In-Depth | Tracing Maharashtra's re-emergence as a COVID-19 hotspot
In-Depth | Tracing Maharashtra's re-emergence as a COVID-19 hotspot
Maharashtra has again emerged as the country’s biggest COVID-19 hotspot amid rising concerns about new, more contagious variants of the novel coronavirus and people flouting safety protocols as lockdown restrictions eased in the state and local trains resumed for general public in Mumbai.
On February 23, Maharashtra became the only Indian state where the COVID-19 pandemic had resurged. The test-positivity rate nearly doubled in the past 14 days in sharp contrast to the rest of the country where the transmission rate declined or rose only marginally.
Positivity rate in Maharashtra grew to 7.7 percent on February 8-21 from 4.7 percent in the previous two weeks, The Times of India reported.
Currently, India’s infections are the second-highest in the world at over 11 million, with over 24,800 new cases recorded, health ministry data showed on March 13. Deaths increased to 1.58 lakh.
Maharashtra and Kerala account for more than 70 percent of the country's total active caseload. Kerala’s positivity rate, however, declined to 7 percent from 9 percent over the second and the third week of February.
After taking stock of the situation, the central government directed Maharashtra — which was also among the worst-hit states when the pandemic began last year — to ramp up testing and follow the strategy of tracing and isolation to slow down transmission of the infectious disease.
According to the union health ministry, the state is the second-highest contributor to India’s daily caseload. However, when the number of cases started receding nationwide, the situation in the western state had also improved.
But COVID-19 numbers in Maharashtra have been on the rise again since the beginning of February.
On March 11, the state reported over 14,000 new COVID-19 cases, according to the daily health bulletin. Mumbai saw the biggest jump of more than 1,400 cases in the last 24 hours, the highest in many months.
Various factors that may have increased the spread of the disease include the resumption of local trains for the general public, easing of lockdown restrictions and large congregations such as the farmers' protest.
The resumption of local train services for the general public may explain the spike in number of positive cases in the Mumbai Metropolitan Region (MMR), but what could explain Vidharba region’s health crisis?
The rise comes at a time when two new variants of the virus have been found in samples in the state’s Vidarbha region. Dr. Jacob John, one of India’s leading virologist, told Moneycontrol that two factors may explain the sudden spike.
The first being people lowering their guard by flouting social-distancing norms in public places and being reluctant to use masks. Even last year, health experts pointed out the lack of “COVID-appropriate behaviour” among people as a reason for increasing transmission rates.
The other factor may be the mutant variants of the virus being discovered in the region. “These could be more transmissible than the mother virus,” said Dr. John.
Thousands of COVID-19 mutations have been detected across the globe since the outbreak of the pandemic last year. Some variants are more infectious than others, such as the one in UK that triggered a second lockdown in Britain over the past few months.
File image: People scramble to board a bus amid the spread of COVID-19 in Mumbai, India on February 25, 2021. (Image: Reuters/Francis Mascarenhas)
So far, Indian researchers have identified 7,684 variants in SARS-CoV-2 (novel coronavirus) genomes from samples collected within the country, reported Business Today.
Dr. Rakesh Mishra, Director of the Centre for Cellular and Molecular Biology (CCMB), said during a recent press conference that the N440K variant is spreading a lot more in the southern states. Researchers in Maharashtra detected this variant in one sample from Yavatmal. It was also found in Andhra Pradesh and parts of north India in December 2020.
He said India needs to step up genome sequencing to stay on top of changes in the virus' structure and to develop the appropriate strategy for treatment and prevention.
India has so far not been using its full capacity for sequencing, having deposited only about 6,400 genomes of the over 10.4 million recorded cases (0.06 percent).
Since February 15, thousands of COVID-19 cases have been reported in Amravati and Yavatmal districts. The state government had imposed a 10-day lockdown in Yavatmal last month and announced a strict week-long lockdown in Amravati too.
On February 18, The Indian Express reported that during genome sequencing of COVID-19 infected blood samples, researchers found the “E484K” mutation of the virus in four samples from Amravati.
Since this mutation has been found in the new, fast-spreading COVID strains in the United Kingdom, South Africa and Brazil, district officials have been concerned that the variant could transmit quickly across Maharashtra and the country.
The research paper 'SARS-CoV-2 genomics: An Indian perspective on sequencing viral variants' by the scientists of CCMB says some of the recently identified spike mutations that are of concern include the N439K, N440K, Q493K and E484K, as they are prone to immune escape.
The paper says the N440K variant has been found in 42 percent of the samples from Andhra Pradesh and E484K in three samples from Maharashtra.
However, the state government denied the detection of any mutations of the virus similar to the ones found in the UK, Brazil or South Africa.
But recently, according to a report by The Quint, Dr. Randeep Guleria, chief of the All India Institute of Medical Sciences (AIIMS) in New Delhi, warned that the new strain found in Amravati is “highly transmissible and dangerous”, and could cause re-infections among people who have already had COVID-19.
File image: Volunteers distribute pamphlets during an awareness campaign on the spread of COVID-19 on a street in Mumbai, India on February 22, 2021. (Image: Reuters/Niharika Kulkarni)
The Indian Council of Medical Research (ICMR) on February 18 said that interim results of the ongoing clinical trials indicated that the indigenous COVID-19 vaccines would be effective against the mutated virus strains reported from the UK, Brazil and South Africa.
Addressing an international webinar 'Kerala Health: Making the SDG A Reality', organised by Kerala government's Department of Health and Family Welfare, Dr. Balram Bhargava, Director General of ICMR said that in the case of the variants from South Africa and Brazil, efforts were on to isolate the mutated virus strains from the samples collected from travellers from these two countries.
The third clinical trial of Covaxin BB152 had been completed as all the 25,800 volunteers involved in the exercise had been administered both doses. "The interim analysis report should be out in a week," news agency ANI reported.
Dr. Bhargava also pointed out that India was the fifth country in the world to isolate the COVID-19 virus as part of the efforts to develop a vaccine for the pandemic.
Meanwhile, Indian pharmaceutical companies Bharat Biotech and Biological E. Ltd. said on February 22 that they could quickly rework their COVID-19 vaccine products to fight new variants once their genetic sequence is known.
ICMR and Bharat Biotech have collaborated to develop India’s first homegrown COVID-19 vaccine, which, along with another licensed from AstraZeneca and Oxford University, is being used in the country’s immunisation campaign that has covered more than 10 million people since mid-January.
Bharat Biotech Chairman Krishna Ella said at a recent press conference that his company would mainly need data from the ICMR or the World Health Organization (WHO) on the genetic sequence of any variant to quickly make an effective vaccine.
Ella said a product to tackle the South African variant could be made in 15 days and would not require any change in the manufacturing process.
File image: A healthcare worker in personal protective equipment collects a swab sample from a resident during a testing campaign for COVID-19 in Mumbai, India on February 23, 2021. (Image: Reuters/Francis Mascarenhas)
Biological E. Managing Director Mahima Datla said there was no need to be “overly concerned” about the mutations.
“Eventually we don’t know which variant of the virus, which mutants will take over, but we think that it’s prudent to work on technologies that address the new variants as well,” Datla said.
Biological E., which is developing a vaccine with Houston’s Baylor College of Medicine and Dynavax Technologies, recently completed Phase 1/2 clinical trial in India, Datla added.
Its product uses the recombinant-protein technology in which a harmless agent is used to stimulate an immune response in cells.
“Once you know the variant, when it’s sequenced, it is fairly quick to deploy into a vaccine,” said Datla, whose company will also contract-manufacture Johnson & Johnson’s shot.
The central government on February 25, deputed high level multi-disciplinary teams to visit 10 states (including Maharashtra) where COVID-19 has surged. The three-member teams headed by joint secretary level officers in the health ministry are deputed to better understand the causes behind the rising numbers and support the states in public-health measures for targeted response and management.
To tackle the rise in the infection cases, Dr. John recommends the same measures that were advised last year. “Mask up always when out of home, minimal outing, avoiding public transport as much as possible, and follow the basic hand-hygiene practices,” he said.
The doctor while cautioning about the spread of virus in rural areas, recommended limited local "lockdown" in the regions most affected by the contagion.
“Measures like keeping provision or raw food shops open and instructing restaurants to be shut, can be taken by the government. All these can be implemented as we monitor how the situation takes shape and evolves,” added Dr. John.
File image: A healthcare worker holding a rose receives an AstraZeneca's COVISHIELD vaccine, during the COVID-19 vaccination campaign, at a medical centre in Mumbai, India on January 16, 2021. (Image: Reuters/Francis Mascarenhas)
