34 weeks ( early preterm delivery) occurred in 3.3% of the aspirin group and 4 % of the placebo group ( a 25% reduction).

Women in the aspirin group also had a lower rate of perinatal mortality ( stillbirth or newborn death in the 1st 7 days of life), compared to the placebo group ( 45.7 per 1,000 births vs 53.6 per 1,000 births.

The risk of high blood pressure disorders of pregnancy at term did not differ significantly between the groups. The low cost and safety of low-dose aspirin therapy suggest that it could be easily adapted for wide-scale use.

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No role of Opioids in reducing pain and disability in chronic osteoarthritis

Opioids provided no clinically relevant pain relief and no clinically relevant reduction in disability compared with placebo in chronic osteoarthritis pain (hip, knee), according to a recent study published in the European Journal of Pain. 

Osteoarthritis (OA) is the most common form of arthritis which has become one of the leading causes of disability in older adults. It occurs due to the break down of cartilage, causing the bones within the joints to rub together causing pain, stiffness, and other symptoms.

OA occurs most often in older people, although it can occur in adults of any age. OA is also called degenerative joint disease, degenerative arthritis, and wear-and-tear arthritis. 

The major treatment hurdle for osteoarthritis is the absence of any good disease-modifying drugs for this disease. Without effective treatment, physicians are left to manage patients symptomatically and the most common thing done by them is to manage their pain. One of the main culprits [driving opioid use] are chronic pain patients and one of the most highly prescribed conditions for opioids is osteoarthritis.

This updated systematic review by Winfried Häuser, Health Care Center for Pain Medicine and Mental Health, Saarbrücken, Germany, and colleagues, evaluated the efficacy and safety of opioids compared with placebo for chronic osteoarthritis pain. 

For the purpose, the researchers searched the online databases from October 2013 to July 2019. Randomized controlled trials comparing opioids with placebo and at least 4 weeks double‐blinded duration were analyzed. A total of 22 studies with 8,942 participants were included in the meta-analysis. Study duration ranged between 4 and 24 weeks.

Primary outcomes were pain relief of 50% or greater, disability, tolerability and safety. Key findings of the study include: 

Based on very low– to low‐quality evidence, opioids provided no clinically relevant pain relief of 50% or greater and no clinically relevant reduction in disability compared with the placebo. 

There was clinically relevant harm related to the dropout rate due to adverse events. 

The frequency of serious adverse events did not differ from placebo. Enriched enrolment randomized withdrawal design: 

Based on very low– to low‐quality evidence, opioids provided no clinically relevant pain relief of 50% or greater and no clinically relevant reduction in disability compared with placebo.
 Dropout rates due to adverse events and frequency of serious adverse events did not differ from placebo. 

"Tolerability of opioids is low and efficacy is not clinically relevant in controlled studies from 4 to 24 weeks for osteoarthritis pain," wrote the authors. 

The study, "Opioids for chronic osteoarthritis pain: An updated systematic review and meta‐analysis of efficacy, tolerability and safety in randomized placebo‐controlled studies of at least 4 weeks double‐blind duration," is published in the European Journal of Pain.

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Evaluating safety and efficacy of migraine preventive treatment for children, adolescents

Cephalalgia, the official journal of the International Headache Society, published the article entitled "Cinnarizine and sodium valproate as the preventive agents of pediatric migraine: A randomized double-blind placebo-controlled trial", by Man Amanat, and Mahmoud Reza Ashrafi from the Tehran University of Medical Sciences, Tehran, Iran.

Migraine affects about 8% of children and adolescents. About half of them continue to experience it into adulthood, leading to remarkable disability and a substantial social and financial burden to the patient and society. Early diagnosis and interventions can diminish the burden of the condition. 

Preventive pharmacologic treatment should be recommended when the frequency of headaches is more than 4 attacks per month or when the quality of life, school attendance or daily activities are restricted. Studies show that migraine preventive treatment can decrease the global burden of migraine. Although various preventive medications have been used for migraine in adults, few have been suggested in a pediatric population.

This paper studied the safety and efficacy of cinnarizine and sodium valproate for migraine prophylaxis in 149 children and adolescents (49 in the cinnarizine, 51 in the sodium valproate, and 49 in the placebo group).

Cinnarizine is a medicine that belongs to the category of antihistaminic medications. It is used to treat problems associated with the inner ear and the brain, dizziness, and sickness associated with motion sickness. Cinnarizine is used to relieve symptoms of motion sickness and balance (vestibular) disorders such as tinnitus (ringing in the ears), vertigo, nausea, and vomiting, as well as Ménières disease (a disorder of the inner ear).

Sodium valproate is a medication primarily used to treat epilepsy and bipolar disorder and to prevent migraine headaches. It is an anticonvulsant drug that is approved for use in epilepsy and bipolar disorder. It has also been used for neuropathic pain and migraine prophylaxis.

The medications were considered effective in reducing (more than 50%) the (frequency) number of migraine attacks and intensity, compared to the placebo group.

"Cinnarizine and sodium valproate may be useful for migraine preventive treatment for children and adolescents. Both medications are safe and well-tolerated in terms of adverse events, but cinnarizine could be considered as a new preventive option for pediatric migraine", explained the authors. Long term safety regarding weight gain should be studied in future trials.

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Does the air we breathe influence our schizophrenia risk?

Schizophrenia affects millions of people around the world and is a chief contributor to disability. Researchers are still working to uncover all the risk factors that could facilitate the development of this condition. A new study suggests that air pollution may be one of them.

According to the World Health Organization (WHO), around 20 million people all around the globe live with schizophrenia.

Hallucinations, persistent false beliefs, disordered thinking, and emotional disconnect chiefly characterize this mental health condition, and it is one of the main contributors to disability.

People who live with schizophrenia also have a higher risk of premature death compared with the general population.

Still, researchers are unsure of what causes this condition and why. So far, they argue that the top risk factor might be a person's genetic makeup, which interacts with environmental factors, such as social isolation and substance abuse.

The search for risk factors, however, continues, and a new study from Aarhus University in Denmark may have identified another one: exposure to air pollution during childhood.

Increasingly, researchers are showing that poor air quality may contribute not just to the development of pulmonary conditions — such as lung cancer or asthma — but also to the deterioration of brain health.

Recently, Medical News Today reported on a study linking exposure to poor air quality with cognitive functioning problems, including memory loss.

The current study — whose findings appear in JAMA Network Open — adds to the evidence that suggests researchers ought to take seriously ambient air pollution as a risk factor for brain and mental health.

Pollution increases schizophrenia risk
In the present study, the researchers analyzed data regarding 23,355 people — all born in Denmark between May 1, 1981, and December 31, 2002 — whose evolution they followed up from the participants' 10th birthday "until the first occurrence of schizophrenia, emigration, death, or December 31, 2012, whichever came first," as they state in the study paper.

The research team had access to information on the participants' genetic data — via The Lundbeck Foundation Initiative for Integrative Psychiatric Research, or iPSYCH — as well as the evolution of their mental health, and data on air pollution during their childhoods.

Of the total number of study participants, 3,531 developed schizophrenia.

The investigators' analysis indicated that individuals who had experienced exposure to high levels of air pollution growing up also had an increased risk of developing schizophrenia in adulthood.

"The study shows that the higher the level of air pollution, the higher the risk of schizophrenia," says senior researcher Henriette Thisted Horsdal, Ph.D.

"For each 10 micrograms per cubic meter [referring to the concentration of the pollutant nitrogen dioxide in ambient air] increase in the daily average, the risk of schizophrenia increases by approximately 20%," she adds.
 
"Children who are exposed to an average daily level above 25 micrograms per cubic meter have an approximately 60% greater risk of developing schizophrenia compared to those who are exposed to less than 10 micrograms per cubic meter."- Henriette Thisted Horsdal, Ph.D.

What this means, the researchers explain, is that if the average person's lifetime risk of schizophrenia is about 2%, people who have grown up in areas with the lowest levels of air pollution will have a risk of under 2%.

By contrast, those who have grown up in areas with the highest levels of air pollution have a lifetime risk of schizophrenia of approximately 3%.

While it is unclear why childhood exposure to air pollution appears to affect the schizophrenia risk, the investigators note that, according to their study, this environmental risk factor is independent of other risk factors for this condition, such as genetic risk.

"The risk of developing schizophrenia is also higher if you have a higher genetic liability for the disease," says Thisted Horsdal. But, she adds, "[o]ur data show that these associations are independent of each other."

"The association between air pollution and schizophrenia cannot be explained by a higher genetic liability in people who grow up in areas with high levels of air pollution," she continues.

Nevertheless, many questions about the potential relationship between schizophrenia and air quality remain unanswered, so the investigators emphasize the need for further research on this topic.

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