How 'America's Frontline Doctors' Sold Access to Bogus COVID-19 Treatments—and Left Patients in the Lurch
BY VERA BERGENGRUEN
AUGUST 26, 2021 6:34 PM EDT Mike says he was struggling with COVID-19 when he felt his breathing getting worse. He did not want to go to the Veterans Affairs hospital near his home, where he believed doctors might put him on a ventilator. And he knew they would not prescribe the treatment he really wanted: a drug called ivermectin.
So in late July, Mike, who says he is a 48-year-old teacher and disabled veteran from New York state, contacted America’s Frontline Doctors (AFLD), a group he had been following on social media. AFLD has been a leading promoter of ivermectin, a medication typically used to treat parasitic worms in livestock, as a “safe and effective treatment” for COVID-19. Through its website, Mike says, he paid the group $90 for a telemedicine appointment with a doctor willing to prescribe the drug.
A week later, he was still anxiously waiting for the consultation. Calls and emails to AFLD went unreturned, he says. Finally, he called his bank to report a fraudulent charge. “Not even an apology,” Mike, whom TIME is referring to using a pseudonym because of his concerns about his job, told TIME in an interview. “This is absolutely nuts. This organization is not helping anyone but their pocketbooks.”
Similar stories have flooded anti-vaccine forums and messaging apps in recent weeks as some customers and donors raise doubts about AFLD. The group describes itself as a “non-partisan” group of medical professionals. But it originated as a right-wing political organization, and since its founding has consistently spread medical misinformation. Its name implies the group consists of physicians on the frontlines of the pandemic, but it’s not clear how many of its members have spent any time treating patients with COVID-19.
Its followers aren’t the only ones with questions about AFLD. It’s hard to pin down how many people the group employs, how much money it’s taking in, or how that money has been spent, in part because the non-profit has failed to file required disclosures. After it failed to submit its annual report in Arizona, where the group is registered under the name “Free Speech Foundation,” the state recently downgraded the organization’s charitable status to “pending inactive.”
Over the past three months, a TIME investigation found, hundreds of AFLD customers and donors have accused the group of touting a service promising prescriptions for ivermectin, which medical authorities say should not be taken to treat or prevent COVID-19, and failing to deliver after a fee had been paid. Some customers described being charged for consultations that did not happen. Others said they were connected to digital pharmacies that quoted excessive prices of up to $700 for the cheap medication. In more than 3,000 messages reviewed by TIME, dozens of people described their or their family members’ COVID-19 symptoms worsening while they waited for an unproven “wonder drug” that didn’t arrive.
“My mom has now been admitted to the hospital with Covid,” one user wrote Aug. 12 on the group’s channel on the messaging app Telegram. “AFLDS has not returned a call or message to her and they’ve taken over $500 out of her account!”
Since its founding last year by Dr. Simone Gold, a Los Angeles physician who was later arrested during the Jan. 6 attack on the U.S. Capitol, America’s Frontline Doctors has nurtured medical conspiracies popular in right-wing circles. Created as a political project to support the Trump Administration’s economic reopening push, it ricocheted from promoting skepticism about COVID-19 to launching a national RV tour to denounce “medical censorship and cancel culture.” It promoted hydroxychloroquine as a miracle drug and billed itself as a provider of legal services for people who refuse to be vaccinated or to wear a mask, or who want to stop vaccinations for children.
The group’s profile has soared amid the rise of employer-imposed COVID-19 mandates and the emergence of ivermectin as an alternative treatment of choice for the broader anti-vaccine community. AFLD’s Telegram channels have rapidly grown to more than 160,000 users. Its website traffic has quadrupled since April, according to an analysis by the web-analytics company SemRush, which estimates it drew nearly half a million visitors in July. In the process, AFLD’s reach has spread beyond to mainstream sites like Instagram and TikTok, making it a leading purveyor of medical disinformation that erodes public confidence and hinders efforts to get the pandemic under control, experts say.
“They’re the 21st century, digital version of snake-oil salesmen,” says Irwin Redlener, a physician who directs the National Center for Disaster Preparedness at Columbia University. “And in the case of ivermectin, it’s extremely dangerous.”
America’s Frontline Doctors declined repeated requests for comment on this story. On its Telegram channels, moderators have blamed user error and overwhelming demand for the ivermectin delays and promised refunds for customers who fail to receive the consultations with doctors that they paid for. Attempts to reach Dr. Gold, the group’s founder, through her lawyer were unsuccessful.
Federal authorities are cracking down on coronavirus-related telemedicine schemes. The Federal Trade Commission has sent nearly 400 warning letters to groups and individuals marketing false COVID-19 treatments, including one missive, in April, telling a Texas medical practice to “immediately cease” promoting ivermectin or face steep fines. It is illegal under the federal COVID-19 Consumer Protection Act, enacted earlier this year, to advertise that a product can prevent, treat or cure COVID-19 “unless you possess competent and reliable scientific evidence substantiating that the claims are true.” No such study exists for ivermectin, according to the FDA.
United Nations’ Computers Breached by Hackers Earlier This Year Yet despite the FDA’s warnings about the dangers of misusing ivermectin to treat or prevent COVID-19, the drug has become highly sought after in anti-vaccine circles. Doctors and pharmacists tell TIME they have noticed a surge in ivermectin prescriptions called in by telemedicine services, and a growing number of patients demanding it as an alternative to COVID-19 vaccines. Many who fail to obtain prescriptions through groups like AFLD or find it too expensive have resorted to buying an alternative from feed stores that is designed for use in livestock, according to Telegram chats, which reveal members advising each other on proper dosages. Mississippi health officials said Aug. 20 that 70% of recent calls to its poison control center were from people ingesting ivermectin meant for livestock.
The ivermectin craze reflects some of the most damaging elements of the post-Trump conservative movement, with a mixture of political profiteering, disinformation, exploitation of social media and conspiratorial thinking combining at a critical point in the pandemic. AFLD has capitalized on “the perfect storm of everything that you needed to have a large population of people susceptible to vaccine misinformation,” says Kolina Koltai, a researcher who studies the anti-vaccine movement at the University of Washington. “America’s Frontline Doctors are really good at what they do. This idea of doctors fighting the system is a narrative that is really appealing to a lot of people.”
‘A coordinated political effort’
On July 27, 2020, a small group of doctors assembled on the steps of the Supreme Court for a news conference. At the time, President Donald Trump was pushing for governors to reopen their states and conservatives had grown increasingly frustrated with lockdown measures. The physicians, who wore white lab coats embroidered with the AFLD logo, had come to repeat a range of White House talking points. They claimed the mental toll of the lockdowns was worse than the virus itself, that hydroxychloroquine was an effective treatment for COVID-19 and that masks weren’t necessary—all of which had been contradicted by U.S. health officials.
To the extent that the mainstream medical community paid attention to the group at all, it was to point out that these doctors making misstatements lacked the expertise to comment. There was no evidence that any of the doctors who spoke that day had treated patients severely ill with the virus, according to MedPage Today, a peer-reviewed medical news site. None of them were infectious-disease experts or worked in intensive-care units during the pandemic. One was best known for promoting bizarre religious beliefs, including tweeting that America needed “deliverance from demon sperm” because people were falling ill from having sex with demons and witches in their dreams. Two of the “frontline” doctors were ophthalmologists, only one of whom was still licensed.
The emergence of AFLD was a coordinated political effort months in the making. The group was the brainchild of the Council for National Policy (CNP), a secretive network of conservative activists. During a May 11 call of CNP members that was leaked to the Center for Media and Democracy, a progressive watchdog group, members complained that Trump was being slammed for his handling of the pandemic, including failing to follow scientific guidelines. The group needed their own medical professionals to promote their message, they said, in the face of data showing two-thirds of Americans were wary of restarting the economy.
“There is a coalition of doctors who are extremely pro-Trump, that have been preparing and coming together for the war ahead in the campaign on health care,” Nancy Schulze, a Republican activist married to a former Pennsylvania congressman, said on the call. “And these doctors could be activated for this conversation now.”
Eight days later, conservative groups publicized a letter signed by more than 500 doctors calling the lockdowns a “mass casualty event.” The lead signatory was Dr. Simone Gold, a licensed emergency-room physician and Stanford-educated lawyer who was working as a part-time, independent contractor in a hospital in Bakersfield, Calif. Ten weeks after the letter’s release, Gold was standing on the steps of the Supreme Court as the founder of AFLD as Rep. Ralph Norman, a South Carolina Republican, thanked the white-coated physicians for coming to “tell us the truth.” The event was hosted and funded by the Tea Party Patriots, a pro-Trump right-wing group.
While few people attended the event, a video of the press conference went viral after it was retweeted by Trump, earning some members of the group an audience with Vice President Mike Pence. And though it was subsequently removed by social-media platforms for spreading misinformation, Gold and other members made the rounds on conservative media, from Fox News to Alex Jones and Pat Robertson.
Since then, the group has positioned itself as the leading alternative medical source for COVID-19 skeptics. Its message has changed to match the moment. At first, Gold downplayed the severity of the virus. “We’re all acting as though there’s a huge medical crisis,” she said in a May 2020 video, as the number of Americans dead from COVID-19 passed 100,000. “I’m not sure that it’s front-page news.” The real issue, Gold added, was that “our constitutional rights are being trampled on right and left.”
Soon after, the group argued there was a conspiracy to suppress an effective treatment for the pandemic ravaging the globe. “If all Americans had access to hydroxychloroquine, the pandemic would essentially end in about 30 days,” another member of AFLD, a child psychiatrist named Mark McDonald, said on a video picked up by Alex Jones’ NewsWars website. The group soon partnered with a telemedicine site set up by right-wing conspiracy theorist Jerome Corsi to sell prescriptions for the medication, which Trump promoted and said he took as a preventive measure.
As it turned out, promoting fictions about COVID-19 could be profitable. AFLD built a slick website, whose domain was bought by the Tea Party Patriots, and an email list of loyal followers whom they urged to make donations. When Gold was arrested for participating in the Jan. 6 insurrection, emails to supporters requesting their “urgent and generous donations to withstand such aggressive assaults from the ruthless enemies of free speech” raised more than $400,000 for Gold’s legal defense.
In the spring of 2021, the group announced a national RV tour, which sold VIP tickets for a “meet-and-greet” with Gold for $1,000. According to AFLD Telegram channels, they frequently canceled scheduled appearances, leaving people who had taken the day off work or driven for hours in the lurch. “Hundreds of us registered and received no information or cancellation notice,” one disappointed supporter in Cleveland wrote on June 22 when the promised tour did not arrive. AFLD moderators, meanwhile, urged followers that such events could “continue only when everyone donates what they can monthly.”
By then, the group had pivoted from hydroxychloroquine and medical choice to anti-vaccine content. AFLD falsely claimed the Covid-19 vaccines were “not effective in treating or preventing” the virus and that they had killed 45,000 people in the U.S. “This is an experimental biological agent whose harms are well documented,” Gold said in a statement on the group’s website in May. The group compared lockdown measures to Communist tactics of the 1950s and urged supporters to call their lawmakers to demand they introduce a “Vaccine Bill of Rights”—versions of which soon cropped up in Wyoming, Kansas, Missouri, Minnesota and South Carolina, including boilerplate written by AFLD.
Then, as the Delta variant tore across the U.S. and people in AFLDs forums started to report themselves or their family members falling ill, the group started heavily promoting ivermectin.
‘I feel scammed.’
Ivermectin first gained prominence in December 2020, when Dr. Pierre Kory, then a pulmonary care specialist at a Wisconsin hospital, testified about the “wonder drug” to a Senate panel chaired by Wisconsin Sen. Ron Johnson, a Trump ally known has touted alternative treatments to COVID-19.
The anti-parasite drug, which is commonly used for horses, is approved to treat certain parasitic worms in humans. It is not an antiviral medication and there is no evidence that it is effective in preventing or treating Covid-19, according to the FDA, which says overdoses of the drug can lead to vomiting, allergic reactions, seizures, coma, and even death.
Two pharmacists told TIME said they were alarmed when they noticed an odd surge in ivermectin prescriptions called in by telemedicine doctors in recent weeks. “We’re calling it the second coming of hydroxychloroquine,” one pharmacist in Maine says, noting he had seen prescriptions come in from “quack telehealth prescribers” in Texas, Florida, Illinois and California. “It’s wild to me and other pharmacists I’ve talked to how people won’t get a vaccine that is well-tolerated and effective because it’s ‘experimental’ but they’ll take a dose of ivermectin that’s been extrapolated based on weight from equine veterinary guidelines.”
On social media, AFLD is one of the top organizations steering customers to the de-worming medication as a coronavirus treatment. On its website, people looking for “Covid-19 medicine” are told to click on a button labeled “Contact a physician” and pay $90 for a consultation. The link takes customers to another website, “Speak With An MD,” where they’re asked to submit payment information and told that one of the “frontline doctors” will call them within a few days, with sick patients being prioritized. The group describes “Speak with an MD” as a “telemedicine service with hundreds of AFLDS-trained physicians.”
But the actual service is Encore Telemedicine, a company that connects patients to teledoctors willing to write prescriptions, according to the web portal and posts by AFLD staffers. Since 2015, it appears to have been run out of a home by a golf club in suburban Georgia, according to its business registration. (Encore’s CEO did not respond to requests for comment.)
The orders made through Encore Telemedicine then go to Ravkoo, a digital pharmacy in Auburndale, Florida, whose address listed online appears to be a dilapidated white structure by a strip mall. Ravkoo is supposed to either mail the medicine or call it into a local pharmacy. (The owner of Ravkoo did not respond to requests for comment). The cost of the medicine is applied on top of the consultation fee, and varies widely, from $70 to $700, according to AFLD customers’ comments.
It’s not clear how much America’s Frontline Doctors gets from each patient referral. The service is marketed on AFLD’s site for $90, while a direct telemedicine consultation through Speak With An MD is listed at just $59.99, a $30 difference. AFLD declined to comment on whether they receive any financial benefit from the referral.
AFLD has been using this system to sell hydroxychloroquine since at least last fall. But the network has been overwhelmed by a surge in demand for ivermectin in recent weeks, according to frustrated customers.
The group’s chaotic Telegram channels are filled with questions. Some say they paid for a consultation but never received a call from a doctor. Others say they were prescribed ivermectin but never received it; still others received the wrong medications or were charged inflated prices. Customers claimed to have paid for the non-refundable consultation and the drugs, only to have their local pharmacies refuse to fill the prescription because ivermectin is not approved to treat COVID-19. All of these people reported that repeated calls and emails sent to AFLD, Encore Telemedicine and Ravkoo went unanswered.
Many users call the arrangement a fraud. “Still no drugs as prescribed! Have not heard from their pharmacy. Very disappointing,” one user wrote on Telegram Aug. 1. “They took my money though. Definitely feels like a scam.” That same day, another frustrated customer wrote: “You tell us the vaccine producers are getting rich off us. Seems like you are doing very well yourselves?”
Another user told TIME she paid the $90 and never got the doctor consultation, but did get a call from a pharmacy that charged her another $100. “I have not heard a word. I feel scammed,” says the user, who would provide only her first name, Denise.
Other supporters, who had been promised they’d speak to “AFLDs-trained physicians,” were upset when the doctor pressed them to get the vaccine during the paid phone consultation. “Not happy at all with that!” wrote one woman who said her daughter’s telemedicine doctor had told her to get vaccinated in addition to prescribing ivermectin. “I felt like I could trust them not to push the vaccine…severely disappointed.”
Dozens of messages reviewed by TIME were from people with sick family members, who were begging for AFLDs to escalate their cases. A woman named Chynthia who had paid the fee—“$90 is a lot for us,” she said—wrote that she had never been called back. “Please help! My husband is sick. And looks like he does have a hard time breathing.”
As the confusion has mounted, some have questioned the group’s motives. A user named Vinod told TIME he had been a monthly donor to AFLD but had to call his credit-card company to stop repeated fraudulent charges and ask for a replacement card to prevent other fees from piling up.
Moderators for the AFLDs group on Telegram acknowledged to frustrated users that they were overwhelmed by the demand, although they said to “blame the CDC for the blockade” of ivermectin. But they insisted that once the physician fee is paid, “this is out of AFLDs hands operationally because of HIPPA [sic].”
‘The anti-vax movement as a whole is one big multi-level marketing scheme.’
The embrace of ivermectin by the broader anti-vaccine community has expanded AFLD’s reach. On TikTok, more than a dozen accounts reviewed by TIME show young people, some of them teenagers, touting ivermectin as a COVID-19 cure and promoting AFLD as the place to buy it. “It’s done wonders for me and it’s kicked Covid’s ass,” said one young user who documented her recovery over six videos, using the hashtag #novaccine and recommending others get ivermectin through AFLD.
Dr. Siyab Panhwar, a cardiology fellow at the University of Tulane, has been using his own TikTok account to refute misinformation about ivermectin. “The unfortunate reality is that there are some doctors that push this, and it harms the entire community,” says Dr. Panhwar. “[AFLD] say on their website that they will ‘review your history’ but I call B.S. There is no physical examination…How is this medically appropriate or safe? AFLD is dangerous and needs to be stopped.” The financial incentive to push products like ivermectin should be a massive red flag, Panhwar says. “The anti-vax movement as a whole is one big multi-level marketing scheme.”
None of this is slowing AFLD’s movement. As fights over vaccine mandates and school-masking policies ramp up, AFLD has created “Citizen Corps” chapters in almost every state, with dedicated Telegrams channels and public events, like a Texas meeting that drew 80 people to hear lectures about vaccine side effects. At the group’s “White Coat Summit” in July to commemorate its first anniversary, it cut a video of children ceremonially burning their masks while singing “We Are The World.”
AFLD has meanwhile garnered significant publicity by touting itself as a legal resource for people who want to defy employers’ mandates to be vaccinated, tested or wear a mask. AFLD has used its “legal eagle dream team” to solicit funds, but according to some donors, that promised help has also failed to materialize. “Still waiting to hear back from legal eagle,” a user named Carlos, who said he had submitted multiple forms and emails for legal help, said on Telegram on Aug. 14. “I’m about to get fired and need legal help.”
Several supporters said they were defying employer vaccine mandates based on information and advice from AFLD. “I hope you guys are right,” a user named Jeffery posted on Aug. 20 in response to a video from the group promising to fight vaccine mandates in court. “I’m about to lose my career of over 20 years, my pension and my livelihood because I’m not taking the shot.” Others say their employers laughed off the vaccine-exemption forms they’ve printed off the AFLD website. “I am losing hope,” wrote one user named Cathy on July 6. “I just spoke with a lawyer that said the proof from Frontline Doctors is a conspiracy theory.”
The pleas of customers who trusted the group have often grown desperate. “Does anyone know how long it takes to hear back from America’s Frontline Doctors about getting Covid medicine?” asked a user who said she was pregnant and having chest pain and shortness of breath from the virus. “It seems like I’ll never hear back from them in my worst moment of need.”
On Aug. 17, one man posted in the group’s Telegram that he had waited on AFLD for weeks before they canceled his consultation for ivermectin. “Wish they hadn’t because my wife is in the ICU now,” he wrote. “Had I gotten the meds she would have been fine.”
With reporting by Alejandro de la Garza, Simmone Shah and Julia Zorthian
Stuart Ray, M.D. In December 2020, news media reported a new variant of the coronavirus that causes COVID-19, and since then, other variants have been identified and are under investigation. The new variants raise questions: Are people more at risk for getting sick? Will the COVID-19 vaccines still work? Are there new or different things you should do now to keep your family safe?
Stuart Ray, M.D., vice chair of medicine for data integrity and analytics, and Robert Bollinger, M.D., M.P.H., Raj and Kamla Gupta professor of infectious diseases, are experts in SARS-CoV-2, the virus that causes COVID-19. They talk about what is known about these new variants, and answer questions and concerns you may have.
Why does the coronavirus change?
Variants of viruses occur when there is a change — or mutation — to the virus’s genes. Ray says it is the nature of RNA viruses such as the coronavirus to evolve and change gradually. “Geographic separation tends to result in genetically distinct variants,” he says.
Mutations in viruses — including the coronavirus causing the COVID-19 pandemic — are neither new nor unexpected. Bollinger explains: “All RNA viruses mutate over time, some more than others. For example, flu viruses change often, which is why doctors recommend that you get a new flu vaccine every year."
Is there a new coronavirus mutation?
“We are seeing multiple variants of the SARS-CoV-2 coronavirus that are different from the version first detected in China,” Ray says.
He notes that one mutated version of the coronavirus was detected in southeastern England in September 2020. That variant, now known as alpha, quickly became the most common version of the coronavirus in the United Kingdom, accounting for about 60% of new COVID-19 cases by December.
Different variants have emerged in Brazil, California and other areas. More infectious variants such as beta, which first appeared in South Africa, may have increased ability to re-infect people who have recovered from earlier versions of the coronavirus, and also be somewhat resistant to some of the coronavirus vaccines in development. Still, vaccines currently used appear to offer significant protection from severe disease caused by coronavirus variants.
What is the delta variant?
Since the beginning of the COVID-19 pandemic, the SARS-CoV-2 coronavirus that causes COVID-19 has mutated (changed), resulting in different variants of the virus. One of these is called the delta variant. The delta coronavirus is considered a “variant of concern” by the CDC because it appears to be more easily transmitted from one person to another. As of July 2021, delta is regarded as the most contagious form of the SARS-CoV-2 coronavirus so far.
Here is what you should know:
The CDC recommends that everyone wait until they are fully vaccinated for COVID-19 before traveling internationally. Traveling internationally if you are not fully vaccinated for COVID-19 is not recommended, because it puts you at risk for coronavirus infection, including the SARS-CoV-2 delta variant. This includes unvaccinated children.
Delta is rapidly becoming the dominant variant of the SARS-CoV-2 virus in the U.S. this year. Delta variant SARS-CoV-2, the virus that causes COVID-19, is now in many countries and people traveling internationally are likely to encounter it. Unvaccinated adults and children should strictly follow mask, distancing and hygiene safety precautions and avoid international travel if possible. Being fully vaccinated for COVID-19 can protect you from the delta variant, but breakthrough infections sometimes occur. All three of the F.D.A.-authorized COVID-19 vaccines can protect you from the delta variant. For Pfizer and Moderna vaccines, you need both doses for maximum protection. People should know that vaccines are very effective at preventing the most severe forms of COVID-19, but breakthrough infections can occur and caution is still warranted after becoming vaccinated. While the authorized COVID-19 vaccines are not perfect, they are highly effective against serious coronavirus disease and reduce the risk of hospitalization and death. Other vaccines available in other countries may not be as effective in protecting you from the delta variant and other mutations of the coronavirus. Although vaccines afford very high protection, infection with the delta and other variants remain possible. Fortunately, vaccination, even among those who acquire infections, appears to prevent serious illness, hospitalization and death from COVID-19. Will the COVID-19 vaccines work on the new variants?
Ray says, “There is evidence from laboratory studies that some immune responses driven by current vaccines could be less effective against some of these variants. The immune response involves many components, including B cells that make antibodies and T cells that can react to infected cells, and a reduction in one does not mean that the vaccines will not offer protection.
“People who have received the vaccines should watch for changes in guidance from the CDC [Centers for Disease Control and Prevention], and continue with coronavirus safety precautions to reduce the risk of infection, such as mask wearing, physical distancing and hand hygiene.”
“We deal with mutations every year for flu virus, and will keep an eye on this coronavirus and track it,” says Bollinger. “If there would ever be a major mutation, the vaccine development process can accommodate changes, if necessary,” he explains.
How are the new coronavirus variants different?
“There are 17 genetic changes in the alpha variant from England,” Bollinger says. “There’s some preliminary evidence that this variant is more contagious. Scientists noticed a surge of cases in areas where the new strain appeared.”
He notes that some of the mutations in the alpha version and some other variants seem to affect the coronavirus’s spike protein, which covers the outer coating of SARS-CoV-2 and give the virus its characteristic spiny appearance. These proteins help the virus attach to human cells in the nose, lungs and other areas of the body.
“Researchers have preliminary evidence that some of the new variants, including alpha, seem to bind more tightly to our cells” Bollinger says. “This appears to make some of these new strains ‘stickier’ due to changes in the spike protein. Studies are underway to understand more about whether any of the variants are more easily transmitted.”
Are coronavirus variants more dangerous?
Bollinger says that some of these mutations may enable the coronavirus to spread faster from person to person, and more infections can result in more people getting very sick or dying. In addition, there is preliminary evidence from Britain that some variants could be associated with more severe disease.
“Therefore, it is very important for us to expand the number of genetic sequencing studies to keep track of these variants,” he says.
Bollinger explains that it may be more advantageous for a respiratory virus to evolve so that it spreads more easily. On the other hand, mutations that make a virus more deadly may not give the virus an opportunity to spread efficiently. “If we get too sick or die quickly from a particular virus, the virus has less opportunity to infect others. However, more infections from a faster-spreading variant will lead to more deaths,” he notes.
How Will New Variants Change the Nature of the Pandemic?
Johns Hopkins Medicine’s Dean Paul Rothman talks about the new COVID-19 variants with pathologist Heba Mostafa, who has helped lead Hopkins’ efforts in COVID-19 testing. Could a new COVID-19 variant affect children more frequently than earlier strains?
Ray says that although experts in areas where the new strain is appearing have found an increased number of cases in children, he notes that the data show that kids are being infected by old variants, as well as the new ones. “There is no convincing evidence that any of the variants have special propensity to infect or cause disease in children. We need to be vigilant in monitoring such shifts, but we can only speculate at this point,” he says.
Will there be more new coronavirus variants?
Yes. As long as the coronavirus spreads through the population, mutations will continue to happen.
“New variants of the SARS-CoV-2 virus are detected every week,” Ray says. “Most come and go — some persist but don’t become more common; some increase in the population for a while, and then fizzle out. When a change in the infection pattern first pops up, it can be very hard to tell what’s driving the trend — changes to the virus, or changes in human behavior. It is worrisome that similar changes to the spike protein are arising independently on multiple continents.”
Are there additional COVID-19 precautions for the new coronavirus variants?
Bollinger says that as of now, none of the new coronavirus variants call for any new prevention strategies. “We need to continue doing the basic precautions that we know work to interrupt spread of the virus,” he says.
Ray concurs: “There is no demonstration yet that these variants are biologically different in ways that would require any change in current recommendations meant to limit spread of COVID-19,” he says. “Nonetheless, we must continue to be vigilant for such phenomena.”
Ray stresses that both vaccination and human behavior are important. “It is striking to note that 99% of COVID-19 deaths are now occurring in unvaccinated people, when most adults in the USA have been vaccinated,” he says. “The more people who are unvaccinated and infected, the more chances there are for mutations to occur. Limiting the spread of the virus through maintaining COVID-19 safeguards (mask wearing, physical distancing, practicing hand hygiene and getting vaccinated) gives the virus fewer chances to change. It also reduces the spread of more infectious variants, if they do occur.
“Vaccines are the medical miracle of 2020, but we need to re-emphasize basic public health measures, including masking, physical distancing, good ventilation indoors and limiting gatherings of people in close proximity with poor ventilation. We give the virus an advantage to evolve when we congregate in more confined spaces,” he says.
Regarding coronavirus variants, how concerned should we be?
“Most of the genetic changes we see in this virus are like the scars people accumulate over a lifetime — incidental marks of the road, most of which have no great significance or functional role,” Ray says. “When the evidence is strong enough that a viral genetic change is causing a change in the behavior of the virus, we gain new insight regarding how this virus works. The virus seems to have some limitations in its evolution – the advantageous mutations are drawn from a relatively limited menu – so there is some hope that we might not see variants that fully escape our vaccines.”
“As far as these variants are concerned, we don’t need to overreact,” Bollinger says. “But, as with any virus, changes are something to be watched, to ensure that testing, treatment and vaccines are still effective. The scientists will continue to examine new versions of this coronavirus’s genetic sequencing as it evolves."
“In the meantime, we need to continue all of our efforts to prevent viral transmission and to vaccinate as many people as possible, and as soon as we can.”
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