Covid-19: New coronavirus variant is identified in UKBMJ 2020; 371 doi: https://doi.org/10.1136/bmj.m4857 (Published 16 December 2020) Cite this as: BMJ 2020;371:m4857
All rapid responses
In November I wrote to Public Health England asking:
"In how many cases of Covid in the UK has the presence of the SARS-CoV-2 virus been established by DNA sequencing? Please provide information about the status of the cases."
On 10 December, just six days before the publication of this article by Jacqui Wise  I received this reply:
""PHE do not use sequencing as a diagnostic test for SARS-CoV 2. Sequencing is only attempted where a sample has already tested positive for SARS-CoV2 using a standard diagnostic PCR test. PHE is not aware of any instances where the presence of SARS-CoV 2 has been determined using sequencing."
So, no mention of COG-UK. I am puzzled, was there any public knowledge of COG-UK before the present episode? For instance, a search on "COG-UK" in Rapid Responses produces no results, so it was scarcely on the tip of everyone's tongue. What could have been the reason for apparently withholding the details of this no doubt very costly public enterprise?
 Jacqui Wise, 'Covid-19: New coronavirus variant is identified in UK', BMJ 2020; 371 doi: https://doi.org/10.1136/bmj.m4857 (Published 16 December 2020)
Competing interests: AgeofAutism.com, an on-line daily journal, concerns itself with the potential environmental sources for the proliferation of autism, neurological impairment, immune dysfunction and chronic disease. I receive no payment as UK Editor. I also moderate comments for the on-line journal ‘The Defender’ for which I am paid. I am also a member of the UK Medical Freedom Alliance
I read with great interest your news item on the new variant of Corona virus (1). In the early stages of the pandemic this section of the BMJ carried my war cry (2) and after nine months this is not only relevant but even more pertinent and I would like to recap key section of this cry. “As we face one of the biggest Public Health crisis in living memory it is time to rekindle our war time spirit and declare loud and clear – “We shall go on to the end”. “We shall fight in our wards, we shall fight on the streets, we shall fight in our homes, we shall fight at our borders, sea ports and air ports, we shall do all in our power to protect our elderly and vulnerable and our dedicated staff; the nurse on the critical care ward caring for COVID-19 patients or our police constable on the street who are keeping our communities safe; we shall fight with growing confidence and growing strength, we shall defend our people, whatever the cost may be, we will protect life, reduce suffering and promote health and shall never surrender”
Last week we proposed the hypothesis in the BMJ (3) that the geographical variation seen in the growth rate in the three regions including London, South East & East could be explained by the new variant as the epidemic has continued to grow despite tiered restrictions in these regions. On Sunday afternoon the Government placed these regions under Tier 4 restrictions (3). We have been warned that we should be very concerned about this new variant (4).
Dark clouds are gathering in the already wet and windy UK skies with countries closing its borders (5) and media carrying the sombre news that over 50 countries have banned flights from our country (6). There is talk of potential fresh produce shortages in one of the most advanced nations in the Western world (7). Evidence (8) based on modelling shows that travel restrictions worked early in the pandemic but became less effective throughout the year. It is possible that national governments are imposing travel bans to appease their domestic audience as bans appear to be a very blunt instrument and guidance from the World Health Organisation is expected soon.
The question we need to ask ourselves is “Is this our Dunkirk moment in our COVID battle?” and my answer will be a reluctant yes. We can recall and relate to the famous words (9) spoken by one of our greatest leaders during the “Darkest Hour” on June 4 1940. “I have, myself, full confidence that if all do their duty, if nothing is neglected, and if the best arrangements are made, as they are being made, we shall prove ourselves once again able to defend our Island home, to ride out the storm of war, and to outlive the menace of tyranny, if necessary for years, if necessary alone. At any rate, that is what we are going to try to do. That is the resolve of His Majesty’s Government-every man of them. That is the will of Parliament and the nation”.
Fortunately, we are not alone and there is excellent international scientific cooperation, and we are all in this together to defeat our common enemy – SARS CoV-2. The government has to respond and react to rapidly changing scientific evidence as happened in the case of the new variant and the details were presented to ministers on 18th of December (10) and the government acted swiftly after this. The government has successfully overcome many challenges in its COVID battle from dealing with PPE shortages to expanding the Test & Trace system. There are plans to test school children regularly so that they can continue their education safety (11). Vaccination of our population is in progress and further vaccines (12) are in the pipeline which we could deploy as soon as they go through the regulatory process.
So as a country we do have plans in place, but they have to be altered as new evidence emerges on occasions at very short notice. Everyone from the nurse on the critical care ward to the community staff caring for the sick and vulnerable in their own homes have been working long and hard under the most trying of circumstances. Many of us as professionals like our fellow citizens have not been able to see or spend time with our loved ones due to social distancing and ongoing restrictions what are the law of the land. The Public Health community both nationally and locally have done their best to prevent and manage outbreaks and work with their communities to stem the tide of this epidemic. They also try to bring the evidence to local and national leaders so that evidence-based policy decisions can be arrived at and implemented. It is true we may be getting tired after almost n year of dealing with the pandemic, but this is not the time to lose hope or give up. The need of the hour is for us all as a country and as citizens to redouble our efforts in this noble cause and do all we can to keep our men, women and children safe from this ever-changing threat.
Just like the “Operation Dynamo” in 1940 we need “Operation Ultimate Victory” in 2020 and beyond. We have done it once during the darkest hour and won and we will do it again against this virus and we will prevail – History will and must repeat itself!
Dr Padmanabhan Badrinath, Consultant in Public Health Medicine,
Public Health Suffolk, Suffolk County Council.
1 Covid-19: New coronavirus variant is identified in UK. [BMJ]16th December. BMJ 2020;371:m4857 [accessed 23rd December 2020]; Available from https://www.bmj.com/content/371/bmj.m4857
2 Let us fight COVID-19 with Compassion, Optimism, Versatility, Inspiration, Determination and invoke the Blitz spirit [BMJ] 13th March 2020. [accessed 23rd December 2020]; Available from: https://www.bmj.com/content/368/bmj.m1053/rr-0
3 Prime Minister announces Tier 4: 'Stay At Home' Alert Level in response to new COVID variant [internet] 19th December [accessed 23rd December 2020]; Available from: https://www.gov.uk/government/news/prime-minister-announces-tier-4-stay-...
4 COVID-19: Government scientist warns we 'should be very concerned' about new strain [Internet] 21st December [accessed 23rd December 2020]; Available from: https://news.sky.com/story/covid-19-government-scientist-warns-we-should...
5 Covid-19: Drivers urged to avoid ports as France shuts border [Internet] 22nd December [accessed 23rd December 2020]; Available from: https://www.bbc.co.uk/news/uk-england-55392801
6 Now more than FIFTY countries ban flights from UK. [Internet] 22nd December [accessed 23rd December 2020]; Available from: https://www.dailymail.co.uk/news/article-9080611/Now-FIFTY-countries-ban...
7 UK supermarkets predict shortage of lettuce, broccoli and citrus fruit [Internet] 21st December [accessed 23rd December 2020]; Available from: https://www.theguardian.com/business/2020/dec/21/sainsburys-port-restric...
8 What the data say about border closures and COVID spread [Internet] 22nd December [accessed 23rd December 2020]; Available from: https://www.nature.com/articles/d41586-020-03605-6
9 We Shall Fight on the Beaches. [Internet] [accessed 23rd December 2020]; Available from: https://winstonchurchill.org/resources/speeches/1940-the-finest-hour/we-...
10 COVID-19 (SARS-CoV-2): information about the new virus variant. [Internet] 20th December [accessed 23rd December 2020]; Available from: https://www.gov.uk/government/news/covid-19-sars-cov-2-information-about...
11 Coronavirus testing for secondary and college students in the first week of the spring term: Your questions answered. [Internet] 17th December [accessed 23rd December 2020]; Available from: https://dfemedia.blog.gov.uk/2020/12/17/coronavirus-screening-for-second...
12 Oxford/AstraZeneca COVID-19 vaccine: MHRA statement confirming letter received. [Internet] 27th November [accessed 23rd December 2020]; Available from: https://www.gov.uk/government/news/oxfordastrazeneca-covid-19-vaccine-mh...
Dr Padmanabhan Badrinath, Consultant in Public Health Medicine, Suffolk County Council & Associate Clinical Lecturer, University of Cambridge. Directorate of Public Health, Endeavour House, Suffolk County Council, Ipswich, IP1 2BX. firstname.lastname@example.org
Disclaimer: The views expressed here are the personal view of the author and in no way represent the views of his employer, Suffolk County Council.
Conflict of interest: The author works in a local authority Public Health Department and leads the local specialist COVID response team.
Competing interests: Conflict of interest: The author works in a local authority Public Health Department and leads the local specialist COVID response team.
The statement “What could happen, will happen” has been attributed to the Greek philosopher Diodorus Cronus (died c. 284 BC) (1,2). Any event which the potential to happen, no matter whether or not the time period that elapses before its eventual appearance is a fraction of a second, a week or a millennium, is said to manifest a “non-vanishing probability.”(1)
Seen from this perspective, the eventual emergence of a new variant of covid-19 (3) somewhere in the world at some time might have been regarded as predictable, simply because a possibility pf it happening did exist. In turn it may have been wise to consider the potential and to plan for such an eventuality.
One implication of the fact that a new clinically important variant of covid-19 with enhanced potential for human-to-human spread has now arisen means that one must seriously anticipate that further new variants could arise in the future, and that those variants may manifest other unhelpful and even dangerous characteristics should also be borne in mind.
What are the further implications of this?
Firstly, viral variation can arise through several mechanisms – including mutation, genomic variation through several forms of recombination, and segment re-assortment in the case of viruses with a segmented genome such as influenza (4) – and it has been pointed out that mutation of covid-19 represents a very major risk for humanity.(5) Given that reducing the overall number of infections - and accordingly overall levels of viral replication - in a population will tend to drive down the opportunities for viral variation to occur, then efforts to achieve that state of affairs should be pursued as energetically as possible. Accordingly, (a) the effective prevention of viral dissemination through case identification, social distancing and the wearing of masks and visors and (b) ensuring the roll-out of an effective mass vaccination programme to reduce the overall burden of infection in a population as rapidly as possible, are even more vital.
Secondly, while the “Cassandra Conundrum” – an apparent lack of willingness of power to listen to “messages of doom” proffered by experts such as doctors and scientists – has been the subject of discussion in the past,(6) following the advice of that great statesman Otto von Bismarck that “Politics is the art of the possible”, if it is indeed possible to anticipate and prepare for a range of relevant outcomes then politicians surely must join doctors and scientists in keeping an open mind about what might actually happen and what might need to be prepared for.
In the current circumstances that includes the need to anticipate the possibility that further harmful covid-19 variants might come along sooner or later, and an associated requirement to plan accordingly. Cassandra has therefore spoken, so to speak, and we have yet to find out if key people are minded to listen.
Competing interests: No competing interests
This article was useful, especially regarding the efficacy of the vaccines, which are expected to remain effective even after slight mutation and their efficacy can be tweaked to made better if the mutation makes it less effective, like tge flu vaccine.
Thank you for providing this much asked for knowledge.
Competing interests: No competing interests
The Covid-19 pandemic is evolving and we are still not learning. Even during the 1918 Pandemic it was clear that overcrowding was of particular significance in transmission  and it is allowed one hundred years later, when the public is given the choice to abandon areas to be quarantined in stampede, easily transferring the virus not only among that group of leavers, but making the restriction measures completely useless, as a multitude of new carriers will spread the virus all over the country.
There is no community spirit and no proper engagement because the political class has failed. They should learn from Eyam’s efforts during the 1665 plague; it was clear the quarantine would be “detested by those who were subjected to it, and often violently opposed” , but it was achieved as the whole community was committed and supported the measures to maintain it.
How can you achieve a proper quarantine nowadays when guidance or adherence to it seems to be politically motivated, when the message is not uniform, when there are many grey areas in the advice, when there is no enforcement, and when there is no example to be followed.
Half measures will not eradicate this pathogen, just the opposite it will feed the virus, allowing it to continue mutating, adapting to the new host, the humans, making transmission easier, creating a never-ending relationship.
It is time to apply learning from history, to put the necessary blockages, to enforce them, to corner the virus so it dies off. Otherwise many more human lives will be wasted, and society as a whole will also suffer unnecessarily.
1. Greenwood M. “The epidemiology of influenza”. Br Med J 1918; 2: 563-566. doi: https://doi.org/10.1136/bmj.2.3021.563
2. Spitale G. COVID-19 and the ethics of quarantine: a lesson from the Eyam plague. Medicine, Health Care and Philosophy. 2020; 23(4):603-9. doi: https://doi.org/10.1007/s11019-020-09971-2.
Competing interests: No competing interests
What is the difference between a variant and a strain? The government described it as a new strain on 17 December, not a variant as you have.
The paper in the link below from the WHO, published in July, identified 5575 distinct variants, so why is this single variant anything more than one of these?
Competing interests: No competing interests