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This viewpoint reviews pathophysiology of viral mutation and clinical consequences associated with the SARS-CoV-2 pandemic. Mutations naturally arise during viral replication and can spread due to natural selection (if a new phenotype confers a competitive advantage) or due to chance (such as the founder effect). Initial variations in the spike protein sequence have been associated with increased viral transmissibility, although also were detected early enough to have been perpetuated due to the founder effect. More recently, a new series of mutations termed lineage B.1.1.7 has been detected in England and is associated with more rapid viral spreading. The currently approved COVID-19 vaccines induce an antibody response to the entire spike protein, so it is anticipated that the vaccine should remain effective against all of these variants.
This paper provides a clinically relevant overview of viral mutation and its clinical significance in the COVID-19 pandemic.
– Amy S. Korwin, MD
This abstract is available on the publisher's site.
Over the course of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, the clinical, scientific, and public health communities have had to respond to new viral genetic variants. Each one has triggered a flurry of media attention, a range of reactions from the scientific community, and calls from governments to either “stay calm” or pursue immediate countermeasures. While many scientists were initially skeptical about the significance of the D614G alteration, the emergence of the new “UK variant”—lineage B.1.1.7—has raised widespread concern. Understanding which variants are concerning, and why, requires an appreciation of virus evolution and the genomic epidemiology of SARS-CoV-2.