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Covid-19: What have we learnt about the new variant in the UK?

BMJ 2020; 371 doi: https://doi.org/10.1136/bmj.m4944 (Published 23 December 2020) Cite this as: BMJ 2020;371:m4944

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New Strain or Brexit Stress?

Dear Editor,

Two weeks before hard Brexit hangs in the winter air: “In Kent in September, scientists now believe, somebody with Covid was the unlucky first person to pass on a variant form of the coronavirus that is maybe as much as 70% more transmissible than the version we have been used to. The exponential recent rise in cases now blamed on that incident and the UK government response have sparked alarm around the world.” [1] This new variant is concentrated in London, South East and East of England. Speaking at a Science Media Centre briefing on 21 December, the epidemiologist Susan Hopkins from Public Health England noted that this region “was seeing increases, whereas by 20 November almost all other parts of the country started to decline.”

The WHO noted: “From 5 October to 13 December, over 50% of isolates were identified as the variant strain in South East England. … Most COVID-19 cases from whom this variant has been identified have occurred in people under 60 years of age. … Further laboratory investigations are required to more fully understand the impact of specific mutation on viral properties” [2]

The New and Emerging Respiratory Virus Threats Advisory Group. NERVTAG meeting on SARS-CoV-2 variant under investigation VUI-202012/01. 18 Dec 2020 noted that there are “currently insufficient data to draw any conclusion on [among other things]: Underlying mechanism of increased transmissibility (e.g. increased viral load, tissue distribution of virus replication, serial interval etc)”. [3] The rate of transmission of the variant has been based on epidemiological, but not patients’ infectivity data. Thus, the relation is only correlational.

Let’s look into three hypotheses for the causal route:

• Hypothesis 1: A new and more transmissible strain of the virus is detected in the Southeast of the UK. This strain causes an upsurge in the number of infected people who fortunately don’t appear to become more ill through infection.

• Hypothesis 2: Pure chance or coincidence: According to (Australian) Victoria’s deputy chief health officer, Prof Allen Cheng, “it could be simply the strain that was involved in a super-spreading event, or spreading in a part of the country where restrictions are less strict or less adhered to. Higher viral loads could reflect detection earlier in the illness.” [4] However, according to Susan Hopkins, an initial review looked at any link to particular groups in the population or workplace. This proved not to be the case.

• Hypothesis 3: A social nocebo reaction in that specific region, co-engendered by acute Brexit mishap, makes people more suggestible, vulnerable to nocebo and vigilance to the symptoms of the viral disease that presently also has a huge symbolic meaning to many people. A stressed immune system is more vulnerable to COVID, whereby people may become more ill and infective. A potentially hard Brexit is specifically notable and damaging to people in the Southeast of the UK and London, where inhabitants have always been strongly anti-Brexit. Possibly, non-retired people (<60 yrs., see above) are disproportionately affected by Brexit-strain. Additionally, social nocebo can spread in unpredictable ways. New strains of the virus appear everywhere and continually. In the UK, a specifically performant detection system incidentally notes this new strain. The enhanced viral spreading is not caused by this new strain but by social nocebo in a region that happens to harbor this strain. The new strain is the surfer, not the surfboard.

This would not be the first recent case of social nocebo with an adverse effect on health, although it – probably – seldom happens at such a scale. For instance, in October 2019, at Starehe Girls Centre, Kenya, 68 students were isolated, showing symptoms of cough, sneezing, and low-grade fever, later concluded to be a case of ‘mass hysteria’ (social nocebo). Another example is the Emirates Flight 203 case in September 2018, in which 106 of 521 passengers on a 14-hour flight from Dubai to New York reported symptoms of coughing, sneezing, fever, or vomiting. The plane was quarantined in New York; only a few passengers turned out to have a common cold. The happening in the Southeast of the UK may show that this kind of phenomenon is not bound to any single culture or circumstance. Moreover, stress makes people more prone to nocebogenic suggestion. Stress and other psychosocial factors influence the immune system and viral disease, [5] including common cold, [6] and even vaccine efficiency. [7]

Questions: Will lab tests indicate some difference relevant to transmission? Will this strain show to be more transmissible also outside of the ‘nocebo region’? Will the new strain more than temporarily (appear to) be more transmissible? If not, this provides an additional pointer to the substantial importance of ‘stress’ – as an immensely complex phenomenon – in the global COVID pandemic. The implication of this far exceeds the present upsurge. For instance, nocebo can also play a substantial role in COVID-19 vaccination trials. [8]

Dr. Jean-Luc Mommaerts, M.D., M.A.I., - Ph.D. Jean-Luc.Mommaerts@vub.be - Vrije Universiteit Brussel (Free University Brussels)
Prof. dr. Dirk Devroey, M.D., Ph.D., Dean of Medicine & Farmacy - dirk.devroey@vub.be - Vrije Universiteit Brussel (Free University Brussels)

Bibliography
[1] https://www.theguardian.com/world/2020/dec/21/new-covid-variant-in-uk-sp...
[2] World Health Organization. SARS-CoV-2 variant—United Kingdom. 21 Dec 2020. https://www.who.int/csr/don/21-december-2020-sars-cov2-variant-united-ki...
[3] https://khub.net/documents/135939561/338928724/SARS-CoV-2+variant+under+...
[4] https://www.theguardian.com/world/2020/dec/21/australian-health-official...
[5] Coughlin SS. Anxiety and Depression: Linkages with Viral Diseases. Public Health Rev. 2012;34(2):92.
[6] Cohen et al., 1991] Cohen, S., G.M. Williamson, 'Stress and infectious disease in humans,’ in: Psychol. Bull., 1991 (109), p. 5-24.
[7] Godbout JP, Glaser R. Stress-induced immune dysregulation: implications for wound healing, infectious disease and cancer. J Neuroimmune Pharmacol. 2006;1(4):421–427.
[8] https://www.bmj.com/content/371/bmj.m4924/rr-0

Competing interests: No competing interests

27 December 2020
Jean-Luc Mommaerts
Medical doctor, researcher
Dirk Devroey
Vrije Universiteit Brussel
Laarbeeklaan 103 - 1090 Brussels, Belgium