The world has come a long way since the inception of the SARS-CoV-2 virus. However, it may not be over yet. With the speedy mutation that we presently are witnessing, it may not be a long time till we see more variants that may have worse symptoms and increased transmissibility. 

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CDC Director Rochelle Walensky, MD, MPH, made a grim forecast at a media conference this week that sounded more like a trailer for a gloomy future film. 

According to Walensky,

"Given the quantity of virus circulating in our nation right now, which is mostly among the unvaccinated, our greatest worry in public health and science is that the virus... [will become] a highly transmissible virus with the potential to outsmart our vaccinations in regards as to how it defends us from serious illness and death."

She speculated that a novel, highly evasive variety might be "only some mutations ahead." That is a really foresighted remark. We've already seen a few identified mutations, and each one increases the transmissibility a little bit. That's evolution at work, and it's what you'd expect to see when viruses evolve from one strain to the next. We've mainly observed this virus develop in order to become more contagious. The fact that Delta is so contagious is one of its most amazing characteristics.

Are technological advances the answer?

One such option is the adaptability of mRNA vaccines. These vaccines may be more readily and rapidly modified to react to a novel, more difficult-to-vaccine variety. If a mutation alters the spike protein to the point that vaccinations no longer recognise it, a vaccine-producer may detect the altered protein and integrate it into a newer mRNA shot.

Genetic variants aren't the only issue

Viruses have a second method for producing new varieties that operates much faster than mutations. When a person is infected with two distinct strains of the same virus, recombination may occur. The viruses may exchange genetic material and create a third, entirely distinct strain if they infect the same cell. Recombination has previously been observed in flu viruses, with H and N genetic segments exchanged to produce H1N1, H1N2, and H3N2 flu strains, for instance.

There was so little variety in the early days of SARS-CoV-2 that recombination didn't matter. However, other strains of the virus are currently spreading throughout the world. If two of these lineages exchange parts, a whole new viral sequence would be created in a single step, without the need to modify to acquire those distinctions. The more the variants spreading, the greater the chance of this happening.

For the time being, we are safe

Walensky's sombre warning came as the CDC issued new guidelines requiring masks to be worn inside in schools and elsewhere in the nation where COVID-19 infections exceed 50 per 100,000, often known as significant or high transmission regions.

In India, we have seen very less breakthrough infections in vaccinated people during the 2nd COVID wave, mainly by delta variant. Vaccines are very necessary to safeguard us from serious illness and death. But, hows the future evolution of the virus and immunological protection by vaccines are yet unanswered questions.

Disclaimer- The views and opinions expressed in this article are those of the author's and do not necessarily reflect the official policy or position of M3 India.

The author is a practising super specialist from New Delhi.