Summer E. Galloway, PhD1; Prabasaj Paul, PhD1; Duncan R. MacCannell, PhD2; Michael A. Johansson, PhD1; John T. Brooks, MD1; Adam MacNeil, PhD1; Rachel B. Slayton, PhD1; Suxiang Tong, PhD1; Benjamin J. Silk, PhD1; Gregory L. Armstrong, MD2; Matthew Biggerstaff, ScD1; Vivien G. Dugan, PhD1
On December 14, 2020, the United Kingdom reported a SARS-CoV-2 variant of concern (VOC), lineage B.1.1.7, also referred to as VOC 202012/01 or 20I/501Y.V1.* The B.1.1.7 variant is estimated to have emerged in September 2020 and has quickly become the dominant circulating SARS-CoV-2 variant in England (1). B.1.1.7 has been detected in over 30 countries, including the United States. As of January 13, 2021, approximately 76 cases of B.1.1.7 have been detected in 10 U.S. states.† Multiple lines of evidence indicate that B.1.1.7 is more efficiently transmitted than are other SARS-CoV-2 variants (1–3). The modeled trajectory of this variant in the U.S. exhibits rapid growth in early 2021, becoming the predominant variant in March. Increased SARS-CoV-2 transmission might threaten strained health care resources, require extended and more rigorous implementation of public health strategies (4), and increase the percentage of population immunity required for pandemic control. Taking measures to reduce transmission now can lessen the potential impact of B.1.1.7 and allow critical time to increase vaccination coverage. Collectively, enhanced genomic surveillance combined with continued compliance with effective public health measures, including vaccination, physical distancing, use of masks, hand hygiene, and isolation and quarantine, will be essential to limiting the spread of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19). Strategic testing of persons without symptoms but at higher risk of infection, such as those exposed to SARS-CoV-2 or who have frequent unavoidable contact with the public, provides another opportunity to limit ongoing spread.
Global genomic surveillance and rapid open-source sharing of viral genome sequences have facilitated near real-time detection, comparison, and tracking of evolving SARS-CoV-2 variants that can inform public health efforts to control the pandemic. Whereas some mutations in the viral genome emerge and then recede, others might confer a selective advantage to the variant, including enhanced transmissibility, so that such a variant can rapidly dominate other circulating variants. Early in the pandemic, variants of SARS-CoV-2 containing the D614G mutation in the spike (S) protein that increases receptor binding avidity rapidly became dominant in many geographic regions (5,6).
In late fall 2020, multiple countries reported detecting SARS-CoV-2 variants that spread more efficiently. In addition to the B.1.1.7 variant, notable variants include the B.1.351 lineage first detected in South Africa and the recently identified B.1.1.28 subclade (renamed “P.1”) detected in four travelers from Brazil during routine screening at the Haneda (Tokyo) airport.§ These variants carry a constellation of genetic mutations, including in the S protein receptor-binding domain, which is essential for binding to the host cell angiotensin-converting enzyme-2 (ACE-2) receptor to facilitate virus entry. Evidence suggests that other mutations found in these variants might confer not only increased transmissibility but might also affect the performance of some diagnostic real-time reverse transcription–polymerase chain reaction (RT-PCR) assays¶ and reduce susceptibility to neutralizing antibodies (2,3,5–10). A recent case report documented the first case of SARS-CoV-2 reinfection in Brazil with a SARS-CoV-2 variant that contained the E484K mutation,** which has been shown to reduce neutralization by convalescent sera and monoclonal antibodies (9,10).
This report focuses on the emergence of the B.1.1.7 variant in the United States. As of January 12, 2021, neither the B.1.351 nor the P.1 variants have been detected in the United States. For information about emerging SARS-CoV-2 variants of concern, CDC maintains a webpage dedicated to providing information on emerging SARS-CoV-2 variants.††
What is already known about this topic?
A more highly transmissible variant of SARS-CoV-2, B.1.1.7, has been detected in 10 U.S. states.
What is added by this report?
Modeling data indicate that B.1.1.7 has the potential to increase
the U.S. pandemic trajectory in the coming months. CDC’s system for genomic surveillance and the effort to expand
sequencing will increase the availability of timely U.S. genomic
What are the implications for public health practice?
The increased transmissibility of the B.1.1.7 variant warrants
universal and increased compliance with mitigation strategies,
including distancing and masking. Higher vaccination coverage
might need to be achieved to protect the public. Genomic
sequence analysis through the National SARS-CoV-2 Strain
Surveillance program will enable a targeted approach to
identifying variants of concern in the United States.