The lack of national surveillance leaves Utah, another state poorly equipped to manage COVID-19 variants, says Dr. U.
(Rick Egan | The Salt Lake Tribune) Zeanne Timbol administers a test for COVID-19 at the Salt Lake Intermountain Clinic on Saturday, January 2, 2021. Two cases of the British variant have been detected in Utah so far.
Health officials at first weren’t sure how to investigate the first known case in Utah of the more infectious variant of the “UK” coronavirus, according to e-mails from federal, state and county agencies.
But that initial uncertainty may reflect the shortcomings of a national disease surveillance system that relies too much on state and private labs to detect changes in infectious diseases, a Utah doctor said last week.
“Our state of knowledge about the variants that occur in the United States and how they are spreading is, I hate to say, quite uneven and inappropriate,” said Dr. Sankar Swaminathan, a specialist in infectious diseases at the University of Utah. , in a press conference on Thursday.
“We do not really have a coordinated and integrated national system for the high-level, proactive detection of genetic variation. … For this reason I would say that we really have a very knowledge, to be honest, inadequate. ”
Summit County announced Monday that a third Utahn – a woman between the ages of 20 and 44 – has contracted the option. The second case, in Utah County, was announced by state officials last week.
Without a national genomic surveillance system, Swaminathan said, it is impossible to know how easily the British variant has spread to Utah and other states since the first Utah patient with the variant was confirmed in mid-January.
On January 14, county health officials received the news that the man’s test sample was one that had been genetically sequenced by the Utah Public Health Laboratory as part of its surveillance for virus variants – and contracted the so-called “virus variant.” from the United Kingdom ”. . ”
The man had already been identified as possible contact by another person who tested positive for coronavirus in late December, according to emails. But two days after confirming the man’s case, on January 16, an epidemiologist in the county wrote that he interviewed the man and the patient who probably infected him.
None of them traveled recently, she reported, and the source patient did not know where he was exposed to the virus.
Meanwhile, health officials announced the case to the public the day after it was identified – but they did not seem to know how to proceed. County health officials were not sure if it would be possible to know if the patient who exposed the man also had the option or if follow-up contacts should be treated differently for patients with the option.
“There is a specific type of investigation form that must be completed for the case[s]? ”Wrote an epidemiologist from the county.
“Do we need to do more thorough investigations?” wrote Dr. Dagmar Vitek, director of the medical division of the county health department. “Collect PCR [a genetic COVID-19 test] about him and contacts, sequence, look at all his contacts? ”
A scientist at the Utah Public Health Laboratory warned that the variant could be confirmed in the source patient only if he continued to throw the virus more than two weeks after he was diagnosed; his initial diagnosis was in an antigen test, with a sample that could not be used for genome sequencing.
“There have been previous discussions about handling case variants to quickly identify any travel and identify a potential source,” Nicholas Rupp, a spokesman for the Salt Lake County Department of Health, wrote Monday when asked about the emails. launched.
County officials have decided that, for COVID-19 case variants, they will return to detailed contact tracking, where investigators track each contact individually, Rupp said. For most COVID-19 cases, county investigators have moved to a “shared responsibility model,” in which trackers ask patients themselves to alert some of the people they may have had contact with.
The US Centers for Disease Control and Prevention requested details of the man’s case the day after the variant was identified, the e-mails show. But the CDC did not require the sample to carry out its own genomic sequencing until January 20.
It is unclear what information, if any, CDC sequencing produces on Utah Public Health Laboratory sequencing. State health officials could not be reached for comment.
The British variant, called B117, is much more contagious than the strain that previously dominated the United States – but it is not yet known if it is more likely to cause serious illness.
“There is not much evidence for this yet, but there is concern in some of the strains that have been less characterized. And we just don’t know how much of a problem it is, “said Dr. Swamainathan.
On Thursday, the Utah Public Health Laboratory identified only two cases of the UK variant, state epidemiologist Angela Dunn told a news conference. “But remember, we’re just sequencing 10 percent of all our positives,” Dr. Dunn said.
It is “much compared nationally with other states,” she said. “But we are not yet able to sequence every person who becomes positive. So the fact that I found two means he’s here. It is already widespread in the community. And so it means that we have to be extremely careful when it comes to taking preventative measures. ”
The more the virus spreads, the more likely it is to develop harmful mutations, Swamainathan said.
“It’s not necessarily that these things come from abroad,” he said. “With the transmission levels we have here, we will have our own home variants.”