LETTERS BMJ: first published as 10.1136/bmj.n445 on 26 February 2021. Downloaded from

1 Sheffield Hallam University and COVID-19: NEW VARIANTS Sheffield Teaching Hospitals, Royal Hallamshire Hospital, Sheffield S10 2JF, UK Covid-19 and : can we predict which genetic

2 School of Law, Criminology, and dangers lurk beyond the horizon? Government, University of Plymouth, Plymouth PL4 8AA, UK Stephen T Green, 1 Lorenzo Cladi2 [email protected] 6 Cite this as: BMJ 2021;372:n445 Emerging data show that the B.1.1.7 variant of World Health Organization. SARS-CoV-2 mink-associated variant strain—Denmark. 6 Nov 2020. https://www.who.int/csr/don/06-november- http://dx.doi.org/10.1136/bmj.n445 SARS-CoV-2 might be associated with an increased risk of death.1 2020-mink-associated-sars-cov2-denmark/en/ Published: 26 February 2021 7 McKernan R. Let’s draw blue skies research out of our universities and into As taught us, the of living the economy. Guardian 2017 Nov 10. https://www.theguardian.com/higher- creatures is inevitable. The evolutionary process can education-network/2017/nov/10/lets-draw-blue-skies-research-out-of-our- universities-and-into-the-economy progress down many different pathways, 8 Green ST, Cladi I. Covid 19—predicting the tough-to-predict, and planning and—regardless of whether philosophers and for it, is essential [electronic response to Wise J. Covid-19: New coronavirus biologists consider viruses to be “living variant is identified in UK]. BMJ 2020. https://www.bmj.com/con- creatures”2—natural selection applies as much to tent/371/bmj.m4857/rr-2 SARS-CoV-2 as it does to any living entity, including beings. This article is made freely available for use in accordance with BMJ's website terms and conditions for the duration of the covid-19 pandemic or until otherwise Given the view that SARS-CoV-2 might have come determined by BMJ. You may use, download and print the article for any lawful, into existence through the chance encounter of a bat non-commercial purpose (including text and data mining) provided that all and a pangolin,3 and in light of the recent copyright notices and trade marks are retained. independent emergence of at least three new (and potentially very dangerous) variants around the world,4 scientific imaginations need to be exercised like never before to anticipate the next steps in this unfolding human tragedy. Could human SARS-CoV-2 re-enter other animal species and—as seems to have happened with the http://www.bmj.com/ bat and the pangolin—encounter and combine with other animal coronaviruses to create yet more variants, some of which might prove to be dangerous to ? This is not an outlandish idea—events of this type happen all the time with influenza5 and have considerable proved potential to damage human health. There have already been suspicions about

SARS-CoV-2 variants from mink.6 on 27 September 2021 by guest. Protected copyright. SARS-CoV-2 is a clear and present danger. All things are possible, and no possibilities can be discounted without sufficient evidence. Engaging in the process of blue sky thinking is a long and tough road,7 but it has to be followed if the human race wants to get ahead of the covid-19 curve, and for maximum chances of success, the effort undoubtedly has to be international and inclusively worldwide.8

Competing interests: None declared.

1 Iacobucci G. Covid-19: New UK variant may be linked to increased death rate, early data indicate. BMJ 2021;372:n230. doi: 10.1136/bmj.n230 pmid: 33500262 2 Li G. Are viruses alive? New Scientisthttps://www.newscientist.com/ques- tion/are-viruses-alive/ 3 Lam TT-Y, Jia N, Zhang Y-W, etal. Identifying SARS-CoV-2-related coronaviruses in Malayan pangolins. Nature 2020;583:282-5. doi: 10.1038/s41586-020-2169-0. https://www.nature.com/articles/s41586- 020-2169-0. pmid: 32218527 4 Centers for Disease Control and Prevention. New variants of the virus that causes covid-19. 2 Feb 2021. https://www.cdc.gov/coronavirus/2019- ncov/transmission/variant.html 5 Centers for Disease Control and Prevention. Transmission of avian influenza A viruses between animals and people. 10 Feb 2015. https://www.cdc.gov/flu/avianflu/virus-transmission.htm the bmj | BMJ 2021;372:n445 | doi: 10.1136/bmj.n445 1