Emergence, Progression and Impact of SARS-CoV-2 Variants in West Virginia

PROGRAM SUMMARY The novel coronavirus SARS-CoV-2 has swept the globe resulting in millions of deaths. Recent descriptions of variants have raised concerns regarding the impact on the effectiveness of COVID-19 therapies and preventive strategies including monoclonal antibodies and vaccines. Though COVID vaccine scale-up in West Virginia is currently among the best in the nation, West Virginia's population is highly vulnerable to emergent variants that may impact the effectiveness of current vaccines and therapeutic monoclonal antibodies. To suppress the ongoing pandemic it is critical to identify, track and isolate new variants before they spread and bring a wave of disease that is resistant to current vaccines. Noteworthy is that we have already established high throughput SARS-CoV-2 sequencing with long-standing collaborations between Marshall University, West Virginia University, and the West Virginia Department of Health and Human Resources. We are well positioned to provide rapid, impactful information regarding the prevalence, changing patterns, and clinical outcomes with respect to variants as well as on the effect of variants among those who have received a COVID-19 vaccine. This project will sequence SARS-CoV-2 from heterogeneous populations by leveraging three existing testing programs that include: 1) the Rapid Acceleration of Diagnosis in Underserved Populations (RADx-UP) that has already tested over 1,500 persons throughout the state, 2) surveillance testing among nursing home residents and staff, and 3) university surveillance testing. Through the RADx-UP initiative, testing is currently conducted in 37 counties; all positive tests will be sent for sequencing, enabling assessment of variants in disparate locations in West Virginia - some within 40 minutes of the metro Washington DC area and others in remote rural locations. Moreover, the WV RADx-UP initiative is also conducting testing among communities of color (predominantly Black/African American) enabling description of variants among this group in comparison to the general population of WV. Relevant to nursing home populations, age has been associated with lower antibody levels in both the Moderna and Pfizer Phase 3 vaccine trials. Nursing home patients may be more likely to have suboptimal immunity, a scenario that is ripe for emergence of existing or novel variants. Finally, university students by virtue of their mobility and variable adherence to social distancing measures suggest fertile ground for emergence of variants. Sequencing of all isolates from the WVU surveillance testing program will provide an excellent opportunity to assess cases caused by variants over time. As this project will support SARS-CoV-2 sequencing in multiple West Virginia populations, we are confident that this surveillance sequencing will quickly identify variant emergence and distributions so as appropriate public health measures may be implemented.