Manipur was technically free from COVID-19 since December 21, with no active cases. In fact since December 15, there have been no new cases and the last two confirmed cases were on December 14. Even in India, as on December 26, the number of active cases was 3,428 which accounted for only 0.01 per cent of the total cases. One should feel comfortable with the figures and be hopeful that the COVID-19 pandemic is now almost over. The pandemic had caused untold sufferings in terms of mortality, morbidity and the economy. This writer had felt that his article on the issue on October 30 should be the last on the topic. But no, a sub-variant is rearing its head in China leading to large-scale infection, morbidity and mortality alerting the world that the pandemic is not over yet and the virus may attack with a new sub-variant avatar.
The sub-variant which is causing havoc in China is claimed to be BA.22.214.171.124 or more commonly BF.7 which is a sub-variant of Omicron. This is not the first time that BF.7 was reported; in October it had started replacing other sub-variants in the USA and several European countries. In India, four cases were also detected earlier, and the chances of more are high as India had drastically reduced genomic sequencing.
In Manipur for many months genomic sequencing had been discontinued. This writer had called for genomic sequencing to determine the sub-variant that is dominant in the state but it fell on deaf ears as the cost of genomic sequencing is high and the number of hospitalisation and death during the 4th wave is limited. In fact the total death was only 29. Thus we do not know which sub-variant was the dominant in the 4th wave, though it is caused by the omicron variant.
As other variants, the impact of BF.7 is more telling on the elderly and those who have comorbidities. China’s policy of zero tolerance was forced to be abandoned due to mass public unrest and the sudden change in the policy by opening up may be a major factor which led to the sudden increase in cases and death. In terms of vaccination, India had used 220.00 crore doses while China had reportedly used 345.59 crore doses as on December 25. India has administered 161 doses per 100 populations against China’s 247 while the world average is 170.
A few countries have crossed 300 doses per 100 populations like in Chile and Cuba; and the vaccination process in India and Manipur is slow to say the least, especially as these are generally administered gratis. As on December 25, Manipur had administered 32.65 lakhs doses; 16.49 as 1st dose, 13.38 lakhs (81.14%) as 2nd dose and 2.79 lakhs (16.92%) as precautionary or booster dose. The data show the tardiness in administering the 2nd and 3rd dose. In fact many are already due to the 4th dose as it has been reported that the immunity tapers with time.
From the data relating to Manipur, what is worrying is that even among the healthcare workers (HCW), all have not been administered the 2nd dose not to speak about the 3rd dose. Among the HCW, only 59.63 % of those given the 1st dose had been administered the 3rd dose, while only 93.91% had been given the 2nd dose. In respect of the Front Line Worker (FLW), the figures are 90.27% and 95.66% respectively.
The administration of the 3rd dose among the general population is very poor despite cajoling from the administration. With the situation in China, there is a need to ramp up vaccination in the state.
As a precautionary measure, the Government of India had insisted on RT-PCR testing from people arriving from China, South Korea, Japan, Hong Kong and Thailand. The concern is that a few people arriving from China are found positive and have been quarantined. There can be a sudden increase in cases. Advisory has been sent to all states to conduct mock drills and to keep sufficient quantities of Oxygen and beds in readiness. The high mortality rate during the second wave was mainly due to lack of oxygen. Advisory to conduct more genomic sequencing needs to be followed and the state should also be prepared for new cases.
Besides, the sudden change in the zero tolerance policy in China, which includes letting mild and asymptomatic cases recover at home, and limiting lockdowns to individual floors and buildings rather than whole neighbourhood, one factor which can be attributed is whether the Chinese vaccines Sinovac and Sinopharm have ability to induce good immunity against omicron variants? There are numerous reports to indicate that the immunity provided by the various vaccines is lesser against the omicron variant and perhaps the Chinese vaccines have low efficacy against the omicron variant and sub-variants. This conjecture has a relevance as China had recently approved Pfizer’s mRNA BioNTech vaccine though only for foreigners.
China seems still wary of mRNA vaccines and even their home produced mRNA vaccine is yet to be approved though it was approved in Indonesia. Both the Chinese vaccines are less effective at preventing disease, severe disease and death than the Pfizer and Moderna mRNA vaccines as studies indicate.
India has already allowed home isolation of mild and asymptomatic cases and lockdowns are limited to single homes as a result many may have contracted the virus without or with very mild symptoms leading to herd immunity. Debate will now rage whether the Chinese model of zero tolerance led to the serious spread and death now.
One unfortunate part is the non release of data on the number of cases and deaths by China which had stopped it after the recent surge. Even earlier, the data provided by China was regarded as untrustworthy, that is with the case of India also with many experts claiming that the death is around 10 times of what was reported.
India may issue fresh advisory like wearing of masks in public places, avoiding crowded places, discouraging indoor meetings, ramping up administration of vaccines including 1st, 2nd and 3rd dose.
Why Manipur must ramp up COVID vaccination?
Manipur should start immediately ramping up administration of 2nd and 3rd dose of vaccine and the earlier practice of home or locality visit must be restored. Vaccination is not mandatory but elective but there should be peer pressure as those who fail to get the vaccination can be a liability and can become a spreader.
The need for vaccination must be drilled and in fact the government can announce that those who have not got the 1st, 2nd and 3rd dose of vaccination will not be provided with free benefits from the government. Or in other words freebies shall be subject to vaccination. This may be a strong incentive for vaccination.
Since September, masks are no longer used and even in hospital environments many HCW are free from masks and a few doctors have even advised to stop wearing masks which make one breath more carbon dioxide! Anyone who contracted the virus and is asymptomatic can infect many, especially HCW and they will be passing it on to those who have health issues.
India and for that matter Manipur also may have attained herd immunity but the question is whether the immunity attained can stay long to combat fresh infection. The efficacy of the vaccines used like Covaxin, Covishield and Sputnik in India against the omicron variant is lower than other earlier variants.
India has approved 12 vaccines- SIIs (Novavax formulation) COVOVAX (Protein sub-unit), Biological E’s Corbevax (Protein sub-unit), Zydus Cadila’s ZyCoV-D (DNA), Gennova Biopharmaceutical’s GEMCOVAC-19 (mRNA), Moderna’s Spikevax (mRNA), Bharat Biotech’s iNCOVACC (Non replicating viral vector), Gamaleya’s Sputnik Light (Non replicating viral vector), Gamaleya’s Sputnik V (Non replicating viral vector), Janssen’s Jcovden (Non replicating viral vector), Oxford/AstraZeneca’s Vaxzevria (Non replicating viral vector), SII’s (Oxford Zeneca formulation) Covishield (Non replicating viral vector) and Bharat Biotech’s Covaxin (inactivated virus).
COVOVAX is approved in 6 countries, Corbevax in 2, ZyCov-D in 1, GEMCOVAC-19 in 1, Spikevax in 88, iNCOVACC in 1, Sputnik Light in 26, Sputnik V in 74, Jcovden in 113, Vaxzevria in 149, Covishield in 49, Covaxin in 14countries. Thus the choice of vaccines is now large; if one is willing to spend extra one can opt for DNA, mRNA, inactivated virus, Non replicating viral vector, or protein sub-unit based vaccine. Reports suggest that the immunity is better if the 2nd or 3rd dose is different from the one used in the 1st dose.
People in Manipur should be prepared by using appropriate masks in public, avoiding crowded places, following hand hygiene and getting vaccinated. On the other hand, the government can prepare the necessary needs in an event of large-scale infection by keeping isolation wards and hospital beds ready with necessary equipment and oxygen in stock and ramp up vaccination.
Some of the oxygen plants and ventilators were reportedly non functional. Nothing much may happen like the fourth wave but better prepare than to firefight. China started the chain in December 2019. Now, after three years, in December 2022, it strikes back!
(The views expressed are personal)