Scientists are working overtime to understand several coronavirus variants now circulating in this country—in particular B.1.617—which has been incorrectly termed as an Indian variant.
A ferocious second wave of COVID-19 has devastated the nation, catching the authorities unawares. The country recorded nearly 400,000 new infections on May 9, taking the total number of infections to more than 22 million.
"While it is true that this strain was discovered in India, it would be incorrect to call it an Indian strain. The scientific name for it is B.1.617 and it should be referred to as that," says Shahid Jameel, virologist at Ashoka University in Sonipat, who chairs the scientific advisory group of the Indian SARS-CoV-2 Genome Sequencing Consortia (INSACOG).
"In India, the virus was mutating around the new year to become more infectious, more transmissible, and better able to evade pre-existing immunity. Sequencing data now tells us that two variants that fuelled the second wave are B.1.617, first found in India in December, which spread through mass events; and B.1.1.7, first identified in Britain that arrived in India with international travellers starting in January. The B.1.617 variant has now become the most widespread in India," he told Moneycontrol.
More deadly that others
Frequently Asked Questions
A vaccine works by mimicking a natural infection. A vaccine not only induces immune response to protect people from any future COVID-19 infection, but also helps quickly build herd immunity to put an end to the pandemic. Herd immunity occurs when a sufficient percentage of a population becomes immune to a disease, making the spread of disease from person to person unlikely. The good news is that SARS-CoV-2 virus has been fairly stable, which increases the viability of a vaccine.
There are broadly four types of vaccine — one, a vaccine based on the whole virus (this could be either inactivated, or an attenuated [weakened] virus vaccine); two, a non-replicating viral vector vaccine that uses a benign virus as vector that carries the antigen of SARS-CoV; three, nucleic-acid vaccines that have genetic material like DNA and RNA of antigens like spike protein given to a person, helping human cells decode genetic material and produce the vaccine; and four, protein subunit vaccine wherein the recombinant proteins of SARS-COV-2 along with an adjuvant (booster) is given as a vaccine.
Vaccine development is a long, complex process. Unlike drugs that are given to people with a diseased, vaccines are given to healthy people and also vulnerable sections such as children, pregnant women and the elderly. So rigorous tests are compulsory. History says that the fastest time it took to develop a vaccine is five years, but it usually takes double or sometimes triple that time.
Evidence is growing that this one variant might be more transmissible and better at evading immunity than existing variants. Animal models also hint that it might be able to cause more severe disease.
Researchers are keen to know if this variant and others might be driving India’s virtually unstoppable second wave and the kind of danger it poses globally. The central government, already under tremendous pressure, is keen that this variant is not seen as an 'Indian virus'.
It said on May 12 that the World Health Organization (WHO) has not associated the term 'Indian variant' with B.1.617, which has now been classified as a 'variant of concern' by the global body. The B.1.617 variant is the fourth variant to be designated as being of global concern and requiring heightened tracking and analysis. The others are those first detected in the US, South Africa, and Brazil.
“Several media reports have covered the news of the World Health Organisation classifying B.1.617 as a variant of global concern. Some of these reports have termed the B.1.617 variant of the coronavirus as an ‘Indian Variant’. These media reports are without any basis, and unfounded,” a statement by the Press Information Bureau (PIB) said.
International experts have noted that in just a few weeks, the B.1.617 variant has become the dominant strain across India and has spread to about 40 nations, including the United Kingdom, Fiji, and Singapore.
Nature, the globally acclaimed British weekly scientific journal, wrote earlier this month "two weeks ago, it looked as if multiple variants were behind a series of surges in India. Genomic data indicated that B.1.1.7, first identified in the United Kingdom, was dominant in Delhi and the state of Punjab, and a new variant dubbed B.1.618 was present in West Bengal. B.1.617 was dominant in Maharashtra. But since then, B.1.617 has overtaken B.1.618 in West Bengal, has become the leading variant in many states, and is increasing rapidly in Delhi."
What needs to be done
Experts believe that if variant 617 is to be countered, and insurance against the appearance of another variant ensured, then stringent public action, including genome sequencing, needs to be undertaken.
Says Dr Giridhar R Babu of the Public Health Foundation of India: "There is urgent need to ramp up genome sequencing to 5 percent of all tests on a monthly basis and ensure that the data on variants of concern (VoCs) from genomic surveillance is shared across the districts so that the intervention to minimize their spread to other areas can be undertaken."
According to him, the need to create an open dataset for real time, including non-traditional methods (observational data for example) to capture variables that are currently being under counted, such as mortality numbers, is the need of the hour.
"For mortality specifically, we recommend using ASHA (Accredited Social Health Activist) workers and informational aggregation from crematorium associations, for example, to gather more accurate data systematically," Dr Babu told Moneycontrol.
What’s more, given the sheer intensity of the infection in India, and because the virus is mutating, there is little doubt that another strain (or strains) is going to be found in the country, sooner than later.
"Whether that strain is going to be as contagious as B.1.617, remains to be seen. But I don’t have any doubt that it is going to be discovered in India," says Rakesh Mishra, Director of Hyderabad based CSIR-Centre for Cellular and Molecular Biology (CCMB).
Offering a slightly different interpretation of this `Indian variant’, he said that B.1.617 was found in only around 35 percent cases in Maharashtra. The virus samples sequenced at CCMB showed B.1.617 in only 2 percent cases in Telangana and 5 percent in Andhra Pradesh, he said.
So, what can the country do to minimise the impact of the current variant and future ones? "There is only one way to tackle variants – wear a mask at all times," he told Moneycontrol, adding, "People should note that no virus, be it from China, UK, or India, can beat the strategy of wearing masks."
Mishra said that masks can not only protect from COVID-19 but also from many air-borne diseases, common cold and pollutants in this second wave. "The symptoms and mortality rates among those infected is not significantly different from what was noticed in the first wave last year," he said.
In addition to all the precautions, there is need for genome sequencing and genome organization, which will help identify the various variants.
Multiple solutions the answer
Clearly then, there is no single response that can defeat the COVID-19 pandemic in India. The intent is to move beyond the policy discourse on lockdowns and to highlight the range of actions needed for an effective response, especially in places with different disease burdens.
At the same time, India cannot allow the pace of vaccinations to slow. It must vaccinate at scale now, aiming to deliver 7.5 million to 10 million doses every day. This will require enhancing vaccine supplies and doubling delivery points.
"There are only about 50,000 sites where Indians can get vaccines right now; we need many more. Since only 3 percent of these delivery points are in the private sector, this is where capacity can be added," said Jameel.For the moment though, it looks like a bridge too far. But if further disasters are to be mitigated, then the Indian government may not have a choice but to soldier on.