This interview is part of a series of conversations MarketWatch is conducting with some of the leading voices in the U.S. on the COVID-19 pandemic.
Of all the news about the virus that has wreaked havoc on our lives for the last year, the emergence of several possibly more infectious variants in different parts of the world is worrying.
Why? Some of the new variants, including the B.1.1.7 identified by health officials in the United Kingdom, the P.1 in Brazil, and the B.1.351 in South Africa, are thought to be more transmissible, which then raises questions about infection rates, the severity of disease, and the burden on hospitals already struggling with an ever-growing number of cases.
“When they’re hyper-transmissible, they double every week,” Dr. Eric Topol, founder and director of the Scripps Research Translational Institute, said in a Jan. 13 interview. “They go exponential.”
This is why Topol, an expert on many things digital health and a longtime advocate of genomic sequencing, is arguing for wider spread utilization of genomic sequencing surveillance in the U.S. Until recently, not many people were making the case for this type of broad use of the technology, but that’s already changing, driven by fear of the new B.1.1.7 strain.
In recent weeks, President Joe Biden said the U.S. “simply [does] not have the kind of robust surveillance capabilities that we need to track outbreaks and mutations,” as he called for new funding for genomic surveillance. Illumina Inc. /zigman2/quotes/203509482/composite ILMN -1.48% and Helix OpCo announced plans to form a CDC-backed national sequencing surveillance system. And Quest Diagnostics Inc. /zigman2/quotes/201001842/composite DGX -5.12% signed a deal with the CDC to sequence new mutations as part of a longitudinal genomic survey of the virus.
MarketWatch: Has the U.S. put enough emphasis on genomic sequencing during the pandemic up until this point?
Dr. Eric Topol: The U.S. has been a no-show for sequencing if you look at the world stage. We haven’t ramped up. You can see countries that are sequencing up to half of their infections . They’ll know if there’s a new variant of concern at the earliest possible time, and they can quickly determine if “X” mutation can lead to more transmission.
Countries like Australia and New Zealand, they’re up there at 40-plus percent, and the U.K. has been the champion of sequencing, not that their percentage is as high but they have done the most, by far. They have been all over this, and it’s a country that’s only got one-fifth as many people as the U.S. [The U.K. had approximately 66 million people in 2019, while the U.S. had a population of about 328 million then.] We’re at 0.2% [as of mid-December, the U.S. had sequenced nearly 0.3% of its virus samples], and they are in high single-digits. We need to be at least 5% of sampling sequencing, to know what’s coming.
Sequencing gives us many different things. It tells us how the virus is moving from place to place. It tells us how fast it’s changing. We can say it was here on this day, and it was there another day. It can tell a super spreader. Take the White House Rose Garden [event in late September , after which several White House officials including former President Donald Trump tested positive for COVID-19 ] — those people never got sequenced. We could have determined if it came from Trump or its source. You can drill down so much and, most importantly, it can tell you if you’ve got a variant of concern that could be a five-alarm alert.
MarketWatch: How prevalent do you think the B.1.1.7 strain is in the U.S.?
Topol: It’s all over the U.S. It may be around 1%. These variants…when they’re hyper-transmissible, they double every week. They go exponential. We’re probably at just around 1%, and if you just go six or eight weeks, we’ll be at 30% to 40%. And so what is happening in Ireland and the U.K., we will have it happen here, unless we get ultra-serious, which obviously is not happening right now. That’s the worst case because that will be more people dying, more people in the hospital.
[The B.1.1.7 strain so far has been detected in at least 434 people in 39 states, as of Jan. 28, according to the Centers for Disease Control and Prevention. The P.1 variant was detected in Minnesota on Jan. 25, and the B. 1.351 strain has been identified in two people in South Carolina, health officials announced Jan. 28.]
It’s a strain when it markedly changes properties. So we can upgrade the B.1.1.7 and the South African B.1.351 both to strain because they are hyper-transmissible. With the P.1 from Brazil, it isn’t entirely clear. That one we will probably say is still a variant unless it becomes clear that it’s hyper-transmissible.
The other thing is, do they have mutations that are going to interfere with the vaccines? We don’t know that yet. You have to test in animals to be sure, and you need to test it with the whole virus, not just the mutation of interest. These mutations, there are 20-plus, and they interact, so if you just test one mutation, you don’t know. There’s a lot of uncertainty with the vaccines. My guess is they probably won’t interfere with the vaccines, but it’s possible they could have a modest impact. [Moderna Inc. /zigman2/quotes/205619834/composite MRNA -4.36% , BioNTech SE /zigman2/quotes/214419716/composite BNTX -2.97% , and Pfizer Inc. /zigman2/quotes/202877789/composite PFE +2.54% , which developed the two COVID-19 vaccines available in the U.S., have said they believe their vaccines still protect people against the new strains and variants. BioNTech and Pfizer published a preprint detailing their findings on Jan. 19.] Someday we’ll probably see drift further where it will interfere, especially if we don’t get containment of this fire hose. The more it spreads, the more this can happen.
One more thing: It was quickly dismissed that the virus strain doesn’t cause worse disease. I don’t know that we know that yet.
MarketWatch: Why hasn’t the U.S. put more focus on sequencing? Is it because it’s been too busy putting out immediate fires, to think ahead to sequencing surveillance?