Photo: Microscopic Imaging of The SARS-CoV-2, also known as the COVID-19 virus Credit: National Institute of Allergy and Infectious Diseases (NIAID) (CC BY 2.0)
By: David Lochead
As Canadians in several parts of the country are locking down through the third wave of COVID-19 the rise of another variant casts a dark shadow: the P1 variant.
Originating from Brazil, P1 is a variant of COVID-19 medical experts did not want to see develop. This variant spreads potentially 2 to 2.5 times faster than the original COVID-19 variant, is deadlier, and has a strong level of immunity to our current vaccines.
Unfortunately for Canada, P1 is quickly making this country its second home. The P1 variant made its way from Brazil to British Columbia and with 1,810 recorded cases of P1 the province now has the largest concentration of this variant outside of Brazil.
But the P1 variant isn’t staying in B.C., there are 207 cases of P1 in Ontario and 153 cases in Alberta. The Yukon and Manitoba have now reported their first case of P1 as well.
With Canada in the midst of a third wave of COVID-19, the contagiousness of the P1 variant threatens to put the country into a nightmarish fourth wave. Hospitals, intensive care units (ICU) and already over-exhausted medical staff will be pushed even further past their limits. To prevent such a catastrophe, medical experts say governments will need to act quickly by implementing effective and fair lockdown measures while rapidly vaccinating the members of the population who need a dose the most. To add, the public will have to abide by lockdown measures.
The question is: Are we capable of doing it?
Why P1 Is So Deadly
The P1 variant has multiple traits that make it concerning. Primarily, the variant spreads faster than previous ones. The B117 variant, which is causing the third wave in large parts of Canada, spreads 40 to 90 percent more than the original COVID-19 variant, so 1.4 to 1.9 times faster. P1 spreads 2 to 2.5 times faster than the original variant.
The P1 variant is also more deadly than the original strain. A pre-print study found the P1 strain is triple as fatal for people aged 20-29 and nearly twice as fatal for people aged 30-59. This study backs up the accounts of doctors in Brazil, who said patients during the country's P1 riddled wave of COVID-19 were younger than the previous wave.
Previously having COVID-19 does not make one immune to the P1 variant either. A recent report states the P1 variant was able to infect 25 to 60% of the people in Manaus, the Brazilian city where the P1 variant initially spread, and some residents already had levels of immunization from COVID-19.
Vaccines also do not work as well on P1 as this variant has a mutation called E484K, which allows the virus to evade antibodies that fight off infection. The B1351 variant, which is also resistant to current vaccines, shares this mutation.
A study from Oxford University showed that Pfizer and AstraZeneca vaccines are three times less likely to prevent someone from getting P1. With both vaccines at a 90% efficacy or above after two doses for the original COVID-19 variant that puts P1 near 30%.
According to Dr. Eric Feigl-Ding, an epidemiologist and senior fellow at the Federation of American Scientists, that is a tolerable result because 30% is the baseline for the medical community accepting the use of a vaccine.
Raywat Deonandan, an epidemiologist and professor at the University of Ottawa, concurs.
“Any kind of immunity is better than none,” Prof. Deondanan says.
According to Dr. Earl Brown, a virologist and retired professor who has been following the P1 variant, viruses mutate constantly, but it takes a rare amount of mutation to create a variant that is more deadly, which is exactly what happened with P1.
“All these mutations are hitting bullseye,” Dr. Brown says.
Photo: Amazon Theatre in Manaus, Brazil Credit: Ivo Brasil (Creative Commons Zero)
The P1 variant was first detected in Japan on January 6 of this year by a group of people that travelled to Manaus, Brazil. The variant was soon traced back to Manaus and the first case of the P1 variant was reported in the city on January 12.
In Manaus, the capital city of the state of Amazonas, the first wave of COVID-19 between March to June 2020 hit so hard that an estimated 76 percent of the population got the virus. With herd immunity for COVID-19 estimated to be between 60-90 percent of the population the hope was that COVID-19 would not return to the city, but it did.
In December 2020, the P1 variant caused a second wave that overran Manaus’ healthcare system. Hospitals and ICUs were beyond capacity, patients had to be airlifted to different hospitals and others could not receive the care needed to survive. In January of this year, the city had over 3200 deaths because of COVID-19.
After spreading through Manaus for a second wave, the P1 variant is now riding across the rest of Brazil. As of April 17, the seven-day average of deaths in Brazil from COVID-19 was just above 2800 according to John Hopkins University.
From The Amazon To The Mountain
Photo: Whistler Village in Whistler, British Columbia Credit: Joe Shlabotnik (CC BY 2.0)
Even though cases of the P1 variant have been reported in more than 10 countries, the largest concentration of the variant is in British Columbia.
The first cases of the P1 variant were acknowledged in the province on March 9, when 13 cases were reported. Nearly a month later, on April 6, the amount of P1 cases in the province jumped to 877.
Since March 29, P1 variant cases in British Columbia have been close to doubling each week. Rising at a faster rate than any other variant.
But by April 13 the number of cases of P1 had jumped to 1,510, which is 29% of the overall cases in British Columbia. The P1 variant is also causing a massive increase in younger Canadians getting the virus. Adults aged 20-49 take up 61% of all variants of concern cases in British Columbia. How does P1 affect this trend? Well, adults aged 20-49 take up 70% of all P1 cases.
Dr. Feigl-Ding has been following the outbreak of the P1 variant from its original outbreak in Manaus. Over the past month, he has been vocal about his concern over how the P1 outbreak in British Columbia can lead to a more severe wave of COVID-19.
To Dr. Feigl-Ding, health leaders in British Columbia are making a critical error by delaying the sequencing for the P1 variant. Sequencing is the process of screening what variant each COVID-19 case is. British Columbia’s Provincial Health Officer, Dr. Bonnie Henry, says the province will now assume that any new COVID-19 case is a variant of concern. By not waiting to see what variant each case is, Dr. Henry says the province can act quicker in how they treat patients. The result is that information on how many of the COVID-19 cases are the P1 variant is delayed.
“The issue is that mitigations that used to work against a less contagious virus may not work against a more contagious virus,” Dr. Feigl-Ding says. In British Columbia’s case the less contagious virus is B117 and the more contagious virus is P1.
Dr. Feigl-Ding uses the example of retransmission rate. Retransmission rate monitors often a case of COVID-19 will lead to more cases. A retransmission for P1 is higher than B1117 since P1 is more contagious. So by not accounting for the increased retransmission rate of P1 in daily virus data, Dr. Feigl-Ding says that British Columbia is underestimated the potential for COVID-19 to spread in the province and the rest of Canada.
When it comes to communicating the spread of the P1 variant health leaders in British Columbia are not prioritizing new data on the variant either. In their weekly report on COVID-19 cases, the B.C. Centre for Disease Control waited until the last page on their 10 page report to mention how much the P1 variant has spread in the province.
The larger ramification of the P1 variant in British Columbia is if it continues to spread in other provinces. However, Raywat Deonandan, an epidemiologist and professor at the University of Ottawa, says there is still time to control the variant's spread.
"It depends on what we do next that decides whether we should be more concerned about (P1),” Prof. Deonandan says, mentioning there is still time to prevent an outbreak of P1. “But if it becomes the dominant strain, that’s a public health nightmare.”
According to Dr. Feigl-Ding, Denmark and Germany are good examples of what should be done. Both countries had overall cases that were dropping, but the countries kept mitigation measures because the B117 variant was rising.
Now with P1, mitigation measures meant to address B117 will not be enough if P1 variant cases continue to grow.
Throughout Canada, stricter lockdowns may be needed.
Government Action in Provinces with noticeable P1 variant count
Photo: British Columbia Premier John Horgan Credit: BC NDP (CC BY 2.0)
The provinces with above 100 cases of the P1 variant -British Columbia, Alberta and Ontario- have varying levels of mitigation measures currently.
In British Columbia, the P1 variant hotspot, Premier John Horgan’s NDP government has enacted measures that are called a ‘circuit-breaker’. To decrease transmission indoor dining and indoor social gatherings are prohibited. In schools and other indoor spaces masks are necessary and outdoor gatherings must be limited to 10 people. The Whistler-Blackcomb ski resort, where nearly 200 people have been infected with the P1 variant, is shut down completely and everyone in that area is eligible to be vaccinated. While these safety measures have been effective previously COVID-19 cases continue to rise in the province and some medical experts are calling for harsher restrictions.
Alberta is also concerning in the potential for the P1 variant to spread. Alberta has modest restrictions, with a ban on indoor dining and fitness, as well as restricted capacity for retail stores. However there is active resistance to COVID-19 restrictions in the province. Members of Premier Jason Kenney’s own caucus are rallying to decrease restrictions, while law enforcement and health officials say some Albertans are openly defiant about restrictions. With Alberta’s COVID-19 cases tripling over the last month from 4917 to over 15,500 the potential for the P1 variant to grow is possible.
Ontario is in a grave position. On Friday the province broke another record with over 4800 new cases. But that record will continue to be broken. Modelling shows that Ontario is expected to reach 10,000 to 18,000 daily cases by the end of May. Ontario Premier Doug Ford's Conservative government has responded by only keeping essential business and services open, prohibiting indoor and outdoor activities, restricting provincial travel and giving police additional powers to card and fine anyone in the province.
Ontario's measures are wrongheaded according to medical experts, who say that vaccinating essential workers and providing paid sick days is critical to preventing the spread of COVID-19, not additional policing powers.
Currently, Ontario has 207 cases of the P1 cases. Whether the modelling on Ontario’s expected rise in cases projects a growth in the P1 variant is unknown.
What Comes Next
The B117 variant is showing that Canada is not immune to large outbreaks of COVID-19. But if Canada is not diligent, medical experts like Dr. Feigl-Ding say the P1 variant can unleash another level of chaos in our country.
For proof, Dr. Feigl-Ding points out there are hospitals in Brazil that are incredibly well-run and are more capable than some Canadian hospitals.
“Even in those places P1 got out of control and their mortalities are surging,” Dr. Feigl-Ding says.
Fortunately, Prof. Deonandan is confident there will be booster shots to current vaccines that address the P1 variant. But those doses will require time to be available. According to Prof. Deonandan that time should be later this year or earlier next year.
For the present, Prof. Deonandan says fighting outbreaks requires political will and tolerance of the public.
With proper mitigation measures, Canada can avoid the catastrophic outcomes of the P1 variant.
With lockdowns being a part of mitigation experts, members in Canada's medical community are calling for policy that helps Canadians who are disadvantaged by staying at home, such as paid sick days and prioritizing vaccination of essential workers.
At the beginning of the pandemic Dr. Michael Ryan, the Executive Director of the World Health Organization’s Emergency Program, emphasized that governments need to act with speed when facing a pandemic.
“Be fast,” Dr. Ryan said.
“You need to be the first mover.”
With cases of the P1 variant rising Canada can still move, but time is running out.