Hello. This is doctor Russell Kohl, chief medical officer with TMF Health Quality Institute, again with you for a COVID Medical Minute on August 30 of 2021. Our topic today will be discussing variants. So, this has been a discussion I have gotten a lot of questions about. What to expect of variants? What is a viral variant? And, what are really the implications of that as we move forward, so wanted to dive a little bit deeper into that today to share a little bit of information with you about what viral variants are and what their implications are for disease. Probably the most important thing to start off with is the fact that variants are normal and variants are expected. As you are probably aware, as the virus enters your body, it uses your body’s mechanisms in order to actually reproduce itself. And so essentially it is making lots and lots of copies of itself. Each of these copies is a transcription. And so, over the hundreds of thousands of millions of copies there are a number of those transcriptions that just don’t quite come out right. And those errors in transcription are what lead to variants. While the vast majority of those variants don’t have any sort of medical significance whatsoever, there are some that create key changes in the virus that can make it get slightly different in a way that can make it easier to infect another host. So, ultimately, it’s impossible to keep from having any sort of variants develop of a virus. But, the key aspect to have those variants develop is there has to be people the virus can actually infect and then make copies of itself within. The greater the unvaccinated population that you have, the susceptible population, the greater the number of variants that are able to be developed by the virus over time. So, while that is great technical knowledge, let’s step back and take this to the practical for a second. The variant I am hearing the most questions about right now, obviously, is delta, which is the predominant variant across the United States right now. What does that really mean? It means that there is a variant version of the virus, as we discussed previously, that has made some changes within its spike protein. What that has actually allowed to have happen is that the delta variant of the COVID virus is much more infectious than previous versions. Epidemiologists have suggested that it is anywhere from two-and-a-half to seven times more infectious than the previous versions of COVID. The most concerning aspect, though, is that vaccinated folks have been able to actually be found to have enough versions of the virus in their nose that they actually can be infectious to other people. So, while severe illness is still incredibly rare in vaccinated folks. Most of the vaccinated population who have tested positive, while that does remain rare, most of those folks are having very, very minimal symptoms associated with it. However, the fact that the virus can replicate within them and be passed to other people, does increase that variant-producing capability of the virus. So, if you combine this ability to spread the virus with an unvaccinated population and a variant that is significantly more infectious, then what you see are very hyperlocal outbreaks. So, these are outbreaks that occur in subpopulations within an area. But, you see that across hospitals right now, where between 95 and 97 percent of the COVID patients are in unvaccinated populations. So, the question then becomes, what can I do about these variants in order to protect myself and my community? As of right now, the different variants that we are experiencing in the United States have all still been susceptible to the COVID vaccinations that we have when it comes to protecting you against severe illness or hospitalization, which, remember, is the actual purpose of a vaccine. It is not necessarily to keep you from getting a disease; it is to keep you from having severe symptoms of the disease. However, if we are going to protect those around us who are not yet vaccinated, be they small children who we don’t yet have a vaccine for, or the elderly with multiple comorbidities, and the immunocompromised, ultimately, the best thing you can do to actually prevent the spread of the virus itself, which is spread as an aerosol, is to continue to use masks. A physical barrier that keeps the aerosol and the virus itself from moving between people continues to be one of our most solid prevention techniques. You’ll recall that as we actually reduced the requirements to wear masks to only those who were vaccinated, if you looked around in public, that’s not what actually occurred. Everyone stopped wearing masks, and as a result, we’ve had this secondary surge of delta variants associated with a combination of a low vaccination rate, and low mask usage in those who are susceptible. And while it hasn’t occurred yet, if we do develop a variant that is called an escape variant, meaning it is a viral variant that is able to go around the vaccine and cause severe illness or death in folks from COVID who have been vaccinated, then we will return to the days when essentially a mask was your only protection. Now, that being said, one of the great benefits of the mRNA vaccine is to rapidly adjust that vaccine. Were that to occur, then we are likely to see the need for widespread boosters of an adapted version of the vaccine. Think of it a little bit like the annual flu shot, where we make adjustments to the vaccine based upon which virus is expected to be circulating. We’ll hopefully this has answered most of your questions about variants. I want to leave you with just one final thought, and that is about an endemic disease. You’ve heard a lot about pandemic over the last year and a half or so, but an important phrase is also endemic. An endemic disease is a disease that is common to a population or a location. The impact of an endemic disease is that it is relatively constant. Instead of seeing the surges of activity that we have seen associated with the pandemic thus far, you see kind of a smoldering, ongoing infection. Certainly, that is the likely future we are looking at with COVID-19, so it does remain pertinent for us to think about variants as those variants can certainly change over time. It will be something we will have to continue to watch. Fortunately, that is something the World Health Organization continues to do, even though we currently have 18 variants, of which four are particularly of interest because of their infectivity. That is something that we will continue to watch and it will be important to continue to think about. Hopefully this was able to answer some of the questions you might have had about viral variants. Feel free to send me any questions or comments that we can add into later episodes. Until then, keep up the good fight, and keep making the world a better place.