Don’t Sweat the COVID Variants with Dr. Monica Gandhi

"Beware the variants!" scream the headlines all over the news. Now that the vaccine is available for SARS-CoV-2, we are pounded with an almost endless daily fear-filled stories about how the variants of COVID are coming and will continue to put people in the hospitals, ICUs, and funeral homes. But are the variants really that dangerous? Are there really wholesale mutations occurring in this virus that will make our natural immunity or vaccine immunity ineffective? According to my guest, Dr. Monica Gandhi of UC San Francisco medical school, the answer is a simple no.

How Does Immunity work?

Our discussion begins not with the variants but in talking about the basic units of our immune response - T cells and B cells. In short, B cells are the ones that make antibodies and persist for life (usually) in our lymph nodes waiting to get reactivated when the virus reappears later in our life. T cells function to clear the virus from our body and also persist long after the infection has gone. They too have life long memory to help us clear infections when the same viruses try and get us sick a second time.

An important point to consider is that we expect the presence of antibodies to wane over time. That is a perfectly normal process in our bodies. That's why we have B cells and T cells which are left to provide the memory or past infections and at the ready to ramp up a quick response if a virus returns. If the antibodies never left our blood would be too thick with proteins said Dr. Gandhi.

Will the Variants Evade our Immune Systems?

The concern a lot of doctors, public health authorities, and elected officials have expressed is that SARS-CoV-2 is mutating. They worry that its variants will not become more infectious or dangerous and they will make the immunity gained through natural infection and vaccination ineffective. This is not something we should worry about according to Dr. Gandhi.

Our immune system is designed to protect against just this very occurrence in nature. Viruses may evolve and change but SARS-CoV-2 is still the same virus. When we develop antibody defenses it is against around 100 sites on the spike protein so if a few of those change we will still have dozens of antibodies still that will work against the virus. This is why despite newer variants showing up they are turning out to be just as susceptible to our immune systems.

Did the Lockdowns Work? How About the Mask Mandates?

Dr. Gandhi also has an MPH in epidemiology and biostatistics and we briefly discussed the effectiveness of the various non-pharmacological interventions like the economic lockdowns and mask mandates. She takes a fairly sanguine view of these measures and feels that there isn't very good date showing that any of them were all that effective. Certainly, more research has to be done but it was clear that strict lockdowns or no lockdowns did not have a clear benefit when comparing various state policies. It that were the case, then California which has had the most stringent rules would have fared significantly better than other states instead of being right in the middle for cases, hospitalizations, and deaths.

Should Children get Vaccinated?

Dr. Gandhi is not sure what the best policy is for kids and getting vaccinated, however, she thinks we should all be glad that COVID rarely causes severe disease in children. What is more pressing, in her opinion, is moving the vaccines we are giving to our kids and distributing them throughout the world where the potential to prevent a lot more serious illnesses in the elderly is far greater. Equity in treatments should be near the top of our considerations right now since the benefit to children and the population at large is so small. Especially when there is an opportunity to do so much good elsewhere in the world.

Transparency is Key.

Finally, we spoke about the controversy with gain of function testing that has been occurring in laboratories around the world and whether that was a wise decision. The key for all these issues including public health is to be up front, honest, and transparent with the public. Every white lie or justification further erodes the public's trust with doctors and the government. One good example is that the push to get children vaccinated really has more to do with protecting adults that kids unlike a lot of childhood vaccines for viruses that affect children (whooping cough, mumps, measles, rubella, etc.).