Are there some dourest forces at work? This unsettling thought is perhaps inescapable each time there is news of a new Covid-19 variant. After all, the air of post-pandemic normalcy is just about settling in. From crowded commutes to conference rooms brimming with lanyard-wearing executives and a travel industry cashing in on a rebound in tourism. Much of it adding a glint of hope in the recently released GDP numbers.
A spoiler on the horizon, as it were, is a new Covid-19 variant under monitoring by the World Health Organisation (WHO). That it has not been detected as yet in India, may provide some relief as would be the comforting words from Dr Soumya Swaminathan, the former chief scientist at the World Health Organisation and the go-to expert on the virus. “At the moment, there is no need to panic. Also, there is lot of immunity in the population. But then, continued surveillance is inevitable,” she says.
Why The VUM matters
On August 17th, BA.2.86 was classified as a Variant Under Monitoring (VUM) by the World Health Organisation. “As of August 30th, 2023,” it says, “21 sequences of this variant have been reported from seven countries (five in the European Region, one in the African Region, and one in the Region of the Americas). One case had travel history from a country in the Western Pacific Region, where BA.2.86 has not yet been reported. To date, no deaths have been reported to WHO among the cases detected with BA.2.86. The potential impact of the high number of mutations in BA.2.86 is presently unknown and is under assessment. WHO continues to call for enhanced surveillance, sequencing, and reporting of SARS-CoV-2 variants alongside clinical metadata as the virus continues to circulate and evolve.”
The reason for the focus on BA.2.86 is also because this variant has an ancestor in BA2, which was the early Omicron (linked to the January 2022 finding in Africa) and has had many mutations but with an older Omicron backbone.
Wastewater surveillance
In times when the viral case load is down and people do not get themselves tested, there are limits to which surveillance is possible. If clinical data from patients is not adequate, scientists and researchers turn to testing the viral load in the sewerage or waste water samples. Based on such a study, Dr Rakesh K Mishra, director, Tata Institute for Genetic and Society (TIGS), India, says, “wastewater surveillance has not picked the new SARS-CoV-2 (medical lingo for Covid-19) variant (BA 2.86) in our study going on in Bengaluru city. Also, there are report that this variant has not been found on other studies. This does not mean that it does not exist in India, more extensive surveillance may reveal more accurate situation in coming days and weeks.”
Dr Mishra, who was earlier the director at the Centre for Cellular and Molecular Biology, says “overall, case load seems to be low (like baseline) and there is no indication of any other clinical aspect (more severe symptom) and therefore at present not much to worry but it will good to keep an eye on how virus is evolving.”
Surveillance is also done by INSACOG (Indian SARS-CoV-2 Genomic Consortium), a consortium of 54 laboratories to monitor the genomic variations in the SARS-CoV-2. It is a pan-India network. The INSACOG is a joint effort by the health ministry, department of biotechnology along with the Council for Scientific & Industrial Research (CSIR) and the Indian Council of Medical Research (ICMR).
Still a new virus
There are good reasons why the surveillance is needed, says Dr Swaminathan, “It is still a new virus for humans so there is a small chance of unpredictability and the next variant could become a severe variant.” Therefore, she feels, it is important to check if the variant starts behaving in a different manner. For example, like in the cluster of cases found in South Africa (in January 2022) when Omicron was first detected.”
Dr Swaminathan today sees Covid-19 as part of the overall surveillance – both clinical and genomic. She does find people “treating Covid-19 as any other respiratory infection, which is fine as many will overcome it with only a very small percentage seriously impacted. But then, this happens to be the case with all diseases where small proportion of people get sick and get admitted to a hospital.”
Dr Swaminathan sees a crucial role for tracking and genomic sequencing of the virus given its huge public health implications. She is also in favour of looking more closely at those suffering from post-COVID severe symptoms.
Step towards preparedness
Advocating continued vaccine effectiveness studies (for instance, plans in the US for a booster), she finds it critical to ensuring vaccine manufacturers stay in sync and in a position to quickly switch their vaccine to the latest variant. The research and development will also help in overall pandemic preparedness.
No hospital admissions
Not seeing any reason to panic, Dr Rahul Pandit, Chair of critical care at Sir H N Reliance Foundation Hospital, says, “one would at best see one or two cases of these patients visiting the hospitals in a month and that too not for admission. Typically, most get treated either in a local hospital or by the general practitioner. Dr Pandit should know considering the complete journey of the virus that he has seen in India, as it were. During the crucial Covid-19 months in India, for instance, he was leading the post-Covid-19 OPD at a leading Fortis Hospital in Mumbai and saw several patients during the day back then.
On the new variant, he does not see any reason to panic and for the moment would rather wait for the government to share any finding either on its presence or the virulence and severity.
