By NK Ganguly and Namita Jaggi
As cases continue to surge across the globe and in India, we live amidst Covid positive cases – infected with the original virus or the variant virus, recovered cases, vaccinated people and the non-vaccinated in the second wave of Covid. For some unexplained, misguided and baseless reason, people feel that the pandemic is improving and demonstrate the same in irresponsible behaviour of unmasking, partying in crowds, and indulging in non-essential leisure travel.
Three variants of concern have been recognised by WHO, the UK variant (B.1.1.7), the Brazilian variant P1, and the South African variant B.1.351, with two more California variants (B.1.427 and B.1.429) reported by CDC and many more arising. All these variants are more contagious and except the UK variant have a moderate ability to evade the vaccine.
India’s health ministry recently released data on genome sequencing of 10,787 samples from 18 states which showed 771 cases of known variants (7.1%). Of these 95.4% were the UK variants, 4.4% were the South African variants and only one case had the Brazilian variant. A new variant of concern – a double mutant with two mutations E484Q and L425R (similar to the South African variant which is known to evade immunity) were found in 206 samples from Maharashtra and also from Punjab, Delhi and Gujarat.
The vaccine rollout is pitted against the variants of concern and seems to be a static solution to an evolving problem of virus mutation. Among all the countries across the globe, the US has vaccinated 32% of its population, the UK 47%, and India 5.1% with a single dose. Some shining stars are Israel and Serbia, which have vaccinated 59% and 66% of the population with at least one dose.
The speed at which the population in India is being vaccinated is still lagging and precious time is being wasted by not broadening the vaccine eligibility criteria in the race against the wily virus. We must act on both fronts and start vaccinating the youth who are the mobile super spreaders. India has already exported 64.5 million doses. While it’s a good diplomatic act it should not be at the cost of the domestic requirement.
A partially vaccinated population also puts pressure on the virus to mutate and find more susceptible hosts compounding the problem. There are worrisome reports coming in of people getting infected after 14 days of the second dose of vaccination albeit with a less serious disease pattern (perhaps with a variant). They could then spread further.
So, what should the new normal be? Another complete lockdown isn’t an answer as we cannot risk another downturn of the economy, which after a year is just about limping back to normal. It’s time to adopt the norms of hand sanitisation, physical distancing, masking and cleaning of high touch surfaces as a way of life. Alongside, contact tracing, surveillance and testing need to keep pace. A grand plan of the entire nation should be outlined with hotspots having the highest restrictions, and orange and green zones having relevant, but lesser restrictions.
Assuming that we must vaccinate at least 60% of our 1,350 million population in the next 6 months for herd immunity to develop, we need to vaccinate 4 million people a day which translates into 50,000 centres delivering 80 doses each per day. The private sector should be roped in for vaccination delivery as well and vaccine wastage should be decreased.
In case there is not much of a turnout a parallel line should be created to vaccinate the younger people. An electoral roll out of the vaccination delivery seems to be an attractive idea and should be explored. Vaccine production needs to be ramped up.
A good investment needs to be made while opening schools and colleges to provide for personal protective equipment, hand sanitisers and vaccination for the teachers. Else the schools and colleges should function as before with online classes being the norm. Corporate offices need to provide flexi hours and continue work from home wherever it can be practised.
This is the time to ramp up our genetic sequencing programme in order to understand more about the variants. We also need to assess the efficacy of existing approved vaccines against the new variants. Other vaccines like Novavax (protein subunit vaccine) and Johnson & Johnson vector vaccine which have demonstrated higher efficacy against variants with E484K mutation must be approved on an emergency use basis, possibly without the local trials.
As a nation, we need to rise up to the occasion, be more careful, give each other more space, physically and metaphorically, be masked at all times and get vaccinated when we can as vaccination would prevent severe disease. It’s also a time for the states and the Centre to come together and formulate health policies in the best interest of India’s population.
We also hope and pray that the second wave would be more sparing of serious infections, hospitalisations and deaths. Meanwhile most vaccine manufacturers are working on adapting their vaccines to the changing mutants and ensuring adequate supplies of the vaccine. It remains to be seen whether the Covid vaccine jab would mimic the annual flu shot taken by many, with new circulating strains each time.
NK Ganguly is former Director General, ICMR. Namita Jaggi is Chairperson, Labs and Infection Control, Artemis Hospital, Gurgaon
Views expressed above are the author’s own.
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