Coronavirus variants call for new public health approach, some medical experts say

In the York Region of Ontario, Medical Officer Dr. Karim Kurji has watched new coronavirus variants spread and is seeing just how they're different — and how public health officials will need to adjust their pandemic approach to keep them out.

There have been household contacts getting sick with symptoms in as little as 12 hours, a higher proportion of cases ending up in hospital and some people appear to be getting infected during shorter interactions, according to Kurji. 

"When we've followed up with cases, some of them have been doing exactly what we've advised them to be doing when they go out just for essential visits, and their contacts externally have been brief, but even within that short period of time, they seem to have acquired infection," Kurji said.

As of Wednesday afternoon, Kurji said the York Region had detected 99 coronavirus variant cases, including 28 cases of B117, the variant first found in the United Kingdom. Health officials are still waiting for sequencing results in the other cases. 

Kurji said only a small proportion have been linked to travel, meaning coronavirus variants are circulating in the community. That has his team taking an aggressive approach to try to stop the virus variants from spreading and taking over. 

"Given that there's a little bit of a delay before we get notification that this is actually a variant we're treating every case of COVID-19 now as a potential variant case and then if it isn't a variant, we can relax," Kurji said.

Kurji said York Region has a special team dedicated to coronavirus variant cases in an effort to identify and isolate contacts quickly. They're following up with virus variant cases daily to ensure people are following guidelines and retesting people before counting the cases as recovered. 

Redefining close contacts

They're also changing the way they determine if someone is a close contact. 

Kurji said the York Region has always been more conservative in their approach to this — it uses a cumulative 10 minute threshold with two metres of distance, rather than 15 minutes. 

But he said now the region is being even more cautious. 

"So we are using subjective methods as well, through the interviews with the individuals to determine whether they would be regarded as close contacts." 

Manitoba health officials learned Monday that the first case of the B117 variant had been detected in the province. 

The person had travelled outside Canada and is now recovered. Health officials said Tuesday that their five household contacts were isolating and had not tested positive for the virus. 

Manitoba said this week they are now screening most COVID-19 positive cases for the B117 variant. 

Dr. Jazz Atwal, Manitoba's acting deputy chief public health officer, said Wednesday anything that screens positive for the virus variant is then sent for genomic sequencing to confirm. 

Atwal said in addition to that, genomic sequencing is also being used for cases involving international travel, outbreaks, severe illness in people under the age of 50 and cases of possible reinfection. 

A spokesperson for the province said it is finalizing plans to contact trace virus variants of concern, including using a lower threshold for identifying close contacts that require quarantine or self-isolation.

Delaying the moment virus variants take over

Dr. Peter Jüni, a professor of medicine and epidemiology at the University of Toronto and scientific director of the Ontario COVID-19 science advisory table, said it's important to ensure the first case of a new virus variant discovered is truly the first case. 

"Is the first one that you detected really the first one? Or, is it just the tip of the iceberg, that's important."

Jüni said the task at hand for Manitoba is to delay the moment new more transmissible virus variants take over for as long as they possibly can.

He said it's believed the B117 variant is roughly 40 per cent more transmissible. 

"Right now, every jurisdiction in the world who doesn't have community transmission, local transmission of these variants yet — be it the B117, be one of the other highly transmissible ones — they will need to try just to keep it now under control," Jüni said.

He said people getting outside when warmer weather hits and a greater vaccine supply will make a difference. 

Viruses don't have legs, viruses don't have wings, they need people.- Dr. Peter Jüni

Currently people entering Manitoba must self-isolate for 14 days, though there are some exceptions. Jüni said that helps.

"You actually really want to avoid additional variants being imported into the province. That's really, extremely important."

He said governments and health authorities also need to be prepared to react faster when it comes to implementing restrictions if coronavirus variant cases start to increase and take over. 

"You need to be much more alert and react immediately based on very subtle signs," he said. "The major signs that we've seen before, you know, that worked with the traditional variants, they won't work anymore."

And guidelines used to limit COVID-19 infections likely won't be the same with new virus variants. 

"We don't know exactly ... but it's safe to assume that the rules that we had, which were all, you know, very arbitrary, 15 minutes etc. ... that these rules probably don't hold anymore. They may never have held before but they might not hold anymore here too," Jüni said.

Still, he said the lines of defence are still the same, including physical distancing of two metres, limiting your interactions inside to people from within your bubble, keeping necessary indoor encounters as short as possible and wearing a high quality three-layer mask or medical mask.  

"Viruses don't have legs, viruses don't have wings, they need people," he said. "If we keep people apart all is good. If we keep people outside, all will be fine. This virus wants to be inside and it's getting transmitted inside if people don't stick to the rules."