Chart of the Day: Should COVID-19 Vaccination be Mandatory?

Source : Statista

SARS-CoV-2 Viral Variants — Tackling a Moving Target

John R. Mascola, Barney S. Graham, Anthony S. Fauci wrote . . . . . . . . .

In this issue of JAMA, Zhang and colleagues report the emergence of a novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variant in Southern California that accounted for 44% (37 of 85) of samples collected and studied in January 2021. The terminology of viral variation can be confusing because the media and even scientific communications often use the terms variant, strain, and lineage interchangeably. The terminology reflects the basic replication biology of RNA viruses that results in the introduction of mutations throughout the viral genome. When specific mutations, or sets of mutations, are selected through numerous rounds of viral replication, a new variant can emerge. If the sequence variation produces a virus with distinctly different phenotypic characteristics, the variant is co-termed a strain. When through genetic sequencing and phylogenetic analysis a new variant is detected as a distinct branch on a phylogenetic tree, a new lineage is born.

New variants become predominant through a process of evolutionary selection that is not well understood. Once identified, several questions arise regarding the potential clinical consequences of a new variant: Is it more readily transmitted; is it more virulent or pathogenic; and can it evade immunity induced by vaccination or prior infection? For these reasons, new viral variants are studied, leading to the terms variant under investigation or variant of concern.

To communicate effectively about new SARS-CoV-2 variants, a common nomenclature is needed, which like the virus, is evolving. Fortunately, the World Health Organization (WHO) is working on a systematic nomenclature that does not require a geographic reference, since viral variants can spread rapidly and globally. Currently, the terminology is overlapping, as reflected in the report by Zhang et al.1 This new variant (CAL.20C) is termed lineage 20C/S:452R in Nextstrain nomenclature,2 referring to the parent clade 20C and spike alteration 452R. Similarly, using a distinct PANGO nomenclature,3 this variant derives from lineage B (B.1.429 and B.1.427). While alterations in any viral genes can have implications for pathogenesis, those arising in the spike protein that mediates viral entry into host cells and is a key target of vaccines and monoclonal antibodies are of particular interest. The new variant, identified in California and termed 20C/S:452R, has 3 amino acid changes in the spike protein, represented using the single-letter amino acid nomenclature: S13I, W152C, and L452R. To interpret this new set of alterations, it is useful to review what is known about recent variants that have become predominant in other regions of the world.

During the early phase of the SARS-CoV-2 pandemic, there were only modest levels of genetic evolution; however, more recent information indicates that even a single amino acid substitution can have biological implications. Starting in April 2020, the original SARS-CoV-2 strain was replaced in many regions of the world by a variant called D614G, which was subsequently shown to increase the efficiency of viral replication in humans and was more transmissible in animal models.4-6 The D614G strain appears to position its receptor binding domain to interact more efficiently with the ACE2 receptor, and it is associated with higher nasopharyngeal viral RNA loads, which may explain its rise to dominance.

In October 2020, sequencing analysis in the UK detected an emerging variant, later termed B.1.1.7 or 20I/501Y.V1, which is now present and rapidly spreading in many countries.7 B.1.1.7 contains 8 mutations in the spike protein and maintains the D614G mutation. One of these, N501Y, appears to further increase the spike protein interaction with the ACE2 receptor. Epidemiological studies indicate that the B.1.1.7/20I/501Y.V1 strain is 30% to 80% more effectively transmitted and results in higher nasopharyngeal viral loads than the wild-type strain of SARS-CoV. Also of concern are retrospective observational studies suggesting an approximately 30% increased risk of death associated with this variant.8

Another notable variant, 20H/501Y.V2 or B.1.351, was first identified is South Africa, where it has rapidly become the predominant strain.9 Cases attributed to this strain have been detected in multiple countries outside of South Africa, including recent cases in the US. B.1.351 shares the D614G and N501Y mutations with B.1.1.1.7; thus, it is thought to also have a high potential for transmission. There are no data yet to suggest an increased risk of death due to this variant. Importantly, this constellation of mutations—9 total in the spike protein—add yet another dimension of concern. B.1.351 strains are less effectively neutralized by convalescent plasma from patients with coronavirus disease 2019 (COVID-19) and by sera from those vaccinated with several vaccines in development.10-12 The decrement in neutralization can be more than 10-fold with convalescent plasma and averages 5- to 6-fold less with sera from vaccinated individuals. Fortunately, neutralization titers induced by vaccination are high, and even with a 6-fold decrease, serum can still effectively neutralize the virus.

Nonetheless, these data are concerning because they indicate that viral variation can result in antigenic changes that alter antibody-mediated immunity. This is highlighted by in vitro studies showing the B.1.351 strain to be partially or fully resistant to neutralization by certain monoclonal antibodies, including some authorized for therapeutic use in the US.12 The prevalent strains in the US appear to remain sensitive to therapeutic monoclonal antibodies; however, recent evolutionary history raises the concern that the virus could be only a few mutations away from more substantive resistance.

COVID-19 vaccine development has been an extraordinary success; however, it is unclear how effective these vaccines will be against the new variants. The interim data from 2 randomized placebo-controlled vaccine studies, the rAd26 from Janssen and a recombinant protein from Novavax, offer some insight. The Janssen study included sites in the US, Brazil, and South Africa with efficacy against COVID-19 at 72%, 66%, and 57%, respectively.13 Novavax reported efficacy from studies in the UK and South Africa with overall efficacy of 89% and 60%, respectively.14 Viral sequence data from infected patients showed that the B.1.351 strain was responsible for the majority of infections in South Africa. Lower vaccine efficacy in the South Africa cohort could be related to antigenic variation or to geographic or population differences. Despite the reduced efficacy, the rAd26 vaccine was 85% effective overall in preventing severe COVID-19, and protection was similar in all regions.

These data suggest that current vaccines could retain the ability to prevent hospitalizations and deaths, even in the face of decreased overall efficacy due to antigenic variation. It is unclear whether changes in vaccine composition will be needed to effectively control the COVID-19 pandemic; however, it is prudent to be prepared. Some companies have indicated plans to manufacture and test vaccines based on emerging variants, and such studies will provide important information on the potential to broaden the immune response.

The recognition of a novel emergent variant, 20C/S:452R, in the most populous US state necessitates further investigation for implications of enhanced transmission. In particular, the L452R mutation in the spike protein could affect the binding of certain therapeutic monoclonal antibodies. The emergence of this and other new variants is likely to be a common occurrence until the spread of this virus is reduced. This emphasizes the importance of a global approach to surveillance, tracking, and vaccine deployment. The approach should be systematic and include in vitro assessment of sensitivity to neutralization by monoclonal antibodies and vaccinee sera, vaccine protection of animals against challenge with new strains, and field data defining viral sequences from breakthrough infections in vaccinees. The infrastructure and process used for tracking and updating influenza vaccines could be used to inform that process. Finally, SARS-CoV-2 will be with the global population for some time and has clearly shown its tendency toward rapid antigenic variation, providing a “wake-up call” that a sustained effort to develop a pan-SARS-CoV-2 vaccine is warranted.

Source: JAMA Network

The Restaurant Before and After COVID-19

Aaron Timms wrote . . . . . . . . .

Have you eaten here before? Well, have you? Since I can tell from your hesitation that you haven’t, I can’t help but wonder: what are you doing here?

Generous as I am, I will guide you. Tonight’s meal will take the form of a series of liquid and solid comestibles served in vessels made sometimes of ceramic, sometimes of wood, sometimes of glass. Ingredients are all seasonal and humanely produced, in the modern tradition, and our chef is an explosive asshole of moderate talent whose best ideas have been stolen from less well-connected cooks with inferior financial backing, as is also traditional. Dishes will appear as they’re prepared, according to an ancient and mysterious protocol known as “making food to order in a restaurant.” Service will be obsequious to the point of viscosity; the waiters will laugh at even your most painful attempts at conversation, mostly as a means of securing a large tip, their only balm for employment in a service economy that regards them as less than human. Despite this it will be impossible to understand the descriptions of any of the food they place on your table, which will emerge less as words than as a series of tuneful sighs.

Dishes will include an amuse-bouche of insipid “soup” in an espresso cup; a signature dish that’s been on the menu for too long; an innovative “take” on an “ethnic” foodstuff spuriously linked to the chef’s bio; a palate cleanser that’s unintentionally the most satisfying part of the meal; and a dessert that’s designed to be witty but just tastes like dessert. Some dishes will arrive on moving vehicles. Others will include strobe lighting. Allergies will be tolerated, but only with contempt. You will be charged for drinking water. Nothing will meet the expectations you have created by feverishly consuming online reviews in the days leading up to this meal. Any questions before we start?

WHAT WAS THE RESTAURANT? To put the question in the past tense implies that it’s no longer possible to ask what the restaurant is. In time that may come to seem a ridiculous position; in many parts of the world outside the United States, where restaurants are holding firm in the face of the coronavirus, it already seems moot. But for now, anyone walking the center of any major city in this country would find it difficult to dispute that the American restaurant as we once knew it is an artifact of history. The US hospitality industry lost almost 5.5 million jobs in a single month at the start of the pandemic; 2 million more people are currently unemployed than were pre-COVID. In New York, over a thousand restaurants have perished since March. This massacre has disproportionately affected workers of color, who made up more than three-quarters of the city’s pre-COVID restaurant labor force, and the working poor, which is the only way to describe the vast mass of people employed in an industry with an average salary of $33,700. Restaurants have been brought to their knees at precisely the moment when the nourishment of the country is most in peril: since the start of the pandemic the number of Americans facing food insecurity has climbed from thirty-seven million to fifty-four million.

This year of death and hunger closes a period in which the restaurant, aided by social media and its mimetic logic of aspirational consumption, enjoyed an imperial phase of growth and influence. Neither inhospitable margins nor a famously high rate of failure for new businesses had, writ large, held the restaurant back. In the decade before COVID hit, the net number of new restaurants and bars in New York alone increased by more than 7,000, to 23,650, twice the rate at which businesses citywide expanded. Since the turn of the millennium the public’s appetite for news about the restaurant industry—for openings, reviews, recipes, and anything that took us closer to the chefs and their journeys into the culinary unknown—grew even more quickly, and a powerful new institution, the “food media,” was salivated into existence. Competition quickly emerged as the food media’s dominant narrative mode, touching off an explosion in competitive cooking shows, awards, and new systems of rating and ranking that turned food into a sorting mechanism for the consumer as well. Food functioned as both a prestige destination for the idle lifestyle dollar and a kind of prize. Restaurants during this era were more than simply a growing industry; for many they became a totem, a lodestar of in-group identification, a shorthand for cultural savvy and openness to experience. The person who frequented the right restaurants was living their best life; the restaurant agnostic was a cultural heathen, left behind by the great hungry tide of progress.

Among those restaurants still standing, or huddling by the feeble warmth of their outdoor heat lamps, forbearance rules the day, since survival through the pandemic is both an exercise of endurance and a cry for financial mercy—mercy that, whether in the form of further state assistance or rent forgiveness, increasingly looks as though it will arrive too late, or never. The shells that pass for restaurants today, grimly subsisting on trickles of revenue from sidewalk seating in the hope that salvation-by-vaccine might arrive by the coming spring, look nothing like the teeming, raucous places that used to line many communities’ streets. Their interiors empty or rearranged at quarter capacity, these half-restaurants present 2020 as a conclusive volemic shock to an urban patient that was already, in many cases, losing blood fast. In the laughter of today’s outdoor brunchers, gamely throwing back mimosas in pustular sidewalk bubbles and military-style dining tents hastily assembled over street gutters—some of these structures so secure they’re more indoor than the indoors could ever be—there’s a bleak determination to prove that despite the cold, despite everything, the show must go on. But it’s difficult to avoid the uncomfortable sense that these people are simply holdouts, and that the restaurant as we have come to know it will not survive the many months—six? Twelve? Who knows?—that the pandemic still has to run. In a country such as this one, so reluctant to redistribute in any direction other than upwards, the pandemic represents not a state of exception but a state of extension, an acceleration of the economy’s guiding inhumanities. What may be the restaurant’s final chapter was already prefigured by the excesses of its recent past. The story is not uniformly pretty.

The first restaurants date to mid-18th-century Paris, but it wasn’t until the early 19th century that the modern restaurant, born of an alliance between capital, power, and the press, was set on its course. In the aftermath of the Revolution, French culinarians—responding to directives from Napoleonic state censors to suppress coverage of politics and instead promote articles about “pleasure”—remapped France and Paris as geographies of edible abundance. Charles Louis Cadet de Gassicourt’s 1809 Course in Gastronomy presented a “gastronomic map of France” that redrew the country as a place of indulgence, not political commitment: cattle, ducks and hare now populated the Vendée and Versailles, rather than royalists and counter-revolutionaries. The restaurant—at that point a still-new institution whose primary points of distinction from the inns, taverns, coffee houses, and tables d’hôte that also offered food to the public were individual seating and individual choice in each diner’s selection of dishes off a menu—figured prominently in this depoliticizing initiative. In a Paris awash with “new fortunes,” Alexandre Balthazar Laurent Grimod de la Reynière promised that his Gourmands’ Almanac, the first volume of which appeared in 1803, would guide the epicurean middle classes through the “labyrinth” of new food shops, restaurants, and caterers that had emerged in the previous three decades, while specifically avoiding all discussion of governance: “For the last 15 years we have spoken about politics too much, and things have only started going well for France since we left the trouble of government to true statesmen,” he wrote.

[ . . . . . . . ]

Read more at n+1 . . . . .

Japanese Mayor: Men Should Do Shopping Since Women are ‘Indecisive and Take Forever’

The mayor of Japan’s Osaka has come under fire for suggesting men should do grocery shopping during the coronavirus outbreak because women are indecisive and “take a long time”.

Japan is under a state of emergency over the pandemic, and residents in some areas have been asked to shop less frequently and only send one family member out to get supplies to limit contact.

Osaka Mayor Ichiro Matsui told reporters on Thursday (Apr 23) that men should be entrusted with grocery runs because women “take a long time as they browse around and hesitate about this and that”, Kyodo news agency reported.

“Men can snap up things they are told (to buy) and go, so I think it’s good that they go shopping, avoiding human contact,” the 56-year-old added.

When challenged by a reporter, he acknowledged his remarks might be viewed as out-of-touch, but said they were true in his family.

But online he was roundly condemned, with one Twitter user accusing him of being “disrespectful to women and men”.

Another dubbed his comment “full of prejudice against women”, adding “there are indecisive men and nimble and sharp women”.

“Does he think (shoppers) like to take time?” added a third. “They are thinking about menus and prices.”

But there was some support for the mayor.

“That’s right. Elderly women, in particular, are always chatting away, unconcerned about shopping,” wrote one user.

Despite its highly educated female population, Japan ranked 121 out of 153 countries in the World Economic Forum’s 2020 gender gap index, primarily because of its poor showing in political representation.

Traditional gender roles are still deeply rooted in Japanese society and women are often still expected to take primary responsibility for childcare and domestic chores, even while holding down professional jobs.

Source : CNA


Read also at BBC:

Coronavirus: Malaysian men in shopping muddle amid lockdown . . . . .

Taste of freedom: How Coronavirus is Changing Asia’s Relationship to Food

Bhavan Jaipragas and Tashny Sukumaran wrote . . . . . . . . .

Even the simple act of eating out with friends and family may seem a pipe dream at the moment for people in food-crazy Asian nations under Covid-19 lockdowns.

But that does not mean they have given up on their culinary obsessions.

In fact, going by the overnight rise in stress-baking and cooking, food may be occupying more than its usual share of head space among Malaysians, Singaporeans and Thais, as culinary adventures serve as an escape from weeks of being cooped up at home.

Beyond that, initiatives to help food vendors hit by the economic shutdowns show how the crisis may be reshaping – in a positive way – our relationships to food and the people involved in food production.

In Singapore, braised duck and pig offal hawker Melvin Chew points to the success of a Facebook page he created to support fellow food vendors.

His “Hawkers United – Dabao 2020” page has amassed nearly 230,000 followers since he set it up on April 3, hours after Prime Minister Lee Hsien Loong announced a partial lockdown of the country to suppress Covid-19 infections.

The so-called circuit breaker came into force on April 7 as cases soared among the city state’s foreign workers, with total infections numbering over 5,000 on Friday, from 266 a month ago.

With dining-in banned as part of the measures, the platform gives the embattled hawkers – especially obscure ones off the radar of food-delivery apps – an opportunity to directly promote their menus to takeaway and delivery customers.

Freelance delivery drivers are also part of the mix, offering fees far cheaper than those of major delivery apps like GrabFood, Deliveroo and Foodpanda.

Singaporeans have so far lapped up the offerings, which include everything from top-grade Mao Shan Wang durians to the traditional kway chap that Chew – a rare second-generation hawker – sells at his stall in the Chinatown district.

“It’s not just that they are food crazy … I think Singaporeans want to preserve this treasure that is the hawkers,” said Chew, 42, who said his revenue was down about 80 per cent without dine-ins.

“They want to save the auntie, uncle who are like family because you buy their food so often. Whether rich or poor, you go to the hawker centre for comfort food.”

Benjamin Yang, a food and beverage profit strategist, said the across-the-board “digitalisation” by hawkers was one silver lining of what was otherwise one of the worst crises faced by the city state’s economy. Yang’s website manyplaces.sg, like Chew’s Facebook page, matches customers with small food businesses.

Yang said his platform had onboarded some 300 small food businesses – for free – after the site was set up last week out of “purely altruistic” intentions to rescue struggling merchants.

OPPORTUNITY IN CRISIS

Such innovation and industry is by no means confined to Singapore.

Some 1,800km away in Bangkok, Thailand, Peangploy Jitpiyatham, the owner of a hostel, has converted the premises into a hub for his newly created food-delivery platform “Locall”. Customers who use the platform will be able to order from 30 restaurants – including the hostel’s kitchen.

Unlike the bigger players, the innkeeper’s app – developed by his staff – allows users to order from different establishments at one go. “We aim to support our community and we want to help small places that cannot adapt during this time,” Peangploy said.

Others in the country – home to ubiquitous street food stalls – see a glimmer of opportunity in food retail as their own industries come under pressure.

Sasimon Chamnansarn, a flight attendant who remains employed with her airline even though flights have dried up, is one such individual. Recently Sasimon, 38, began selling sun-dried pork – based on a special recipe devised by her mother and grandmother – to friends in Bangkok, and was pleasantly surprised by rising demand.

The idea came to her after flights were suspended and she returned to her hometown of Udon Thani in the country’s northeast.

“If I go back to work, I’ll continue this business. I have contacted a local factory which can help me produce and package.

“Nothing is certain. I’m always ready for change. Who would have thought a pilot or an aircrew would one day find their job unstable?”

‘PARCELS OF LOVE’

In Malaysia, a different kind of food revolution is brewing – one that does not necessarily involve food vendors.

On social media, many have been posting about their “food swaps” – where delivery drivers are utilised to send family and friends parcels of home-cooked food.

Human rights activist Firdaus Husni said her undergraduate brother – who must remain on campus while the country’s “movement control order” is in force – was among the recipients of the parcels of love she had been dishing out.

“I worry about him often. It was nice to be able to surprise him by having food delivered to his hotel,” she said.

Swapping food has become part of Malaysia’s “new normal”, said Firdaus.

One of Firdaus’ friends saw her post on social media about having a grocery delivery cancelled, and quickly picked up a selection of essentials for her, while others have sent cooked food.

“I mentioned to friends that I missed having crab rasam [a tamarind-based soupy Tamil dish], and one made and delivered it still nice and warm,” said the activist, 34, adding that she had also received home-made curry laksa and nasi lemak – traditional Malaysian dishes.

“The thoughtful gestures and effort they must have put into preparing and making the delivery make me feel very thankful … Social distancing does not mean that we shouldn’t stay in contact with our family and friends,” she said.

Yudistra Darma Dorai, a Kuala Lumpur-based lawyer, said food had become a “form of communicating” in his circles while the lockdown – scheduled to end on April 28 – was in force. The lawyer said his friends, made aware of his decision to bring his elderly mother to stay with him during the lockdown, sent him home-cooked food so that he was not overtaxed working and preparing meals.

Redzuawan Ismail, a celebrity chef also known as “Chef Wan” who has an Anthony Bourdain-type of reputation in Malaysia and Singapore, said he expected sweeping changes in eating habits when lockdowns were lifted.

While people would probably slowly go back to eating out, many would come out of the experience having a more favourable view of home-cooked food and dining at home, the chef said.

“A lot of people’s usual eating habits are going to change for sure,” Ismail said.

“People are going to be more careful now – what goes on the plate, who sits next to them – and they will take some time to regain confidence,” he said. “Many will likely become more ready to entertain in their own homes, eat with their families, and allow those they’re comfortable with to visit for meals. Home delivery and takeaway will become more popular.”

Source: SCMP