Carrots, sticks, vaccines and variants

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A temperature check before entry to a San Diego bar. Image: Nathan Rupert/Flickr

People who watch police shows often hear about a "person of interest." According to Wikipedia, this is a term used by U.S. and Canadian law enforcement to identify someone possibly involved in a criminal investigation who has not been arrested or formally accused.

Person of interest has no legal meaning. It actually refers to someone in whom the police are interested either because the person is cooperating with the investigation, or has information that would assist the investigation, or possesses certain characteristics that merit further attention. They are not necessarily suspects.

The World Health Organization (WHO) uses a similar term to categorize variants to the COVID-19 virus. A variant of interest is a mutation with genetic changes that are predicted or known to affect virus characteristics such as transmissibility, disease severity, immune escape, and diagnostic or therapeutic escape.

The variant must also be identified as causing significant community transmission or multiple COVID-19 clusters, in multiple countries, with increasing relative prevalence alongside increasing number of cases over time. It could also demonstrate other impacts to suggest an emerging risk to global public health.

In other words, a variant of interest is a mutation that gains attention for significant changes to the original virus, although initially, the full extent of the changes may not be understood completely.

One level up from a variant of interest is a variant of concern. This is a variant of interest that has grown, spread and/or caused other significant changes to the criteria of the original virus. Not all variants of interest graduate to variants of concern. Some fade away; others are absorbed into other variants of concern.

In early 2020, the WHO convened an expert panel to consult on nomenclature of the variants that began to appear. Ultimately, the recommendation was made and the WHO accepted the naming of variants after the Greek alphabet.

This alphabet contains 24 letters. To date, the WHO has recognized and named variants from alpha through theta. Students of Greek history and others interested in orthography recognize that this uses the first 11 of the 24 letters. Canada and the WHO agree on four of the variants being those of concern. Canada considers all others to be variants of interest. 

Greek letters, in alphabetical order

Location of origin

Canadian classification for variant

WHO classification for variant

alpha

UK

concern

concern

beta

South America

concern

concern

gamma

Brazil

concern

concern

delta

USA

concern

concern

epsilon

Southern California

interest

unclassified

zeta

Rio de Janeiro

interest

unclassified

eta

India

interest

unclassified

theta

Philippines

interest

interest

iota

USA

interest

interest

kappa

India

interest

interest

lambda

Peru

interest

interest

Thirteen letters from the Greek alphabet remain as potential names for variants of the COVID-19 virus. In general, all the variants share an important characteristic: they spread more rapidly than the original virus. Significantly, however, the variants have different effects on people who are and are not fully vaccinated. While people who are fully vaccinated can, in rare circumstances, contract COVID, their symptoms tend to be very mild and do not require hospitalization or aggressive medical intervention.

The same cannot be said for the unvaccinated. Although the data change almost daily, at present the unvaccinated account for well over 90 per cent of hospitalizations for COVID-19. Many of these patients are children under the age of 12, who are as yet too young for vaccines. The remainder are generally younger adults, i.e., people between 20 and 40.

Canada is now a world-leader in the percentage of the eligible population that is fully or partially vaccinated. Yet there are groups who still have not had shots. Some of these people are unable to do so for medical reasons; others are unsure, either because they do not feel they have enough information, or because they believe in the various non-scientific theories that circulate on-line, or because they do not trust government, pharma or some other group that is encouraging vaccination.

A third group is determined not to be vaccinated. In my neighbourhood in Ottawa, there are notices on lampposts comparing the vaccine and mask campaigns to totalitarian regimes and urging people to throw off their masks to shed shackles of oppression. In the UK, the antivaxxers call themselves "awoke" and they support "unject," a movement willing to create separate societies for unvaccinated people.

Thus far, there has been little success in changing the minds of the unvaccinated. Incentives such as lotteries and payments have not worked well. Ironically, many of the unvaccinated believe that because so many people have already received two doses, even the unvaccinated are protected.

Governments in the Maritimes, in Quebec and Prince Edward Island have already or are very close to issuing their own version of COVID passports. The federal government is now working to have a national passport that relies on provincial vaccination records.

Not every passport is meant to grant access to venues such as restaurants, sports events, theatres and the like and to deny access to those without vaccination. But in Quebec, where the passport to be available by September 1 will affect the holder's ability to enter such venues, the number of appointments for vaccinations shot up when the passport was announced. People do not want to be excluded from places they have missed during the worst of the pandemic. It appears that neither carrots nor sticks alone can change the minds of the vaccine-hesitant. Both are required.

In the interim, research continues on the appropriateness of giving vaccines to younger children and babies. But until these young ones can be vaccinated, it is incumbent on adults to be vaccinated if only to protect children from severe sickness.

COVID-19 and its variants do not spread on their own. They rely on transmission from one individual to another. Until everyone eligible for a vaccine receives the necessary shots, young children will continue to be hospitalized in greater and greater numbers, as will the immunocompromised and the frail elderly. We may well run through the Greek alphabet before the virus ultimately plays itself out in Canada and around the world. Before then, the WHO may then have to find another alphabet to use.

Evelyn H. Lazare is a retired health-care planner, strategist and executive. Currently living in Ottawa, she now devotes her writing primarily to novels.

Image: Nathan Rupert/Flickr

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