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Covid London: Just half of carers vaccinated in Lambeth care home with South Africa variant outbreak

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The South African Covid variant has caused an outbreak in a care home in a London borough where only half of staff have been vaccinated – the lowest rate in England.

At least 13 staff and 10 residents in a home in Lambeth, in the south of the capital, tested positive for the mutated strain of the virus this month.

Six of the residents and one of the staff members are believed to have been vaccinated at least two weeks earlier but got infected anyway, while others hadn’t been jabbed. Although studies have suggested the jabs are slightly less effective against the variant, scientists expect they will still prevent serious illness and help to stop Covid spreading, but only if uptake is high and communities develop mass protection.

NHS Test & Trace has started surge testing in Lambeth, as well as in nearby Wandsworth and parts of Barnet and Southwark after variant cases were found there, too. There have been a total of 600 found in the UK so far.

Surge testing was already going on in parts of the Harrow and Hillingdon boroughs, and it started up in bits of Sandwell and Birmingham today after cases were discovered there.

The Lambeth outbreak appears to have been triggered by someone who travelled to Africa – but not South Africa itself – and then returned to London and went into a care home, the BBC reports.

The borough, which extends south from the River Thames and contains Waterloo Station, the London Eye and Brixton and Clapham, has the lowest vaccine uptake rate in the country, NHS data show. Only 50 per cent of care staff there had had a jab by the end of last week.

The Government and health officials have urged all carers to get vaccinated to protect people in care homes but thousands are refusing to take up the offer, so worried ministers are now considering making it a legal requirement.

Experts fear the South African variant will be able to keep circulating even after people are vaccinated because jabs don’t work as well against it. One SAGE adviser said on Wednesday that local lockdowns could be needed to contain it in London. 

Lambeth has the lowest vaccine uptake among care home staff in London, at 50 per cent, which is also the lowest across all of England, NHS data show

Lambeth has the lowest vaccine uptake among care home staff in London, at 50 per cent, which is also the lowest across all of England, NHS data show

Surge testing is being done in London to weed out cases of the South Africa variant, which experts describe as 'the most worrying' strain

Surge testing is being done in London to weed out cases of the South Africa variant, which experts describe as ‘the most worrying’ strain

The Lambeth care home where the South African variant is thought to have caused an outbreak has not been named.

The individual is thought to have been in Africa – but not South Africa – and picked up the virus before returning to London and passing it on to people they live with and then to people in the care home, the BBC reported.

It is not clear whether they work at the care home or were visiting. 

Vaccine uptake among care home residents in Lambeth is high – 92 per cent of them have had at least one dose of a jab, with only 40 residents thought to be unvaccinated.

SURGE TESTING IN LONDON AS SOUTH AFRICA VARIANT SPREADS

Surge testing started in Barnet yesterday after a case of the South African variant was discovered.

Thousands of residents in Wandsworth and Lambeth have already queued up to take coronavirus tests after 44 cases of the South African variant were found in those areas. 

Barnet Council said teams of officials will go door-to-door in areas in the N3 postcode to deliver PCR test kits, and a mobile testing unit will be set up in the car park of Finchley Central Station. 

Meanwhile, Wandsworth Council said the testing operation was a ‘mammoth task’ but urged all adults in the area to get tested even if they do not have any symptoms.  

Additional testing has also been set up by NHS Test and Trace in the SE16 area of Southwark, where the Department of Health said a case linked to the cluster in Wandsworth and Lambeth has been identified and is self-isolating.

SAGE adviser Professor John Edmunds said the situation in London could be a sign of things to come across the country.

Speaking on ITV’s Peston this week he said that strain was ‘the most worrying’ and that officials should do everything possible to control it. 

‘What we are looking at in south London is an example of what we’ll see now in the coming months as we try our best to keep that variant out, or at as low a level as we possibly can.

‘Because if these mass testing events don’t work that well, and we don’t know yet – I mean, we’ll have to evaluate this one very carefully – then it’s possible that we’ll have to impose some sort of local restrictions back in place and nobody wants to do it.’ 

This is slightly lower than the England average, at 94 per cent, but still significant coverage. 

The rate among care staff, however, is the lowest in the country at just 50 per cent.

Out of 905 care workers in the borough, only 453 had taken up the offer of the vaccines designed to save the lives of the residents they care for. The latest data count vaccines given up to April 11.

Scientists and politicians have warned it is vital that carers and NHS staff get vaccinated against Covid because their patients are at such a high risk from the virus.

The Department of Health this week revealed a proposal to change the law to make it mandatory for carers to have the jab before they can work in a home.

At least 41,448 care home residents have died with Covid-19 since the pandemic began – around 10 per cent of the entire population.

Health Secretary Matt Hancock said this week: ‘Older people living in care homes are most at risk of suffering serious consequences of Covid-19 and we have seen the grave effects the virus has had on this group.

‘Making vaccines a condition of deployment is something many care homes have called for, to help them provide greater protection for staff and residents in older people’s care homes and so save lives.

‘We have a duty of care to those most vulnerable to Covid, so it is right we consider all options to keep people safe.’

Other London boroughs also have among the lowest vaccine uptake rates among care home workers.

Only two thirds of care workers have had a jab in Wandsworth and Redbridge (63 per cent); Southwark, Enfield and Hackney (64 per cent); and Barnet (66 per cent).

Those boroughs are also the ones where the South African variant is known to be spreading – cases were recorded this week in Wandsworth, Southwark and Barnet.

This double threat – low vaccine rates and the presence of the variant – makes the Covid risk higher than in other areas.

The low uptake rate may be because the areas have a large proportion black and ethnic minority groups, who are more likely to refuse the vaccine. 

Uptake is also low among carers nationwide for this reason, and also because they are usually in low income households, where people are also less likely to get a jab.

Professor Anthony Harnden, deputy chief at the JCVI vaccines committee, said in a Royal Society of Medicine seminar this week: ‘There are problems in London, where the coverage rates are lower, and there are problems among certain ethnic minority groups, such as black Africans, where rates are lower, and we still need to do a lot of work with those groups.’

AREAS OF ENGLAND WHERE THE FEWEST CARE HOME STAFF ARE VACCINATED

Areas marked with * are boroughs of London 

% OF CARE HOME STAFF VACCINATED

 % OF HOME RESIDENTS  VACCINATED

Lambeth* 

Luton 

Redbridge*

Wandsworth*

Hackney*

Southwark*

Enfield*

Manchester

Barnet*

Greenwich* 

50%

60% 

63% 

63%

64%

64%

64%

65%

66%

67% 

92%

89%

93%

90%

90%

92%

93%

91%

 92%

94%

A total of 600 cases of the South African strain, known as B.1.351, have now been detected by Public Health England and it has been spreading since autumn last year.

Experts fear that, because vaccines don’t work as well against it, it could continue to spread even as the rollout reaches the majority of adults.

Professor John Edmunds, a member of the SAGE government advisory group, said on ITV’s Peston this week: ‘What we are looking at in south London is an example of what we’ll see now in the coming months as we try our best to keep that variant out, or at as low a level as we possibly can. 

‘Because if these mass testing events don’t work that well, and we don’t know yet – I mean, we’ll have to evaluate this one very carefully – then it’s possible that we’ll have to impose some sort of local restrictions back in place and nobody wants to do it.’

The reason scientists are concerned about the South Africa variant is that it has mutated in a way that appears to make it less susceptible to immunity from vaccines.

It spreads about equally as fast as the Kent variant that is dominant in the UK, but has an extra mutation that makes the immune system’s antibodies less able to recognise it.

This is because vaccines and immunity in people who have had Covid before are targeted at older versions of the virus and the super-specific proteins it uses to attack it struggle to recognise the mutated version.

Studies suggest that the vaccines will still prevent death and serious Covid caused by the variant, but might be less effective at stopping mild infections or preventing transmission – although they will still protect people.

Pfizer, AstraZeneca and Moderna are all working on booster jabs that could be given to the most vulnerable members of society in the autumn, to make sure they have maximum protection if the strain becomes dominant.

In the meantime, health officials in the UK are launching testing blitzes in areas where the variant is found and also checking almost every single positive swab to weed out the cases. 

Public Health England’s Dr Susan Hopkins said: ‘It’s really important people in the local area play their part in stopping any further spread within the local community.

‘PCR testing is now available for all and I would strongly encourage everyone, whether they live, work or travel through the boroughs, to get tested even if they don’t have any symptoms of coronavirus.’ 

A real-world study done in Israel and published last week suggested the B.1.351 variant might slip past protection given by the Pfizer jab in some people.

The study compared almost 400 people who had tested positive for Covid-19 14 days or more after they received one or two doses of the vaccine, against the same number of unvaccinated patients with the disease. 

It found the variant was eight times more common among vaccinated people than unvaccinated – 5.4 per cent versus 0.7 per cent – suggesting the jabs were stopping other strains but not the South African one. 

‘We found a disproportionately higher rate of the South African variant among people vaccinated with a second dose, compared to the unvaccinated group. This means that the South African variant is able, to some extent, to break through the vaccine’s protection,’ said Tel Aviv University’s Adi Stern.

The researchers cautioned, though, that the study only had a small sample size of people infected with the South African variant because of its rarity in Israel. The study has not been reviewed by other scientists.

WHAT DO WE KNOW ABOUT THE SOUTH AFRICAN VARIANT? 

Real name: B.1.351

When and where was it discovered? 

Scientists first noticed in December 2020 that the variant, named B.1.351, was genetically different in a way that could change how it acts.

It was picked up through random genetic sampling of swabs submitted by people testing positive for the virus, and was first found in Nelson Mandela Bay, around Port Elizabeth.

Using a computer to analyse the genetic code of the virus – which is viewed as a sequence of letters that correspond to thousands of molecules called nucleotides – can help experts to see where the code has changed and how this affects the virus. 

What mutations did scientists find?

There are two key mutations on the South African variant that appear to give it an advantage over older versions of the virus – these are called N501Y and E484K.

Both are on the spike protein of the virus, which is a part of its outer shell that it uses to stick to cells inside the body, and which the immune system uses as a target.

They appear to make the virus spread faster and may give it the ability to slip past immune cells that have been made in response to a previous infection or a vaccine. 

What does N501Y do? 

N501Y changes the spike in a way which makes it better at binding to cells inside the body.

This means the viruses have a higher success rate when trying to enter cells when they get inside the body, meaning that it is more infectious and faster to spread.

This corresponds to a rise in the R rate of the virus, meaning each infected person passes it on to more others.

N501Y is also found in the Kent variant found in England, and the two Brazilian variants of concern – P.1. and P.2.

What does E484K do?

The E484K mutation found on the South African variant is more concerning because it tampers with the way immune cells latch onto the virus and destroy it.

Antibodies – substances made by the immune system – appear to be less able to recognise and attack viruses with the E484K mutation if they were made in response to a version of the virus that didn’t have the mutation.

Antibodies are extremely specific and can be outwitted by a virus that changes radically, even if it is essentially the same virus.

South African academics found that 48 per cent of blood samples from people who had been infected in the past did not show an immune response to the new variant. One researcher said it was ‘clear that we have a problem’.

Vaccine makers, however, have tried to reassure the public that their vaccines will still work well and will only be made slightly less effective by the variant. 

How many people in the UK have been infected with the variant?  

At least 105 Brits have been infected with this variant, according to Public Health England’s random sampling.

The number is likely to be far higher, however, because PHE has only picked up these cases by randomly scanning the genetics of around one in 10 of all positive Covid tests in the UK.

This suggests that there have been at least 1,050 cases between December and January 27.

Where else has it been found?

According to the PANGO Lineages website, the variant has been officially recorded in 31 other countries worldwide.  

The UK has had the second highest number of cases after South Africa itself.

But other nations where it has been found include South Korea, Sweden, France, Australia, Germany, Kenya, United Arab Emirates, Switzerland, Norway, Portugal, Denmark, Belgium, USA, Netherlands, Mozambique, Ireland, Botswana, New Zealand, Finland, Spain and the French island territory Mayotte.

Will vaccines still work against the variant? 

So far, Pfizer and Moderna’s jabs appear only slightly less effective against the South African variant. 

Researchers took blood samples from vaccinated patients and exposed them to an engineered virus with the worrying E484K mutation found on the South African variant.

They found there was a noticeable reduction in the production of antibodies, which are virus-fighting proteins made in the blood after vaccination or natural infection.

But it still made enough to hit the threshold required to kill the virus and to prevent serious illness, they believe.

There are still concerns about how effective a single dose of vaccine will be against the strain. So far Pfizer and Moderna’s studies have only looked at how people given two doses react to the South African variant. 

Studies into how well Oxford University/AstraZeneca‘s jab will work against the South African strain are still ongoing.

Johnson & Johnson actually trialled its jab in South Africa while the variant was circulating and confirmed that it blocked 57 per cent of coronavirus infections in South Africa, which meets the World Health Organization’s 50 per cent efficacy threshold. 

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