How India can overcome the Covid-19 surge
Since February 1, when India recorded the lowest daily Covid-19 infections in over eight months, there has been a steady rise in numbers. This reached an all-time high on April 4 when over 100,000 RT-PCR confirmed cases were reported on a single day, the highest since the outbreak of the pandemic. The record was overtaken on April 6, when the total cases crossed over 115,000 cases.
It is important to identify reasons associated with this unprecedented rise in numbers, and examine measures that must be taken to halt the upsurge.
The steady fall of Covid-19 numbers since the beginning of 2021, coupled with the news about the availability of two reasonably effective indigenously manufactured vaccines in India and the possibility that at least three more equally effective vaccines were in the pipeline, made people let down their guard, relax and act as if life was back to normal again. As businesses, educational institutions, malls, restaurants and the entertainment industry opened, most people abandoned observing Covid-19 appropriate behaviour. Home quarantine and social distancing measures, coupled with business losses that people had experienced over several months, had brought in an element of fatigue, and they suddenly started to enjoy uninhibited freedom.
RNA viruses keep undergoing duplications and adding mutations to their parental strain because of pressure from host immunity. Due to its recent association with humans, the Sars-CoV-2 that causes Covid-19 may not yet have been fully adapted to the human host. This has led to the speculation that the virus may be evolving continuously towards higher transmissibility. It has already accumulated novel mutations leading to patterns of genomic diversity and behaviour, specific to different regions of the world.
Although the majority of the mutations are inconsequential, the three of reasonable concern are those detected in the United Kingdom (B.1.1.7), South Africa (B.1.351), and Brazil (P1). The UK variant, with the potential of high transmissibility, has already been detected in over 10% of the sequenced samples in India, with the most concentrated in Maharashtra and Punjab. It is possible that there could be additional, as yet unrecognised India-specific mutations, whose behaviour needs to be identified.
The emergence of multiple variants of concern of Sars-CoV-2 raises the possibility of the immune escape mechanism adopted by the virus. This means that the host immunity may eventually lose its ability to attack a particular variant (or strain) and eliminate it effectively. Current data indicates that the existing lot of vaccines are equally effective with the known new variants. While this is good news, it is important to be on guard since higher infectiousness could lead to the development of viral resistance to both natural and vaccine-induced immunity.
What must be done to deny an opportunity to the virus to spread? A combination of scientific and administrative strategies can be considered.
First, besides vaccines, it is important to give equal attention to developing novel therapeutic options through genomic approaches. India has already upscaled its infrastructure in at least half-a-dozen centres of international standards that can perform highly efficient sequencing of the genome of coronavirus isolates, obtained from infected individuals. Viral cloning technology could help in designing more effective therapeutic options against Covid-19, particularly for those who get hospitalised and develop severe disease.
The second scientific approach is to develop new strategies to create designer therapeutic antibodies, with efficient neutralising ability for the virus just like it was done successfully for treating the Ebola virus infection. Regeneron Pharmaceuticals in the United States has already developed an investigational product, REGN-COV2 on similar lines for Covid-19, which was successfully used to treat Donald Trump. More research is needed to develop new products on similar lines that are equally effective against new variants and, more importantly, are affordable.
The third is to further jack up the vaccination drive to cover, on an average, five to six million people a day and perhaps adopt a staggered roll-out according to containment zones. Robust data on sero-surveillance, using the more sensitive chemiluminescence immunoassay (CLIA), is needed to identify hot spots, just as it was done earlier with tangible results. Vaccinating every susceptible individual in these areas, irrespective of age group, and banning all social activities there could go a long way in halting the second wave. The critical question is whether the faster spread of the infection in younger age groups will lead to faster herd immunity, and thus contraction of the pandemic faster.
Fourth, it is clear that human behaviour has played a key role in driving the second wave. A more administrative approach would be to adopt strict measures, round up and fine those who violate Covid-19 stipulated behaviour. All establishments must be made more responsive and routinely test their personnel, track the positives and treat them as per the protocol. The authorities may close these establishments even if one person is not tested or the positive person is not quarantined properly.
While India has to successfully battle the second wave, it is important not to create panic, but stay calm. The surge will settle soon and what worked before during the first will surely work again — but for that, a mix of scientific, administrative and behavioural changes are essential.
Narinder Kumar Mehra is honorary emeritus scientist of the Indian Council of Medical Research and former Dean of the All India Institute of Medical Sciences, New Delhi
The views expressed are personal