EVANSVILLE — Feared variants of COVID-19 have been kept in check in Southwest Indiana so far, say medical professionals who cite vaccination, a comprehensive behind-the-scenes surveillance plan and good luck.
Sequence analyses performed as part of a local-state-federal partnership had identified 17 cases of COVID-19 variants in Vanderburgh, Warrick, Posey and Gibson counties as of Thursday afternoon, the Indiana State Department of Health reported. All are the "UK variant," so named because it was first detected in the United Kingdom in November.
"But keep in mind that only a sample of cases is sent for sequencing, so the raw number may not be an accurate reflection of the prevalence of variants in a given area," an email from ISDH stated.
COVID-19 vaccines are holding up against the UK variant, as the initial discovery of the variant in Vanderburgh County in January has not manifested itself in an explosion of coronavirus cases.
In fact, local cases have declined dramatically. Vanderburgh County's seven-day moving average of cases was 11 as of Sunday. It was 100 on Jan. 28, the day Deaconess Health System announced it had identified the quicker-spreading, potentially more deadly variant here.
Good fortune has been a factor, said Deaconess President Dr. James Porter, who noted that other COVID-19 variants have shown up elsewhere in the United States.
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"I think the timing of them showing up has been good for us so far," Porter said. "I think the other thing that’s been good for us is, while the results of trying to evaluate the efficacy of the vaccines in the lab for a number of these variants hasn’t looked good, what we’ve seen happen in a real world-real people population has been more favorable than what it looks like might be likely from just some lab bench research."
But Porter, a forceful advocate for vaccination, cautioned that COVID-19 variants have proven unpredictable.
"How much they might cause us problems down the road, is really a lot of guesswork that somebody smarter than me needs to be doing," he said.
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Like many other hospital systems in the state, neither Deaconess nor Ascension St. Vincent Evansville possesses the technology to perform costly and labor-intensive wide-scale sequence analyses of coronavirus-positive patient samples. Likewise, not every specimen taken from every patient is sequenced.
"Our PCR (polymerase chain reaction) technology allows us to see when it’s a different virus, but it doesn’t allow us to see which virus it is, specifically," Porter said. "So we need to send those specimens off and get them sequenced for us to be able to know for sure that it’s, for example, the UK variant versus the Brazil variant versus the South African variant.
"And fortunately, for us so far, it’s been the UK variant.”
The White House in April announced plans to help states detect and curb the spread of emerging COVID-19 variants by investing $1.7 billion in genomic sequencing, or the process to map the genetic code of a virus.
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The funding, which came from President Joe Biden's nearly $2 trillion COVID-19 relief package, is allocated through the Centers for Disease Control and Prevention to help states and other jurisdictions monitor potentially more contagious COVID-19 strains.
Indiana is participating in the CDC's variant surveillance program, submitting samples from hospitals that meet criteria meriting the state's interest or suspicion for testing. ISDH has the capacity to do some of the sequencing as well, results of which it reports to the CDC.
It's part of a larger web of public and private partnerships the federal government has formed with academic and commercial laboratories that have the capacity to do sequencing. Labs at Purdue University have been sequencing variants for months, sometimes sent from the state in lieu of CDC labs.
Dr. Heidi Dunniway, chief medical officer of Ascension St. Vincent South Region, said St. Vincent and the commercial lab with which it works have been sending specimen readings for sequencing to the CDC since early April. Dunniway said St. Vincent has had no variants confirmed through that process.
Like Deaconess, St. Vincent can tell it's looking at a suspicious sample, but not which variant it may include.
"But the ones that have looked suspicious that have gone out so far have not proven to be variants," Dunniway said.
The state casts a wide net looking for COVID-19 variants
Dunniway and Dr. April Abbott, microbiology director at Deaconess, said the state spells out many criteria for samples that should be flagged on suspicion of including variants.
Deaconess sends ISDH only the patient samples the state agency requests, Abbott said.
A sample could come from a patient who suffers a severe case of COVID-19 and doesn't respond to treatment. It could come from a patient who was vaccinated more than two weeks ago, and yet still tests positive.
Deaconess is required to report to the state who it vaccinates and who tests positive, Abbott said — and, yes, the state cross-references the two lists.
"And so they’re able to look at those two lists and tell us, 'OK, this patient, it looks like they should have been fully vaccinated, and now we’re interested in their sample because they’ve now tested positive,' " she said.
They're called "breakthrough infections" — fully vaccinated people who have contracted COVID-19 — and a new CDC database tracks them. But they are exceedingly rare. The CDC reported 9,245 breakthrough infections on Friday — among nearly 111 million Americans who have been fully vaccinated.
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Highlighting the imperative to make no assumptions about any given case, Abbott said sometimes what looks like a breakthrough case isn't a breakthrough case at all.
"It could be that, maybe after their first vaccination they were exposed and they just didn’t know it, and so then they had some partial protection and they didn’t have really severe illness," she said. "And then they come in to get tested because maybe they had another exposure or something happens. We do occasionally see where individuals probably were exposed before their second vaccination."
But the CDC is looking for more than breakthrough infections.
Abbott said physicians and other providers have been asked to report severe or unusual cases that are perhaps unexpected for someone in a given patient's age group — especially if that patient has traveled to a region where a different variant is more prevalent.
If ISDH finds out about such a case, she said, the state agency might reach out to Deaconess, which would send the state that patient's sample for sequencing.
There's a wide variety of circumstances under which the state will get involved.
"That’s how we partner with the state to get them samples that they’re interested in," Abbott said.