While the recent COVID-19 surge in China has been attributed to an omicron sub-variant called BF.7, a new variant dubbed XBB.1.5 is rapidly becoming predominant in the United States and spreading quickly in parts of Europe and Asia. Hence, though the current situation in India looks sanguine, we still need to remain cautious and watchful.
The Surge in China
According to a Peking University study, about 900 million people in China has been infected with COVID so far (Wion News, Jan. 13, 2023). That’s a huge number, amounting to about 90 crores or nearly 1 billion people. That figure amounts to about 64% of China’s population. With the virus circulating among such as huge population, a large section of which is under-vaccinated or vaccinated with less effective vaccines, there is the alarming possibility for the emergency of more infectious and/or more virulent strains. The world must remain watchful about the continuing surge in China.
The data about deaths isn’t clear as the government there has stopped publishing Covid-related data; however, according to some news channels, about 60,000 deaths have occurred in just a month. There is the possibility of the surge spreading in rural areas in the next few months. Why is there such a rapid surge? One factor is the widespread travel ahead of the Chinese New Year that starts on January 23. WHO has warned that China is under-reporting Covid deaths, which is jeopardizing the development of global policies on containing the pandemic.
China’s Covid peak is expected to last 2-3 months, with rural areas to be the target of the wily virus in the coming weeks (ET, Jan. 14, 2023). The spread in rural areas will be concerning as medical facilities are lacking in such parts. That may lead to more hospitalizations, more deaths and even the rise of new variants!
COVID Situation in India
The current situation in India looks sanguine but we still need to remain cautious. India has logged just 179 Covid cases in the last 24 hours (IE, Jan. 14, 2023). That’s a decrease of 30 cases compared to the previous daily caseload. We must remain watchful about the incidence of dangerous new variants through careful testing, tracking and genomic surveillance. At the same time, positive cases at risk of hospitalizations must be administered new Covid drugs such as Paxlovid or VV116 (new oral pill)-as soon as it’s approved.
We all must remember that COVID hasn’t ended yet, it’s still circulating among significantly high pockets across the globe, and there’s still the possibility for the rise of new and risky variants.
New COVID Variants
As per a news report, many subvariants of the Omicron strain have been found across the globe (Washington Post, Jan. 13, 2023). Omicron was first detected in South Africa in late 2021, when it out-competed the Delta variant. Since then, the variants have evolved into a huge constellation of subvariants. Scientists have even given nicknames to some of them as they have run out of letters and numbers-names such as “basilisk”, “gryphon”, and “kraken” etc.
Among the Omicron lineages, the subvariants which are fastest-spreading include BQ.1.1, BQ.1, BQ.1.3, BA.2.3.20 and XBB. According to a WHO report (Jan. 11), XBB is the most immune-evasive variant known so far. The most recent sub-lineage of XBB is XBB.1.5 which has been nicknamed “kraken.” It carries several mutations than enable it to bind more tightly to healthy cells and speed up its transmission. XBB 1.5 has rapidly taken a foothold in the US, accounting for nearly 70% of infections in the northeastern part of the country. The number of infections from XBB 1.5 is also rapidly increasing in Asia and Europe. India has also detected 8 cases of XBB 1.5 till date.
The concerning thing is that immunity from vaccinations has reduced effectiveness against Omicron variants. Booster doses, preferably with Pfizer or Moderna vaccines, provide protection against severe symptomatic disease but the benefit dips over time. Some experts feel that mix-and-match strategy (first 2 doses of one vaccine followed by booster shot of another vaccine) is more effective against Omicron infections. Some even talk about the need for bivalent vaccines i.e., vaccines that target Omicron as well as the original SARS-CoV-2 virus. However, India has not yet taken a stand about bivalent vaccines.
We must remain vigilant about the further spread of XBB 1.5, as our vaccination strategy must be revamped, if XBB 1.5 spreads in large parts of the globe.
New Covid Drugs
A new drug made by a Japanese company (Shionogi) has been recently approved (fiercepharma.com, Nov. 22, 2022). The new drug is called Xocova. It would, hopefully, give a stiff competition to Paxlovid of Pfizer, and Lagevrio, the antiviral drug of Merck.
An experimental pill called VV116 has also been found effective at curbing mild to moderate illness in a phase-3 trial in China. The new pill also has fewer side effects than Paxlovid. These side effects could arise from complications of cross-reactions with other medications for hypertension, seizures, and insomnia etc. The new pill has been made by Junshi Biosciences and Vigonvita Life Sciences and is a pill form of the intravenously administered remdesivir.
According to a US News report (Dec. 30, 2022), VV116 oral pill may protect people against severe COVID disease. The results of phase 3 clinical trial of this antiviral drug have been published in the Dec. 28 issue of New England Journal of Medicine. About 98% of patents taking this drug recovered within 4 weeks and none developed COVID-19. Only 67% of people taking the pill reported side effects whereas 77% of people given Paxlovid developed side effects. VV116 also had fewer reactions with other medications such as those for insomnia, seizures or hypertension (high blood pressure).
Need for Scaling-up Vaccinations
In view of the China surge, possible rise of new strains and the dip in immune protection over time, there’s the urgent need to ramp up vaccination rates in India (and Manipur). The full vaccination rates must be scaled up to 90%, and single dose administration to 100%, if possible, in the next few weeks. In addition, the rate of booster administration may be ramped up from the current 28% to 50%, at least, in the next few weeks, if possible. The relevant authorities may also consider giving a 4th dose to the elderly and those with weak immune systems.
To avoid the possible surge of a new COVID wave, we must once again mask up in crowded settings. The health authorities must once again enhance the testing rates. All positive cases must be subjected to genome sequencing in order to track the spread of BF.7, XBB 1.5 or other risky new variants. A random percentage of people arriving at airports and other stations must be tested and tracked, if possible. Meanwhile, the rate of vaccinations especially booster administration must be increased on war footing. Meanwhile, infrastructure such as testing centers, hospital beds, ventilators and oxygen cylinders etc. must be once again re-activated and scaled up, if necessary; to face a surge in infections, even if unlikely.
Health authorities and private centers may also start acquiring the new intranasal vaccine for possible use as a booster shot as well as COVID drugs such as Paxlovid, Xocova and VV116 etc., as and when available.