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Covid-19: New coronavirus variant is identified in UK

BMJ 2020; 371 doi: https://doi.org/10.1136/bmj.m4857 (Published 16 December 2020) Cite this as: BMJ 2020;371:m4857

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Covid 19 – predicting the tough-to-predict, and planning for it, is essential

Dear Editor

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.

References

1. http://article.sapub.org/10.5923.j.am.20130302.01.html
2. https://plato.stanford.edu/entries/diodorus-cronus/
3. https://www.bmj.com/content/371/bmj.m4857
4. https://www.sciencedirect.com/science/article/pii/B9780128163313000027?v...
5. https://www.sciencedirect.com/science/article/pii/S2052297520300251
6. https://www.bmj.com/content/369/bmj.m1852

Competing interests: No competing interests

21 December 2020
Stephen T. Green
Honorary Professor of International Health
Dr Lorenzo Cladi
Sheffield Hallam University & the University of Plymouth