Most of us thought that COVID-19 has been “tamed”, if not completely eliminated. Recent developments have proved how wrong our naïve presumptions were. China is now facing a scary surge, though the real scenario isn’t known to the rest of the world.
The recent surge has been attributed to an omicron sub-variant called BF.7. But this variant is neither new nor confined to China alone. It had been detected in over 91 countries and most reports claim that four cases of BF.7 has been detected in India.
How concerned should we be, is there a need for fresh lockdowns, masking up in crowded places, and aggressive testing, genomic sequencing, tracking and treating?
Today, let’s discuss the interrelated issues of BF.7 and other possible new variants, possible 4th Covid wave, need for booster shots for adults and the introduction of an intranasal vaccine in India.
BF.7 and Other Variants
It is estimated that nearly 248 million Chinese have been infected in just first 20 days of December 2022; about 37 million people might have been infected in a single day this week (NDTV.com, Dec. 23, 2022). This gives a clue about how transmissible and immune-evasive BF.7 could be. We all must be genuinely concerned about the rise and spread of this Omicron sub-variant.
What exactly is BF.7?
BF.7 is a sub-lineage of the Omicron strain. BF.7 is a derivative of BA.5 sub-variant of Omicron. It’s also known as BA.126.96.36.199 Omicron variant. It’s highly transmissible with an R value of 10-18 (Omicron R value: 1-5) (ET, Dec. 24, 2022). That means, a person infected with BF.7 could theoretically pass it on to another 10-18 people.
How immune-evasive is BF.7?
BF,7 has 4.4-fold higher neutralization resistance than the original virus. That means the antibodies from the vaccination may not be effective enough against the BF.7 strain. People who had been naturally infected and later got vaccinations may be better protected. But still there are so many unanswered questions and we need to tread very cautiously.
How widespread is BF.7?
The China surge is driven by BF.7. Similar surges have been observed in several other countries, including Japan, South Korea, UK, Brazil, and USA. Four cases of BF.7 have also been detected in India. Another concerning thing is that BF.7 has shorter incubation period (time gap between infection and manifestation of symptoms is shorter). It has higher capacity to cause reinfection. It may infect even those who have been vaccinated.
What are the symptoms of BF.7?
BF.7 symptoms include fever, cough, runny nose, fatigue and gastrointestinal issues (vomiting and diarrhea etc.). BF.7 has a mutation in its spike protein (R346T) that contributes to its increased infectivity and enhanced ability to evade the immune system (ET, Dec. 23, 2022).
Will there be a 4th Wave in India?
The only heartening thing is that of some reports indicating that there may not be a new Covid wave in India (ET, Dec. 23, 2022).
The reasons for India possibly escaping a 4th wave are manifold. One is that, unlike China, India faced 3 waves of Covid-19 that naturally immunized millions of people. Experts opine that most Indians have acquired hybrid immunity: immunity developed through vaccines as well as natural COVID infections. Also, India’s vaccination rates are high, 95% (single dose), 88% (double doses), and a small percentage with booster doses. It is also claimed that India’s indigenous vaccines are highly effective compared to what China used such as Sinovac and Sinopharm etc.
Is there a need for Booster Shots?
Compared with single-dose and double-dose rates, India’s rate of booster shot administration is still quite low. According to government data, only 28% of the eligible population has received a booster shot (Business Today, Dec. 22, 2022). That means about 72 per cent of the population is yet to receive the booster shot. This booster rate is too low in view of dangerous variants such as BF.7.
Manipur needs to step up
India (and Manipur) needs to aggressively accelerate the rate of administering booster shots. In Manipur, the relevant health authorities must take steps to increase the booster shot administration in the near future. In addition, the rates of single and double dose shots must also be increased, if necessary. This time, we may try the mix-and-match strategy of booster administration. That means if a person has earlier received two doses of CoviShield, he/she may now be given a third shot of another vaccine (maybe the new nasal vaccine that India has recently approved).
The mix-and-match boosting (heterologous boosting) is possibly a better tactic than using homologous boosting (Indian Express, Dec. 24, 2022). This strategy may trigger enhanced immune protection. It also gives more options to people to get booster shots as the vaccine they used earlier may be out of stock.
World’s First Intra-Nasal Vaccine
India has just approved the world’s first intranasal vaccine (Tribune News Service, Dec. 23, 2022). It’s made by Bharat Biotech and is named INCOVAC (BBV154). The government says that this vaccine will be available at private centers at nominal cost. For now, there seems to be no policy to distribute it free of cost.
INCOVAC is a recombinant replication-deficient adenovirus vectored vaccine meant to be delivered through nasal drops. This vaccine design enables faster development of variant-specific vaccines and easier administration of vaccines without even the need for healthcare workers.
The only unattractive feature of this new and easy-to-use vaccine is that it’s to be used for people of age 18 and above and it hasn’t yet been approved for younger individuals.
This intranasal vaccine may be a convenient tool for increasing the boosting rates in India (and Manipur) in view of its ease-of-use, low cost, and the enhanced effectiveness of mix-and-match policy.
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 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 centres may also start acquiring the new intranasal vaccine for possible use as a booster shot.
It's better for all of us to be surprised with a positive development instead of being dismayed with a sudden onset of adverse scenario.