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An epidemiologist is warning that he expects another coronavirus surge in Florida in the spring because of a combination of factors. WMNF interviewed Dr. Eric Feigl-Ding, an epidemiologist and senior fellow at the Federation of American Scientists in Washington, D.C.
One factor is that Florida leads the nation in the number of cases of the more contagious “U.K. variant” of the coronavirus, which is also called “B.1.1.7.” Another is that Dr. Feigl-Ding feels that more action is needed from Florida leaders — especially Governor Ron DeSantis — for statewide mitigation efforts to stop the spread of the coronavirus, like requirements for wearing masks and a halt to indoor dining.
Governor DeSantis’ office did not respond to an interview request in time for publication.
SK: Let’s start with the good news, at least. In Florida, cases, hospitalizations and deaths are going down, right?
“Yes, that is very good news. And I’m glad to see that. At the same time, while the cases are going down, hospitalizations are going down, the proportion of cases that are the more contagious and possibly the more severe B.1.1.7, variant from the U.K. is inching up. And it’s now over 15%, approaching 20%, of all cases.
“So that is very worrisome. Because as the old strain is declining, the more contagious one is replacing it, and becoming more successful in dominating. And that may lead to some worry in the next coming weeks or months.”
SK: And we’ll talk more about that B.1.1.7, or U.K., variant, in just a second. But let’s remind our listeners: How does any virus, like the coronavirus, become a variant? How does it get variants?
“Right. A variant means just a special mutated combination that is different from the original. It’s a mutant, basically. But a variant is more than just one mutation.
“Sometimes, what gives a variant its power, is the cluster of mutations that allows it to, usually three properties: Either become more contagious as it binds to human receptors and replicates faster, usually. Or it is more severe, as in the viral load is higher and infects and makes you sicker. Or, the third way, is that it is more evasive against prior antibodies and prior vaccinations. By invasive, I don’t mean completely dodging. It just ducks a few more antibodies in your immune system than it previously does.
“So, these are the properties of variants that usually makes them a little more troublesome than traditional wild-type / common type.”
SK: And we know enough about the U.K. variant, also called B.1.1.7, that we know that it’s more contagious, that it spreads more quickly. Also, Florida leads the country in the number of cases of that U.K. variant. And you’ve looked at the math, and based on the doubling time of this, you anticipate that it could become the most dominant variant in Florida.
“That is correct. The B.1.1.7 has already shown, beyond a shadow of a doubt, that it is more contagious by 40 to 60% by some estimates.
“And there’s also evidence that it is 30 to 70% more severe, as in higher rates of hospitalization, and ICU and deaths. That’s also in U.K.
“So, you know, the B.1.1.7 is spreading across the country. But, as I mentioned, it’s starting to replace. Although cases are overall coming down, it’s to starting to replace the previous one [coronavirus].
“In certain ways, this is almost like a ‘2.0’ potential pandemic virus. The old one is dying out. But, that this one is somehow spreading so much faster. That what used to hold the old virus in check, the less transmissible ‘1.0, 1.2’ virus in check, now doesn’t work. When you multiply it by 1.5. When this virus has faster transmissibility and contagiousness.
“So, an R, for example, that is less than 1 — R is the ‘reproductive number’ — for every person who infects, how many additional people? If it’s one, it means it’s even. If it’s higher than one, then the epidemic grows.
“Many states were at 0.8 or 0.9, so slowly our cases are dropping. But that’s with the old variant, for the most part. And if you multiply that by 1.5, then you get a number that is greater than 1. That means the more contagious one, under the same scenario, whatever the mitigation / lockdown you have, it will keep growing. And that is the concern.”
Coronavirus in Florida – “a new surge — probably in April or May”
“[In] Florida it’s declining overall. But the more contagious one is becoming more and more popular. And it might become dominant by mid-March. And it could completely replace the old strain by probably April or May. And that is when we’re going to see a new surge — probably in April or May.”
SK: On Twitter you said, ‘Come on Florida. I don’t want to be that epidemiologist dude who has to remind Governor Ron DeSantis daily that he has a civic responsibility to stop the outbreak of B.1.1.7 in his state, and it spreads to the rest of the country.’ So how do you feel that Governor DeSantis is doing, specifically when it comes to stopping the spread of this B.1.1.7 variant?
“Well, Florida has some of the least restrictions. It’s the most lackadaisical among many states. It has indoor dining, it has a lot of things that’s already happening. And mask compliance is not great.
“But the key is what [Governor DeSantis is] seeing is, he’s seeing the total cases dropping. But he’s avoiding the nuance, that the underbelly of the rise of B.1.1.7 is going to cause greater problems.”
Governor Ron DeSantis should recognize the “looming disaster”
“I’m trying to basically make him understand that the total number is deceptive. Because I’m trying to help him see around the corner. That there’s a looming disaster coming around.
“And the looming potential disaster is when B.1.1.7 becomes dominant and becomes 80, 90% of all cases. And what works now will no longer work.
“So, it’s a matter of early action. We learned that last year. Early action saves lives. But right now, he’s just not seeing that.
“It’s just like when early on in January, February , there weren’t that many cases. You could, you know, rewind a whole year and say, ‘well there’s not that many cases.'”
The U.K. coronavirus variant in Florida is “going to unleash an epidemic”
“But you know what? It’s growing fast. It’s growing the fastest in Florida of all states in the country. And it’s going to unleash an epidemic. And it’s going to transmit out of Florida to many other states. And so we need to stop it at its source. And that is, for the most part Florida, where is growing the fastest. So that’s why I was trying to beseech him to listen.”
SK: What would stop it?
“What would stop it is more mitigation. What works for mitigation still works for this. You have to work more aggressively.
“Like you have to have much more aggressive masking. And as I said, we should adopt double-masking, because we know oftentimes, one mask is not enough, especially if there is poor mask compliance.
“That’s the nature of masks, cloth masks, especially. Cloth masks work if everyone wears them, because its source protection. It protects by masking the source of people who are carrying it [the virus]. But cloth masks are not that great for inhalation protection, for you inhaling it. And a problem is when a lot of people don’t wear masks, it doesn’t protect them if half the people don’t wear masks. So, you need to double mask, with at least a surgical, or switch to premium masks.
“And I think that restaurant indoor dining is too risky. Outdoor dining, I’m okay with if there enough spaces between tables.”
Without good ventilation standards, “this virus will continue to spread”
“But also, schools have to have ventilation. Ventilation is so key. Ventilation is what actually stopped the old pandemic in 1918. Ventilation, and fresh air, or air cleaning. In many buildings, in schools and offices, have poor ventilation. And without good ventilation or air cleaning standards, this virus, this airborne virus will continue to spread.”
SK: We are speaking with epidemiologist Eric Feigl-Ding and this is WMNF’s Midpoint. Keep talking a little bit about the B.1.1.7 variant, which is also called the UK variant and especially how it’s spreading in Florida. You write that that variant carries a package of mutations, including many which change the structure of the spike protein that enhance its ability to bind to the human ACE2 receptor. And that yields higher viral loads — it may shed more virus when coughing or sneezing. So, this might be one of the reasons why it’s more contagious. Because people who have this variant are spreading it to more people?
“That’s correct. And this property is seen by many viruses. There are tons of variants out there. But what makes a variant successful, is when it can replicate faster, when it can survive better, right?
“And it’s a survival of the fittest. The virus is evolving. And the more chances you give the virus to evolve, the better likelihood that it will proliferate. And also find ways to become even better in the next generation, and then the next generation. So, every person that transmits, is giving it another chance to evolve, evolve, evolve again.”
Use mitigation to go for zero COVID
“And so, the only way to stop it is a combination of vaccination — and the vaccine still works pretty well for B.1.1.7, thankfully — and to mitigate as fast as we can. The best way is to go for zero COVID. Go for zero now, instead of being in this Purgatory – open/close open/close. When we could have just slammed it down and eliminated it like many countries, like New Zealand, Australia, Thailand and Vietnam, which is not at all an island at all.
“So, it is possible. If you wouldn’t live with a small simmering fire in your house. No firefighter will allow that. Firefighters want zero fire. We need zero COVID, and this is why. With zero COVID, the virus can’t mutate if it doesn’t replicate. So, this whole mutation thing. I don’t want to live through more mutation cycles. I want to eliminate it. Eliminating it will prevent so much more agony in the long run.”
SK: I think you briefly touched on this just a second ago. Earlier, you were saying that a variant could be more contagious, it could be more severe and it could be evasive. You’re saying that this B.1.1.7 variant that’s increasing in Florida, may not be as evasive as is it could be. It still can be contained through things like antibodies for people who’ve already had coronavirus or from the vaccinations?
“Yeah. It still does work. Vaccines still work against it. The antibody therapy still works against it. This is not entirely true for the South Africa and Brazil variants, which we believe are more evasive. Evasive means partially ducking some of the antibodies and attenuating some of the vaccine efficacy for the South Africa and Brazil [variants]. But for the B.1.1.7, it still works, which means, all the importantly, vaccinate as quickly as possible.
“But it could get worse. And as we’ve seen in California — the new California variant has this triple threat of being more contagious, likely. Of showing some evidence of being more evasive against antibodies and prior infection. And also, possibly more severe. So, all these things, we need to stop playing around with this virus and letting it, ‘Oh we can re-open again. Let it spread a little.’ It’s not okay, because we’re going to have more mutations. We don’t want to play whack-a-mole for the rest of the year and for years to come.”
SK: So, there are mutations — if there are variants out there, you’re suggesting that one way for us to get a handle on what’s there is by ramping up what’s called ‘mutation sequencing.’ How would that work, and what good would it do?
“Well, sequencing is critical because, unlike testing, which identifies the virus, sequencing tells you which version of it. Early last year, remember the saying ‘no testing, no pandemic?’ And now, the saying is ‘no sequencing, no mutation.’ And we don’t want to be blind-sided by this.
“Only by sequencing enough will we know what we’re up against. Are we dealing with a variant that is semi-more contagious, or more contagious? Are we dealing with a variant that more severe, causes more illness, or less so? And do we have a variant that evades prior people’s immunity, or partially attenuates vaccines? We need to know that.”
Some states and leaders are taking “the ostrich approach”
“And so, we need to ramp up all these resources and surveillance. But some states and leaders, they are not sequencing that much. They are basically taking the ostrich approach, and sticking their head in the sand, hoping that the virus goes away.
But, you know, what? The virus will virus. It will not just go away. And it’s something doesn’t care about the sweet little lies that we tell it. It will do its virus thing. And especially mutate, become more infectious. And when more people are immune, they’ll try to find ways to hop over the fence of people’s immunity. That is what nature and evolution has taught it to do.”
We have to fight back “and not be laissez-faire, as Ron DeSantis has been with the virus”
“So, we have to fight back, and fight back hard, and not be nonchalant, and not be laissez-faire, as Ron DeSantis has been with the virus.”
SK: Our guest is Dr. Eric Feigl-Ding, an epidemiologist, and you’re listening to WMNF Midpoint. We’re going to transition now to California. We were talking about Florida and the B.1.1.7 UK variant — it’s likely to become dominant in Florida very soon. But let’s talk now about California. There are two variants there B.1.427 and B.1.429. What do we know about those variants in California, and how they’re spreading?
“This is a home-grown version. This is not imported from anywhere else. It showed up mid-last year. But it’s been slowly creeping up and becoming more and more successful. And it has essentially replaced almost all of the previous ones. It is now more than 50% of all cases in California. Some places even more than that.
“So, we’ve seen that this variant has the triple-threat properties. It is more contagious. How much more? The data is still unclear. It is possibly more severe. They’re looking at rates of disease, of severe disease. And it possibly evades neutralizing antibodies. And laboratory studies have shown that. Vaccine efficacy, we have to see for sure with an actual trial. But if it invades neutralizing antibodies in the lab test, it could bode some problems down the road.”
“We have quite a bit of concern on the horizon”
“But at the same time, our vaccines are very good, so we’ll have to see. But the triple threat, especially the more contagious part, is what I’m worried about. And the fact that it’s replaced and become 50% of the total cases, and possibly driving a lot of the Southern California outbreak in the past month, is really concerning. And it is now in many, many states. Now in 45 different states, but still epicentered on California. And at the same time, it’s also competing with B.1.1.7.
“So, we have now potentially two, I say the two in California are almost the same, I call them one, between that and the B.1.1.7, we have quite a bit of concern on the horizon. And what works now in mitigating the old ‘1.0’ virus may not work against these new ones, if it is more contagious.”
SK: Dr. Eric Feigl-Ding, those are all of my questions. Is there anything else you’d like to leave our listeners in Florida about the COVID-19 pandemic?
“I would say take the vaccine as soon as you can. Don’t be picky about which one. Take it. It’s safe. No one has ever died from the vaccine in any clinical trial. And the rates of success are really, really high.
“But still be careful in the first 14 days after you get any shot, because that’s when your immune system is still building immunity to it. Still wear a mask because there’s still a chance of asymptomatic transmission even if your disease is very, very mild or non-existent. But you could still be carrying it. So still wear a mask.”
Tell your school district to ventilate with fresh air
“And for schools please, please tell your school district to ventilate. Ventilate with fresh air. Open windows, if possible. If you can’t open windows and there’s not good air system with fresh air, get a hepa-filter. I have no conflict of interest, whatsoever, but get an air cleaner that will make sure you get five air exchanges per hour. And, you know, we can have a longer call about this, but this is clearly what we need to do to stop an airborne virus.
“Just because you don’t see the virus, just because you’re outside of 6 feet from someone, does not protect you against an airborne virus. So please stay safe everyone.”
Watch the interview:
2) Florida on pace for early March when #B117 passes >50% & dominant. Study by @K_G_Andersen put it at ~March 9th, with ~9 day doubling time. #B117 is 38-49% more transmissible in Florida, but 40-60% more transmissible according to UK 🇬🇧 data. pic.twitter.com/ENET9bjJeW
— Eric Feigl-Ding (@DrEricDing) February 11, 2021
15) Here is what is going to happen… currently R is ~0.9 in many places, but with the more infectious #B117, the R will jump ~50%. And it is inevitable (CDC & Danish & German models say this) that B117 will take over as the reigning dominant variant soon. @GosiaGasperoPhD pic.twitter.com/VJxF8sBlY2
— Eric Feigl-Ding (@DrEricDing) February 11, 2021
Thank you to Blannie Whelan for transcription help.