COVID-19's Return: New Variants, Mild Symptoms, and the Gaps in India's Public Health Preparedness
Published : Jun 09, 2025 17:07 IST - 7 MINS READ
COVID-19 is once again making headlines. As of June 9, India has 6,491 active cases, according to the Union Health Ministry. Kerala remains the most affected State with 1,957 cases as of June 6, followed by Gujarat (980), West Bengal (747), and Delhi (728). While hospitalisations remain low and most cases are mild, the government has increased surveillance, testing, and hospital preparedness.
According to the Indian SARS-CoV-2 Genomics Consortium (INSACOG), one case of the NB.1.8.1 variant was found in Tamil Nadu in April, and four cases of LF.7 were reported in Gujarat in May. The dominant variant in the country is JN.1, which is highly transmissible but generally mild, accounting for 53 per cent of current cases.
'When COVID first came, it was hugely problematic. We weren't prepared for it,' said Dr. Sylvia Karpagam. 'But now it can be endemic, in the sense that the virus is floating around, and given the right environment (such as certain seasons or overcrowded areas) and host, we can see a flare-up. We do expect, because of the vaccine and previous infections as well, that there will be some level of immunity. So, mostly we are not taking this as seriously as we would a new organism.'
Also Read | WHO sees 'incredibly low' COVID-19, flu vaccination rates as cases surge
However, Dr. Karpagam urges constant monitoring of the situation as the virus is a new mutation, and although there are fewer chances of another pandemic, it cannot be said for certain. 'We thought polio was contained, but suddenly it surged and that was because it was a new form of polio. So, lab checking, taking samples, and constant research must be done,' she added.
Several groups in India remain particularly vulnerable: the elderly; those with underlying health conditions such as cardiovascular disease, lung or respiratory illnesses, diabetes, hypertension, or obesity; immunocompromised individuals, including cancer patients and transplant recipients; pregnant women due to physiological changes; and children under five, especially the unvaccinated. During any spike in respiratory infections, individuals in these categories are advised to take precautions: wear masks in public, avoid crowded areas, stay home when possible, and practise regular hand hygiene.
Dr. Karpagam urges a more proactive public health system. 'We need a public health system that is prepared. We have to be able to prevent diseases before they occur, instead of waking up on the day of [the disease spreading] and trying to find a cure. It's a big problem in India. In the case of COVID, in case it rises, in case there are new mutations, just how prepared are we? That system of prevention and preparedness is not at all there.'
In response to the recent surge, the Centre conducted facility-level mock drills on June 5 to assess hospital preparedness. These followed technical review meetings chaired by the Director General of Health Services, Sunita Sharma. States were instructed to ensure the availability of oxygen, isolation beds, ventilators, and essential medicines. A separate drill on June 2 tested oxygen supply systems, including PSA plants, LMO tanks, and MGPS lines.
Hospitals have been directed to follow the revised ABC Guidelines 03, issued in June 2023, for treating patients with COVID-19 and influenza symptoms. All patients with symptoms of ILI (Influenza-Like Illness), ARI (Acute Respiratory Infection), or SARI (Severe Acute Respiratory Infection) must be tested. If a Rapid Antigen Test returns negative, an RT-PCR is mandatory. District RT-PCR facilities must be fully utilised, the department said.
Preventive strategies remain familiar, but their urgency has returned. Respiratory viruses tend to be seasonal, with recurring waves. Vulnerable individuals—or anyone with symptoms—are advised to avoid crowded, enclosed, poorly ventilated spaces such as buses, trains, planes, offices, malls, and cinemas, especially without a mask. While rapid testing is widely available in urban areas, rural access remains limited, prompting calls for expanded distribution.
Dr. Karpagam stressed the importance of vigilance—not just against the virus, but also against misinformation. 'If the virus is a mild version, pharmaceutical companies may hike the vaccine prices and say they have modified the vaccine to treat the mutation, and it becomes a business. Which is why we need research, labs, the Indian Council of Medical Research, and we need the government to put out regular statements. If it's a very serious mutation, then the government must put out notices regarding a vaccine and guidelines on how to manage symptoms. When there is no central regulation, then random people step in and give out misinformation to try various treatments without any scientific backing.'
Global cases also climbing
On May 28, 2025, the World Health Organization (WHO) reported a global increase in SARS-CoV-2 activity based on its Global Influenza Surveillance and Response System. Test positivity rates have risen steadily since mid-February, reaching 11 per cent—levels not observed since July 2024.
This surge is concentrated in the Eastern Mediterranean, Southeast Asia, and Western Pacific regions and is being driven by new subvariants including LF.7, XFG, JN.1, and NB.1.8.1. Of these, NB.1.8.1 has caught WHO's attention and has been designated a Variant Under Monitoring (VUM). As of late April, 518 sequences of this variant had been reported across 22 countries, accounting for 10.7 per cent of global submissions. While the variant appears to spread more rapidly, WHO has found no evidence of increased severity. Symptoms remain largely familiar: sore throat, fever with chills, congestion, fatigue, and headache.
Dr. Soumya Swaminathan, former chief scientist of WHO and chairperson of the M.S. Swaminathan Research Foundation, said such spikes of infections are normal. 'Like any other respiratory viral infection, it's self-resolving. Yes, there's an increase, and periodically we can expect to see an increase—I think every six to eight months is what it seems to be from looking back.'
'What we've seen in the past is that every time there are some additional mutations which confer an increase in transmissibility, you do see a spike, because the immunity that we have does not protect us against infection. Whether it's a vaccine or whether it's naturally induced immunity, it only protects us against severe diseases. So, infections are occurring, but the majority of them seem to be mild or do not require any hospitalisation or inpatient care or any specific treatment,' she added.
A 2024 study in Nature found that vaccines updated to target JN.1 or related sublineages such as KP.2 elicit robust neutralising antibody responses against JN.1 and its descendants, including KP.3.1.1, XEC, LF.7.2.1, and LP.8.1. However, neutralisation titres against these newer variants are slightly lower than against JN.1 itself, suggesting some immune escape but continued protection.
A 2024 Eurosurveillance study published in The Lancet estimated that the XBB.1.5 vaccine—a precursor to JN.1-targeted versions—had a vaccine effectiveness of 41 per cent in adults aged 18–59 and 50 per cent in those aged 60–85 against JN.1 infection.
Also Read | COVID-19 rates are rising again—what you need to know
Dr. Swaminathan urged long-term investment in vaccine development. 'What are those priority pathogens? WHO has priority pathogens for 25 or 26 viral families. India could decide out of that which are those ones which are of most importance or threat to us. I think if we had that kind of a list for India, then the industry would be able to develop and stockpile a certain number of doses of vaccine. This has to be done in a sort of private-public partnership, just like it was done for COVID,' she said.
WHO shifts strategy
In May, WHO released two new guidance documents in response to the global spike: Strategic and Operational Plan for Coronavirus Disease Threat Management: 2025–2030; and Implementation of the International Health Regulations (2005): Extension of the Standing Recommendations for Covid-19.
'This plan sets out WHO's strategic and operational framework to support Member States in the sustained, integrated, evidence-based management of coronavirus disease threats, including Covid-19, Mers, and potential novel coronavirus diseases of public health importance,' the document states.
WHO no longer recommends lockdowns or blanket travel bans. Instead, it advises targeted, evidence-based responses that do not disrupt daily life: early variant detection, focused vaccination campaigns, and stronger public communication.
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