How do you know if you have a variant of COVID-19?

While many North Texans have returned to their pre-pandemic lifestyles as COVID-19 vaccinations continue, variants of the virus are still circulating and posing a danger to people who aren’t yet protected.

Variants of any virus are common and expected — but mutations in the virus that causes COVID-19 are particularly worrisome to health experts because of the danger they may pose to unvaccinated people.

Communities in North Texas and across the country are racing against the mutating strains to get as many shots in as many arms as possible so new, potentially more contagious and severe versions of the virus can be wiped out.

But how do you know if you are infected with a variant of the virus? Here’s what you need to know.

Which variants are circulating in Dallas County?

The Centers for Disease Control and Prevention has identified four variants of concern of the virus that causes COVID-19: B.1.1.7, also known as Alpha, which was first detected in the United Kingdom; B.1.351, also known as Beta, which first detected in South Africa; P.1, also known as Gamma, which was first detected in travelers from Brazil; and B.1.617.2, also known as Delta, which was first detected in India.

A variant of concern is classified by the CDC as any mutation of the virus for which there is evidence of increased transmissibility, more severe disease or a reduction in the effectiveness in treatments, vaccines or diagnostic tests.

Local health experts say those strains of the virus probably have overtaken the initial strain that was circulating in 2020 in most places. Of particular concern in recent weeks has been the Delta variant, which appears to spread even more quickly than the Alpha variant, particularly among young people, and may cause more severe illness, health experts say.

By July 2, 166 instances of COVID-19 variants had been confirmed among Dallas County residents: 131 cases of the Alpha variant, two cases of the Beta variant, nine cases of the Delta variant and 15 cases of the Gamma variant.

Nine cases of another variant that was first detected in California, known as B.1.429 or Epsilon, have also been confirmed in the county.

The Epsilon variant is classified by the CDC as a variant of interest, meaning it has genetic characteristics that may have the same impacts as variants of concern. Variants of interest also may have lower prevalence or growth in communities.

How do health officials know who has a variant?

Although county health officials give regular updates about the number of confirmed variants among residents, local health experts say it’s not a complete picture.

“That is by no means comprehensive,” said Dr. Philip Huang, director of the county’s health department, referring to the county’s daily update of variant counts. “The message is that it just confirms that [a variant] is present and circulating in our community.”

Part of the total comes from positive tests taken by Dallas County that are sent to the state health department for analysis, Huang said. He said the county sends at least half of all its positive samples to the state.

The other portion of the total comes from analysis of tests by researchers at UT Southwestern Medical Center.

Dr. Jeffrey SoRelle, an assistant instructor in the department of pathology, is co-leading that effort. He and a team of about 10 other researchers analyze COVID-19 tests from the university hospital, clinics and drive-through test sites.

The first step in the process is to take all positive COVID-19 tests and identify the ones that have a high enough viral load for them to be sequenced, or analyzed.

The amount of viral load in a COVID-19 test is almost entirely dependent on when a person is tested for the disease, SoRelle said. Viral load is usually higher when someone initially gets sick and then tapers off after about two weeks.

“It’s true that this is a small proportion of the total number of tests being performed,” he said. “But in general, the trends have tracked fairly well with what we’re seeing with statewide numbers, which at least gives us some confidence that there’s similar trends. When the UK Alpha variant first arose, we saw it at similar levels at our institution as were being reported across other areas of Texas.”

Once researchers determine there is enough viral load in a test for sequencing, two processes are performed. The first process, called targeted PCR, gives the team a more general idea of the makeup of the virus.

“We look for about eight different mutations that might be present in some of the different variants of concern. This is a sort of snapshot, small picture, but can be quite sensitive,” SoRelle said.

The second process, known as whole genome sequencing, gives researchers an in-depth look at the genetic makeup of the virus.

“Base by base or nucleotide by nucleotide, we see if there’s any changes different from the original strain,” SoRelle said. “In many cases there’s many random mutations, but in the variants of concern, there are usually many specific mutations that can be recognized.”

An algorithm is then used to determine if the virus is one of the variants.

The whole process can take up to two weeks, he said.

“Our goal is to see if there are any variants in our population, and then see if there’s any novel variants that no one’s ever seen before,” SoRelle said, adding that the team has identified all of the CDC’s variants of concern among UTSW tests.

He said the university is talking to the state health department about the possibility of sequencing COVID-19 tests on a larger scale from other providers.

He also has submitted a grant proposal to begin analyzing the demographic information about people who test positive for COVID-19 variants.

“It’s challenging. It’ll help when we can get more specimens from different areas to get a better picture,” SoRelle said. “We get a general idea of what’s going on, but you need a larger magnifying glass.”

Do individuals need to know whether they are sick with a variant?

SoRelle’s team notifies the public health department of any positive variants they detect. But neither UTSW or the county health department notify individuals if they test positive for a variant.

Although the way tests are analyzed is not unique to the COVID-19 virus, the team doesn’t notify individuals because the type of test is used only for research purposes. He said there aren’t any tests approved for giving patients information about variants.

Health experts say on an individual level, it doesn’t matter whether people know they tested positive for variants or not, because the guidance is still the same no matter what mutation someone may have.

“There is no difference. We don’t have a particular treatment based on your variant, we don’t have a particular protocol based on your variant,” said Dr. Marcial Oquendo, a pediatrician and a member of the Dallas County Medical Society. “At the end of the day, the recommendations for you as a person who’s infected, it doesn’t change based on whether it’s one or the other.”

But epidemiologists and other health experts need to know about variants in a community so they can better determine a community’s risk level based on how the virus is spreading.

Health experts are concerned that if vaccination rates slow, the variants will have adverse impacts on people who haven’t gotten shots.

“Now that we’ve somewhat to a degree plateaued or hit this little bit of a lull in individuals getting vaccination, that’s our concern,” said Dr. Mark Casanova, former president of the Dallas County Medical Society. “There’s enough dry wood in the pile that this next wave has enough fuel to set off another fire. Now, will it be a raging blaze, like last summer, last winter? No, but it’s going to be a fire nonetheless.”

At this stage of the pandemic, health experts say severe outcomes of the disease, like hospitalization and death, are preventable on an individual level. The fact that more transmissible variants of COVID-19 are circulating should motivate people to get vaccinated.

“It’s more important for the individual to know that, ‘Hey, listen, this isn’t the COVID of 2020. This is the COVID of 2021,’” Casanova said. “It is important to be aware that it not only is more transmissible, so there’s a greater likelihood you could acquire it, but it does seem to cause more severe, significant infections.”