Is a new variant driving Maharashtra’s surge?
As Covid-19 infections continue to surge in the second wave of the pandemic, health department officials in Maharashtra, which has the highest daily case load in the country, said that there was not enough data to attribute the rise in numbers to the new double mutant variant found in the random community samples from the state processed for genome sequencing.
A new variant of Sars-Cov-2 was detected in random community samples from Nagpur, the Union government said last week, confirming the presence of mutations that are being tracked. The Union health ministry said a novel variant with a combination of two mutations E484Q and L452R was found in 206 samples taken from Maharashtra since December. Both these mutations could make the coronavirus spread more readily and, at least to a degree, resist immunity from a past infection or triggered by vaccines, the Centre said.
However, state officials said that while the double mutant variant could be one of the reasons for the spread, it was certainly not the main reason for the surge, which they attributed to a lack of Covid-appropriate behaviour and Covid-fatigue among citizens. State health officials in Nagpur also pointed out that the cases were being reported from areas that did not have many cases in the first wave.
“In any pandemic, it is a natural phenomenon for the viruses to mutate. So far, we have seen that only a small percentage of the newly infected people have been diagnosed with a mutated strain. Thus, it is not scientifically correct to call it as the main reason for the rise in new Covid-19 cases but just as one of the contributing factors,” said Dr Subhash Salunke, advisor to the Maharashtra government on Covid-19 management.
“People were suffering from fatigue and had put down their safety guards which gave an opportunity to the virus to spread further. But it is not as strong as it was in the first phase as the fatality rate is still under 1%. However, this can also be attributed to the growth of public awareness,” said Dr Rahul Pandit, a member of the state Covid task force.
The state reported 27,918 new cases on Tuesday bringing up the total cases to 2,773,435. This signals a rise of 618,365 cases from March 1 to March 30, the steepest 30-day rise. The case fatality rate (the number of deaths per 100 positive cases), however, declined from 2.42% to 1.96% in the same period.
Task force members said that while the virus circulating in the state could be said to be more infectious than the first wave but not as lethal, more data was needed to draw the correlation to the surge.
“With lax behaviour, people have allowed the virus to enter their bodies and mutate and spread further. Even now people are least bothered about the rules,” Salunkhe said.
“We are hardly genome sequencing only a percentage of the samples and so the results are not widely applicable. The currently reported double mutation could further go into more mutations,” he added.
India is only genetically sequencing 0.1% of its positive cases, far below the United Kingdom’s 5%, so it is believed that these figures are an underestimate, experts said.
“The double mutant variant has been found in 206 samples in Maharashtra and in Nagpur, it is particularly high at 20% of samples, but there is not enough data yet to correlate this with the nature of the surge being recorded there,” National Centre for Disease Control (NCDC) director SK Singh in New Delhi had said last week.
Singh said that three known variants of concern (VOCs) were also found in Maharashtra: 56 of these were of the UK variant (B.1.1.7), five of the South African variant (B.1.351) and one of the Brazilian variant (P.1).
Of the 220 samples from Mumbai sent to the National Institute of Virology (NIV) in Pune for sequencing, only 22 of them had the B 1.1.7 variant. Of those, half the persons had a travel history, while the other half comprised close contacts.
The NIV and National Centre for Cell Science, Pune, refused to comment whether any new information could be gleamed from samples sent across for genome sequencing. Thus, it is as yet unknown what the latest number of samples with the double mutant variant are and what proportion they constitute of all samples sequenced.
Every week, Mumbai’s civic body sends 50 samples for genome sequencing of infected patients with travel history, from hot spots and families with higher infection rates. “It generally takes 15 days for the reports to come to us. So, we are yet to get the latest report. But so far, we haven’t found “double mutation” except for the UK variant,” said Suresh Kakani, additional commissioner, Brihanmumbai Municipal Corporation.
“Only around 10% of the samples that were sent for analysis had the UK variant. All these patients have successfully recovered without any fatality. Other than this, we haven’t found any other mutated strains,” Kakani added, referring only to Mumbai cases.
In health ministry’s weekly media briefing on Covid-19 updates on Tuesday, VK Paul, member (health), Niti Aayog, also said that the situation was turning “from bad to worse”. Ten districts in our country currently account for maximum active Covid-19 case load, of which eight districts -- Pune, Mumbai, Nagpur, Thane, Nashik, Aurangabad, Nanded, and Ahmednagar -- are in Maharashtra alone.
Dr Shashank Joshi, Covid task force member said that the genomic data from NCDC did not establish a correlation. “They had said last week that 20% of the Nagpur population had the [new] strain. There is no clarity on it, and they have not been able to conclusively establish a link [between mutation and the surge. However, the possibility cannot be ruled about.”
However, officials and medical practitioners across affected districts have noted that all members of a family are being affected. Dr Jitendra Oswal, deputy medical director from Bharati hospital in Pune said, “It is true that everyone in the family is getting infected now, it could be either because of the mutated strain or because people are not strictly following the home isolation rules. We have seen even multiple families in the society getting infected.”
“In this wave we can see that the spread is faster and that the entire family is being affected even if one member gets the infection which did not happen in the first wave. Earlier cases were coming from slums and congested areas now most of the newer cases are coming from societies and middle-class families,” said Salunkhe, who also got infected after receiving the vaccine.
Officials are also noting cases of infections among those who have taken the vaccine.
“We have also seen infections among those who got the vaccines. One of our health care workers who got the vaccine tested positive for the infection, but the symptoms were just mild to moderate. We have observed that none of those on ventilators or who currently require critical care in our hospitals have got the vaccine even once. Even after getting the second shot, it takes at least 28 days to develop complete immunity,” Oswal said.
Dr HK Sale, executive director at Noble Hospital, Pune said, “I have also tested positive for the infection despite getting both doses of the vaccine. I have mild symptoms like cold and cough. For almost a year I worked throughout without a single holiday and now I have got the infection. We have noticed a trend this time that patients are coming in large numbers suddenly which did not happen last time. In a short span of time, we saw multiple people come for admission which created a load on the infrastructure. The entire family is testing positive and the beds which were earlier occupied by non-Covid patients are now being reserved for Covid patients. The strain circulating in Pune needs to be studied.”
The Centre attributes surge in cases due to inadequate Covid-19 testing, lack of public health measures, and to specific events or places where crowding happens, or where a large number of people are in close physical contact, coupled with lack of Covid-19 appropriate behaviour.
Dr Lancelot Pinto, a Mumbai-based pulmonologist and epidemiologist said variants were par for the course in any pandemic. “Variants are expected to evolve when a highly transmissible virus moves rapidly through a host population. Such new variants of the coronavirus could have escape mutations which help the virus evade the body’s immune system, thereby conferring the virus with a survival advantage. Escape mutations in the spike protein could result in infections among individuals who had existing antibodies to earlier strains of the virus.”
Health experts claim that as the line of treatment for the mutated virus remains the same, the public don’t need to panic. The focus should be on three things—double masking, robust testing and mass vaccination.
“The type of patients landing in a serious situation remain the same those aged above 50 and those with comorbidities,” Oswal said.