I'm curious and worried about the coronavirus mutations and variants. Viral mutations are common, and with the sheer number of infected individuals in the world right now, they're inevitable. The vast majority of mutations do very little, but the few strains we're seeing could pose a significant danger. I'm most worried about strains like the UK and South African strains (N501Y and B.1.351) which may have increased infectivity. Increased spread translates into a much higher mortality than one would assume. One might think a mutation causing 50% increased lethality is worse than one causing 50% increased infectivity, but modeling studies show that increased infectivity and the exponential spread of virus translates into a much higher death rate at the population level. Furthermore, increased spread means control of the virus and herd immunity will be more elusive. 

This is echoed by reports that the Brazilian strain B.1.1.248 may evade neutralizing antibodies. Since our vaccine targets the unique spike protein of COVID-19, mutations in this spike protein may mean our immune systems may not recognize the pathogen. If this happens to be the case, our ~95% vaccine effectiveness may be attenuated. But I think a lot remains to be studied and understood.

Although these mutations and variants are disappointing in the outlook for the pandemic, I think it will be the new reality. Pandemics are not static entities, and we must adapt as the virus adapts. I have so much gratitude and appreciation for those tireless scientists working to understand and predict the course of this pandemic. As a clinician, I realize the importance and the challenge of understanding the basic virology going on here. It's not my area of expertise, and I depend so much on the researchers studying it.