What is the COVID-19 situation in India?
The story so far: After a rise in COVID-19 numbers in Southeast Asia, India has started to show an uptick in the number of cases over the last couple of weeks. The numbers slowly grew to hit 5,755 cases (as of Saturday 5:30 pm) as per the Ministry of Health's COVID-19 dashboard.
What is the medical advice?
The same dashboard states that 5,484 people have been discharged. Even as the numbers rise, doctors and experts have repeatedly stated that seasonal spikes and dips in COVID-19 cases are to be expected, since it had moved from a pandemic to an endemic infection. The COVID-19 virus is co-circulating with other seasonal viruses, they point out, and currently the dominant strain is an Omicron sub-variant from which the subcontinent has adequate immunity. The cases have not been severe; from the point of transmissibility too, the R0 (reproductive number) is not that worrying to indicate a high contagion factor.
What is the situation in the country today?
As of now, the variants of COVID-19 doing the rounds in India are descendants of the Omicron variant, first reported in November 2021. The emerging sub-variants, NB.1.8.1 and LF.7, driving the current COVID-19 surge are descendants of JN.1, a sub-lineage of the Omicron BA.2.86 variant. In Kerala for instance, a senior health department official said that 'almost all of the samples sent for whole genome sequencing from the State have shown that the circulating virus variant is LF.1, one of the descendants of Omicron, the immune evasiveness of which is quite well-known.' Cases have mostly been mild, according to the Indian Council of Medical Research (ICMR). The reported symptoms are those of the common cold or seasonal flu, including fever, cough, sore throat, runny nose, headache, fatigue, body aches, and loss of appetite. P. Senthur Nambi, senior consultant, Infectious Diseases, Apollo Hospitals, Chennai, said most of the COVID-19 patients he had seen so far have done well. 'Most of them had only an upper respiratory infection. These patients were managed based on their symptoms and most of them did not require any COVID specific antiviral medications. Prior exposure to the infection, the effects of the vaccines taken or a combination of both factors with vaccine-induced antibodies could be playing a protective role,' he explained. 'The key difference with these new strains,' said Sujan Bardhan, consultant (Tuberculosis and chest diseases), Narayana Hospital, R.N. Tagore Hospital, Kolkata, 'is their speed, not their severity. Hospitals are well-prepared and the healthcare system remains under no immediate strain. Nonetheless, the importance of basic preventive measures cannot be overstated.'
What is the vaccine position?
India launched the world's largest COVID-19 immunisation drive in January 2021. To date, over 220 crore doses of COVID-19 vaccines have been administered in the country as per the CoWIN dashboard. These were primarily of the two vaccines available then, AstraZeneca's Covishield and Bharat Biotech's Covaxin.
Rajiv Bahl, Director General of ICMR, has said there is absolutely no need to initiate mass booster doses for COVID-19 vaccines at present, and neither is there a direction from the Central government on this. As cases rise, Dr. Bahl noted that individual doctors could recommend booster doses to patients on a case-to-case basis.
He further explained that the need for mass vaccination, while not felt at present, could arise, with perhaps a mutation in the virus or its spread. 'For that, India already has the capacity to scale up production and provide for the general public. We have done this before and there is no need to panic,' he said. Since vaccines which were stocked and used in 2021 and 2022 have now fallen into disuse and expired, there are no stocks at present, a government official said. The official, however, added that the government could direct manufacturers to produce more stocks as and when necessary. Most States, including Kerala, Tamil Nadu, Karnataka and West Bengal, have no stocks or supplies of the vaccine at present either in the government or private sector.
Are vaccines needed at present?
Doctors across the board say that at present they see no need for a mass vaccination drive.
'By the time Omicron ran its course, almost all of our population had been exposed to the virus. Even when this antibody protection wanes, the long-term immune memory remains. This innate immunity plus the vaccine-derived immunity through good coverage of the initial two doses means that most people have strong hybrid immunity against COVID-19,' the Kerala health department official said. Previous vaccines may not be very effective against the Omicron variants but would, however, offer protection against serious forms of the disease.
Though two indigenously developed nasal vaccines specifically targeting the Omicron variant from Bharat Biotech and Indian Immunologicals, as well as another vaccine for the Omicron variant, were made available in the Indian market, the uptake was low, doctors said.
Kiran Madala, a Hyderabad-based doctor, part of an international group of genetic epidemiologists under the COVID Treatment Exchange Organisation, said the current World Health Organization guidelines recommend vaccines primarily for individuals above 70 years of age, those who are immunocompromised, and patients with multiple co-morbidities. Children, especially those aged two to six years, do not need vaccination unless they have underlying health issues or are immunosuppressed. Dr. Nambi in Chennai said some patients, those who have travel obligations, have requested the vaccines, but none are available at present. 'But I wish that there was an option of vaccination, not for the general population in large but for two subsets of patient groups in whom the infection could cause problems,' he said. One, those who have not received any COVID-19 vaccines or missed an infection, leaving them without immunity, while the second are those with co-morbidities and who are immuno-compromised.
T. Jacob John, retired professor of clinical virology at Christian Medical College, Vellore, also said that the elderly and immunocompromised people needed to be vaccinated again, irrespective of whether they were fully vaccinated (two doses and a booster) or had been exposed to the virus earlier.
State governments, however, have taken a more cautious stance: 'Whether vaccination is required or not depends on many factors,' said T. S. Selvavinayagam, T.N. Director of Public Health and Preventive Medicine. 'We need to study the epidemiology of the current cases before commenting on the requirement for vaccination now.' Kerala has said it was 'not advocating for or against COVID booster shots' because of the lack of epidemiological data that booster doses offered enhanced protection against emerging immune-evasive variants.
What next?
The Delhi High Court, earlier this week, directed the Centre to submit a thorough status report detailing its actions regarding the policy for sample collection, collection centres, and transportation of samples. The court also stressed urgency to finalise and implement Standard Operating Procedures.
As the virus continues to adapt, so must we, Dr. Bardhan pointed out. Staying informed and following trusted health sources, personal protection and hygiene measures such as hand washing, avoiding crowded places when possible or masking up, refraining from going outdoors when ill and maintaining a healthy, well-balanced lifestyle could help navigate this phase and any more to come.
Compiled by Zubeda Hamid, with inputs from C. Maya in Kerala, Serena Josephine M. in Chennai, Bindu Shajan Perappadan in Delhi, Afshan Yasmeen in Bengaluru, Shrabana Chatterjee in Kolkata and Siddharth Kumar Singh in Hyderabad.
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