Stresses of strains: emerging coronavirus variants

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Hello and welcome to the Intelligence on Economist Radio. I'm your host Jason Palmer. Every weekday we provide a fresh perspective on the events shaping your world. A lawsuit filed by America's Department of Justice against Walmart is just the latest salvo in a growing war on the country's opioid crisis. But retailers are just one link in the drug supply chain and a settlement of any size won't solve the deeper problem. And the odds are that you weren't able to take all of your annual leave last year. Our management columnist looks at the problems raised by all that carried over time off for those lucky enough to carry it over in the first place. But first, Yesterday, Britain's Prime Minister, Boris Johnson announced another full national lockdown for England after a dramatic rise in Covid cases.

Our hospitals are under more pressure from COVID than at any time since the start of the pandemic.

It's the latest attempt to keep the coronavirus under control after a new strain thought to be 50 to 70% more transmissible has has swept through Britain.

It's clear that we need to do more together to bring this new variant under control while our vaccines are rolled out.

And it's not the only variant.

We will all have heard that there is a new variant of COVID 19 that is now well established in South Africa. Our scientists briefed.

Another new strain has also been identified in South Africa after cases surged there, leading to further restrictions, including curfews and a curb on the sale of alcohol.

And its effect. It appears that it may be more contagious than the virus that drove the first wave of infections.

Viruses are expected to change over time and now policies and perhaps even vaccines will have to change with them.

Mutations happen in all living things. They're the driving force of evolution.

Jeff Carr is the Economist's science editor.

They happen at random and then the ones which are successful are selected for and spread through a population. And that seems to be happening at the moment with COVID 19. The two new variants of the virus have appeared recently, but these two have started spreading quite fast.

And so why is it these two variants then are in the news if they happen all the time? What's special about these two mutations? These two variants, the one in Britain.

Can be traced back to September, the one in South Africa can be traced back to October. And what is interesting is that although the British version has 17 mutations which cause changes in its proteins, and the South African one has three, they have one mutation in common. And this is a mutation in a protein called spike. It's a particular change in a particular amino acid, as the components of proteins are called. And spike is the protein by which the virus attaches itself to its target cell. So it is also known that this particular place in the protein is very important to the attachment and that if you make the swap in this component, it increases the strength of the attachment. So it seems likely that this mutation is causing the virus to become more infectious.

So it's a set of mutations that has made two different variants, in possibly a common way, more transmissible. But are they inherently more dangerous?

As far as we can tell, they're not more dangerous. By evolutionary theory, you would expect a disease causing organism like this to succeed if it becomes more transmissible and less dangerous, because if it becomes less dangerous, its host will live longer and it will be able to transmit more widely. So variants that are favoured by natural selection are those which are more easily spread, which this one appears to be. It appears to be about 50% more contagious than the normal variants, but as far as we know, it's not more dangerous.

And it stands to reason that if it gets around more efficiently than the, let's call it the original version of the virus, then these variants will eventually dominate.

Yes, you would expect them to. They haven't met yet. So we don't know which one of them is likely to be more successful. But you would expect one of them to become a dominant part of the viral population? Yes. And the one that seems to have started in Britain has been found in, I believe, 20 other countries. The one that's started in South Africa has been found in a fewer. So it's possible that that could be contained in South Africa, but I think it's unlikely.

And what does that say then about the attempt to stop all this with a vaccine, given that the vaccines that we have have been designed for a very slightly different virus?

The answer, of course, is that at the moment we don't know. But it would be a coincidence if Any of these mutations made the viruses that have them more resistant to the vaccine or to the immune changes that the VAC causes. Because if these variants had emerged when people had been routinely vaccinated, then you would expect that they would be resistant to the vaccine. But because there are very few people vaccinated so far, and when the viruses appeared, there were none, if there is resistance to the vaccine, it's a coincidence. And given that the vaccines raise multiple antibody responses and also things called T cell responses, the chances that either of these variants are resistant to the vaccine are low. They're not zero, but they're low.

But nevertheless, if not, perhaps these mutations, then future mutations that we might expect could interfere with vaccines. I mean, what's to be done if that's the case?

You're absolutely right that future mutations which got around the vaccines would spread. That's how natural selection works. What's interesting about some of the new vaccines is that they are made in a way which would make them very easy to tweak. And it would be a matter of days to design a new version which would be able to tackle a variant virus. Of course, it would then have to be tested and approved, so it wouldn't be introduced immediately. But if there was a variant virus, we know how to deal with it and deal with it in fairly short order.

So in that regard, the real worry here about these variants is simply the number of infections and deaths that will come before people are vaccinated. This isn't a new front in the war, really.

It's not exactly a new front. It's a resurgence, and it can be contained. But in the meantime, more people will die unless precautions are taken. Yes, because these variants are more contagious, you're more likely to catch them if you're exposed. And more people will catch them, which increases the risk that they'll pass them on. In other words, the R number goes significantly over 1.

And because these mutations will keep happening and some that create different problems will just keep arising, I suppose the watchword here is surveillance.

Absolutely, yes. You have to be realistic about evolution. You have to be realistic about natural selection. Viruses in particular mutate all the time, so there's a constant generation of slightly different versions, most of which go nowhere. Obviously, some of which are as good as the existing one, but a few of them, as we're seeing at the moment, are better, better in evolutionary terms. And they will spread. They will replace the existing ones. That's how evolution works. But it looks as though we now have the tools to be able to track the process. Some countries are better at doing this than others. And as it happens, Britain and South Africa are both quite good at it, which may be why these variants have been noticed here. But it is necessary to keep surveillance for new variants.

Thank you very much for your time, Geoff.

Thank you, Jason.

Between June of 2019 and May of 2020, about 80,000Americans died from drug overdoses, most of them involving opioids. This is the worst drugs related death toll in American history and a Stark reminder that COVID 19 isn't the only health crisis ravaging the country. As the opioid epidemic continues to grow, there's also been a marked uptick in the number filed against the companies that supply these addictive painkillers. And now, in what could be a landmark case, America's Department of Justice has set its sights on the country's biggest retailer.

The DOJ is accusing Walmart, or rather the 5,000 pharmacies that Walmart runs within its supermarkets, of fueling the opioid epidemic.

Wendel and von Bredo writes about business.

For the Economist by filling out prescriptions without vetting the patients properly.

And what evidence does the Department of Justice have to back up these allegations?

So the Department of justice produced a 160 page complaint and they listed 20 examples of doctors who were flagged by Walmart's own pharmacists as acting suspiciously. For instance, prescribing dangerously large quantities of an opioid to a single patient, or a patient's even turning up, slurring his words and showing signs of drug abuse. In each case, the DOJ says that even though the pharmacists had flagged these doctors to Walmart's compliance team, nothing was done. And so hundreds and indeed thousands of potentially dodgy prescriptions were filled by their pharmacists. Walmart also until 2018 was the operator of distribution centers and shipped 37.5 million orders of controlled substances, but reported only 204 as suspicious. Whereas a smaller distributor called McKesson shipped far fewer of these orders but reported 13,000 as suspicious. So Walmart seems to have clearly turned a blind eye on a high number of dodgy orders because they wanted to get more customers to spend more time in their stores. So they wanted Farmer Pharmacist to fill these prescriptions quickly and they're also getting a cut off whatever drugs they sell in their pharmacies.

And how has Walmart responded to the allegations? To the lawsuit?

Walmart responded very aggressively. They sued the DOJ even before the DOJ sued Walmart, that's highly unusual. And they say they are being used as a scapegoat. And they blame the opioid crisis on the federal government's own weak enforcement. And they also say it's the pharmacist's role to second guess doctors. Prescriptions is the doctor's role. And the regulators of the doctors are in charge to basically police that these prescriptions are properly and actually needed for pain medication rather than to fuel a drug habit.

And so Walmart's argument is the problem doesn't lie with them, but with the supply chain before them, with the doctors making dodgy prescriptions. The doctors are licensed by the government's own drug enforcement agency. It's a sense of not being able to pin this down to a single culprit.

There's not a single culprit, as you say, there's a whole supply chain. And of course it does start in some ways with the doctors who prescribe sometimes criminally large quantities of opioids to their patients. So I do think Walmart has a point, but it doesn't mean that they should have just continued because they do have by law they are required to flag or to signal dodgy prescriptions and they didn't do that. So I think both the DEA and Walmart are not blameless.

So when will this suit make it to court?

So it's not yet known when the suit will make it to court. And there is a possibility that the DOJ's suit will join the so called multi district litigation, which is a huge lawsuit or a combination of 2,000 lawsuits overseen by a judge in Ohio. But they may just proceed on their own and possibly sometime this year it'll go to court.

And on the basis of the allegations that the DOJ made last month, what's at stake for Walmart if they were to lose?

Well, as the DOJ says in its complaint, the fine for each unlawful prescription filled could be $67,627 and 15,691 for each suspicious order not reported. And you know, given that they filled thousands upon thousands of potentially dodgy prescriptions, it could be very, very expensive even for a behemoth like Walmart. But of course, you know, the question is how this lawsuit will go. And I think what's much, far more likely is that they'll find a settlement that will be expensive for Walmart, but not that expensive.

And where does this fit in with the broader litigation going on around the opioid crisis?

So there is a complex web of litigation in the works. But of course all these lawsuits are a symptom of the disease. And the disease has really become worse this past year in 2020 because of course social isolation and people's despair increased with the COVID 19 pandemic. So they were even more susceptible to addiction. And the costs that come with opioid addiction, everything, first responders, orphaned children, I mean you name it, these are individual tragedies on an unimaginable scale. And so the money needed to help is huge and the sums expense will be huge. We already got a little bit of an inkling of what's to come by Purdue Pharma pleading guilty and settling for $8 billion with the Department of Justice in October. And Johnson and Johnson, another maker of drugs settled for 26 billion dollar deal. So that just to give you an idea of the scale of payments to come and even these billions and billions of dollars won't be enough to really compensate for the harm caused.

Vendelin, thank you very much for joining us.

It's been a pleasure. Jason.

Holidays are great. Whether it's sipping a cocktail on a sun kissed beach or putting your feet up by an apres. Well, actually holidays were great last year many of us found our holidays mostly consisted of sitting in the same room we spent the past few months working in. And that's if we took our allocated leave at all.

2020 was a year which really put worker morale to the test.

Philip Coggin writes Bartleby the Economist's column on work and management.

One of the ways it did so was that many employees weren't able to enjoy a normal holiday. Either they couldn't get away because they were too busy or they was nowhere to go away to. The upshot is that people have unused holiday which they're hoping to carry forward into 2021.

And are you in that camp yourself?

Yes. Fortunately the Economist is a very benign employer and allows us to carry two weeks over from one year to the next. And that indeed is what I've done.

And what's the problem with not taking your allocated holiday?

Plenty of people might say, well it's a bit of a first world problem not having a holiday. But for many workers who've been working at home, it's a particular problem in that you've been stuck inside the four walls for the last nine months or so and just having some sort of break is extremely appealing.

And so what is going to happen with all of the unused leave?

It depends on the country and indeed in America it depends on the individual state. So Some countries and states have a use it or lose it rule whereby you have to use up all your leave either by the end of the year or by the end of the first quarter or by the end of the first half of the following year. Countries including Britain and Denmark, have adjusted their rules to allow people to carry more of it forward. In Britain, virtually all your annual leave, it seems, can be carried forward over the next couple of years. But still, you need usually to agree that with the employer in advance. You can't have employers suddenly finding that many of their staff have disappeared for July and August. This is going to be the difficult thing. Probably the more vital the worker you are, the more difficult it has been to get away during 2020 because you were the core staff covering the core functions of the company. And you've got this balance between making sure you have enough staff and making sure workers get the holidays that they seek.

So how to strike that balance then?

It's very difficult and different employers will take a different approach. Now, for the Economist to lose their management columnist for a few weeks is not going to be a great hardship either for the editors or the readers. But it's all clearly going to be much more difficult if, you know, you're the supervisor at the semiconductor factory or you're the key client relationship manager with your top customer, and this is where managers are going to really have their jobs cut out, finding alternative arrangements. You know, even if the workers are willing to keep going in 2021, you know, they may not be on their top form if they haven't had a proper break for 12 months or so. So it's in the interests of both employers and employees to work this out well.

And when the restrictions and the lockdowns go and it's something like back to normal, there's going to be an un godly rush to holiday spots, right?

Absolutely. The Gadarene rush for the airports. Now, the summer, which is traditionally where a lot of people go on holiday, will easily be the most difficult period. So employers may well have to think about letting people carry over more leave into 2022, never mind 2021 if they want to get through that hump of the summer.

Thanks for your time, Philip.

Thank you, Jason.

That's all for this episode of the Intelligence. If you like us, give us a rating on Apple podcasts and you can subscribe to the economist@examiner.com intelligenceoffer the link is in the show Notes. See you back here tomorrow. Sam.