Macabre, the record says a lot about the ongoing tragedy in Brazil. More than 4,000 people died from Covid-19 in just twenty-four hours, between April 5 and 6. The average over a week flirts with the equally unprecedented threshold of 3,000 daily victims. The number of new contaminations also remains exceptionally high, with peaks of nearly 100,000 cases depending on the day. It should be remembered again: the Auriverde nation is the second most damaged in the world (351,334 deaths). And unwittingly runs after another record, that of the United States, of 561,074 deaths linked to Covid.
Blind political management on the part of populist President Jair Bolsonaro is no stranger to disaster. His mistakes are reflected in the four corners of the territory by inexplicable health decisions. In this context, and while 600 patients are waiting for a hospital bed in the region, the State of Rio de Janeiro for example made the decision to reopen bars and restaurants on Friday. After the mayor of his megalopolis, Eduardo Paes, had yet decided to close it at the end of March.
On a strictly medical level, the culprit has a barbaric name: 20J / 501Y.V3. Also called “Brazilian variant” or simply “P1”, the dangerous strain of the SARS-CoV-2 virus reigns over the vast country. This is a VOC (variants of concern, or “variants of concern“), just like those spotted in the United Kingdom and South Africa, which are more dangerous because they are more contagious. The Fiocruz Public Health Institute (Oswaldo Cruz) warned on Tuesday against any slackening on him: “The epidemic could remain at critical levels throughout April, prolonging the health crisis and the collapse of services and systems health.” While revealing the existence, in passing, the emergence of 92 variants on the territory, making some observers fear a new phenomenon of the escape of a virus that has become totally uncontrollable. What if this risk spread to the rest of the world?
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A “source to dry up”
“Brazil could turn into a laboratory of open-air variants that can compromise the fight against the pandemic around the world”, alarmed, Thursday, a former regional coordinator of the team to fight against the disease, Miguel Nicolelis, at the microphone of RFI, also describing to Reuters the next day the emergence of a “Organic Fukushima“.
Without necessarily adopting the wording “laboratory”, many experts understand the message sent. “The more viruses circulate, the more they have the possibility of evolving, of generating new variants better adapted to populations. And this, even in the context of an immunity which sets in, natural or by vaccination”, decrypts without astonishment, the virologist at the CNRS Etienne Decroly, at L’Express. For these reasons, “Brazil is an infectious source of variants that should be tried to dry up”, replies to L’Express his colleague Bruno Lina, virologist at the University Hospital of Lyon and member of the scientific council.
The number of variants (92, for the Fiocruz Institute) is not in itself necessarily revealing. “These are for the most part genetic lineages as we detect in France”, with slight differences with known strains, Judge Bruno Lina. Brazil appears to be catching up further in sequencing the virus, with less than 0.5 analyzes per 1,000 cases so far, one of the lowest rates in the world according to the Gisaid platform where scientists share their findings. The Fiocruz Institute recently presented a whole new sequencing method allowing it to be more efficient in this area.
Le journal local A Gazeta however, reported Thursday the discovery in the east of the country of a strain carrying a combination of 18 mutations, some present in the Brazilian P1 and P2, South African and British variants. Although not much more is known, this is typically the kind of reaction that healthcare professionals dread. “Because of the lack of on-site control, variants such as P1 which have emerged in Brazil have already acquired the possibility of infecting people who have had the disease,” recalls Bruno Lina. And the longer the situation persists, the greater the risk of seeing them strengthen with new particularities.
Three questions are essential to assess their real dangerousness. “Are they more infectious variants, able to gain the upper hand, like the British in Europe? Are they more pathogenic, able to send more people to the hospital, and more deadly ? And finally, do they escape vaccine protection? “Lists L’Express virologist Yves Gaudin, research director at CNRS. Impossible to know for the vast majority of them, yet. With the exception of the reassuring P1.
The shadow of P1
In Brazil, the P1 strain accounted for 65% of new contaminations at the start of April, according to the platform Nextstrain and dominates the country in the same way as the B.1.1.7 (British) in Europe. Brazilian works published in March 2021, on MedRxiv (pre-print), suggest under its hood a transmission potential up to 2.52 times higher than the original strain of SARS-CoV-2. And nearly 68% larger than that of the variant from the UK, writes epidemiologist Eric Feigl-Ding, on Twitter. Its capacity for reinfection would vary between 25 to 61%. These effects are made possible by two particularly worrying characteristics: mutations in the S (Spike) protein N501Y, E484K, respectively shared with British and South African strains, as well as K417T, which boost transmissibility and resistance to immunity.
More recently, AMIB (The Brazilian Intensive Medicine Association), insisted on the high mortality figures since the strain became dominant in the country, with a 193% increase in those under 45 since the last wave. of autumn.
On the vaccine aspect, recent tests with the Chinese vaccine CoronaVac (already authorized), published in Science, are only 50% effective against symptomatic forms of P1. Barely more than those carried out by the Brazilian biomedical research center, the Butantan Institute, carrying a “homemade” vaccine project of the same name supposed to accelerate a very slow campaign.
Vaccination, started late in Brazil using AstraZeneca serum, whose precise resistance to this variant is not known, is struggling to take off with only 10% of the population having received a first injection on site. . The Pfizer-BioNTech vaccine, perhaps the most promising given its results on the South African strain and the E484K mutation, is not yet available on site. The order for 100 million doses was not placed until around mid-March by Jair Bolsonaro. About 13 million are expected to be received before the end of the first half. Enough to immunize barely 3% of the global population.
What about France?
The P1 strain worries, especially since it is able to cross Brazilian borders. Several hundred cases were recently detected in British Columbia (Canada), in a ski resort, where local authorities were able to observe the very particular virulence of the virus in the youngest. If cases are observed everywhere in Peru, Uruguay, and throughout Latin America, the situation is more contrasted on the continent where P1 (22% of the sequences observed) faces stiff competition from B.1.1. 7, the British variant (28%), according to figures published on Nextstrain.
In France, the last epidemiological bulletin of Sante publique France (SPF), dated April 8, reports a “stable” situation, as regards “the suspicions of variant 20H / 501Y.V2 (South African ) or 20J / 501Y.V3 (Brazilian) “, to 4.2% of the positive cases recorded in the territory. Even within this estimate, the share of the Brazilian strain, first identified in February, appears to be minimal. In the order of 0.5 to 1%, figure Jacques Izopet, head of the virology department of the Toulouse University Hospital, at La Dépêche du Midi. Strong departmental disparities exist, between a Moselle weakened by the South African variant and Guyana geographically perhaps more likely to receive new cases of P1. “There, we are currently witnessing a gradual increase of cases infected with this strain“, notes Bruno Lina, who reassures despite everything:” The competition between the variants is for the moment turning largely to the advantage of the British variant which is transmitted better and tends not to give way to the others. ”
This modest spread of P1 in France does not prevent calls for stricter border control from flourishing. Random inspections do take place at Paris airports, checked the daily Release, without knowing those specifically dedicated to the few flights crossing the Atlantic every day. Isolation, however, is not compulsory but only recommended. Quite the opposite of countries practicing the so-called “zero Covid” strategy such as Australia.
“Simply asking for a test may not be enough,” said the virologist Vincent Maréchal to L’Express. “Insulation must be mandatory before the variant stains oil.” For the P1, particularly dangerous, just like others. “The circulation of viruses should calm down until the summer. This will then be the time to take decisions to limit the reintroductions of variants. It would be dramatic if some who escape vaccination appear on the territory”, says t -he.
The P1 variant already has the appearance of a “champion”, due to its high contagiousness, and its dominance in a country like Brazil. In his eyes, all that is lacking is the “founding” effect, as Vincent Maréchal calls it. A massive introduction, allowing him to struggle with the British strain. And why not acquire other mutations annihilating all the efforts made to restrict its propagation. A catastrophic scenario to which this virus has unfortunately accustomed us.
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