New Covid Variants
We were hoping that the Omicron will be the last variant. But we were sadly mistaken. A new SARS-CoV-2 strain named XE had recently emerged in the United Kingdom. Shortly after that, the XE Covid variant has allegedly been detected in Mumbai and other parts of India such as Gujarat.
What is XE?
XE is a recombinant of both BA.1 and BA.2 sub-variants of Omicron, the latter often dubbed as 'Stealth Omicron.' Therefore, XE is also classified under Omicron family.
What is concerning about XE? It is estimated that XE is about 10 per cent more transmissible over BA.2 variant. Please note that it does not mean 10 times more transmissible; it only means that XE varinat is 10 per cent more transmissible than the Stealth Omicron. It is yet not clear if infections caused by XE would lead to more severe disease.
The WHO has issued a stern warning about the emergence of this hybrid variant called XE (The Mint, April 6, 2022). This variant was first detected in the UK in January and hence since been spotted elsewhere in the world, including India. As per a report by the UK Health Security Agency (UKHSA), there are currently as many as three hybrid COVID variants: XD, XE and XF. Of these, as already explained before, XE is a hybrid of BA.1 and BA.2 and XD and XF are recombinants of Delta and BA.1.
The WHO report (April 1) says "The XE recombinant was first detected in the United Kingdom on 19 January and >600 sequences have been reported and confirmed since."
Possible fourth wave in India
According to a report by the Serum Institute of India (SII), a fourth wave of COVID infections is likely to hit India in the near future (Zee News, April 4, 2022). Adar Poonawalla, CEO, SII-the maker of CoviShield-says that the 4th wave, if it comes, will be hopefully mild. This, he opines, is because India chose the right vaccine. He says cases are much higher in US and Europe because Indian vaccines are better than theirs. We can only wait for the COVID trajectory to unfold to see if he is right. We can only pray that he turns out right. Poonawalla also stresses upon the need for booster doses, especially for those who need to travel.
We need to be vigilant about the symptoms. The third wave was driven by the Omicron variant. Common symptoms were sore throat, headache, muscle pain, diarrhea, fever and extreme weakness etc. (The Mint, April 7, 2022). We must be vigilant about new symptoms of XE, if any.
As per many reports, the fourth COVID wave is likely to hit around June in India and may peak around August 2022.
Meanwhile, for the second day running, India has witnessed a spike in daily cases (FE, April 9, 2022). On Saturday, India logged 1,150 new cases in the last 24 hours. The active caseload stands now at 11,365. Although the Centre refutes the detection of XE in India, there are reports of this new variant in Mumbai and Gujarat. Asia is seeing large outbreaks and a new wave is sweeping across Europe. In China, Shanghai is the hotpot, logging 21,000 new cases. In Europe, Germany is logging an alarming surge, with over 1.5 lakh cases in the last 24 hours.
Universal Booster Shots
As XE variant is detected in UK and other parts of the world and has possibly arrived in India, the GOI is now tweaking its booster dose policy, to possibly avoid a 4th wave or, at least, blunt its possible impact.
The GoI has now recommended administration of booster (3rd) dose to all Indians age 18 and above. However, the booster shots for now would be made available only in private clinics. The Centre has also made it clear that the booster shot would be the same vaccine used in administering the 1st and 2nd doses. India is yet to approve a mix-and-match strategy of vaccinations.
The administration of the booster dose would begin on April 10, 2022 and would be done on self-payment basis (The FE, April 9, 2022). All those who have completed 9 months after the administration of the 2nd dose would be eligible (The Hindu, April 9, 2022).
New COVID Drugs
A few experimental therapies for COVID-19 is in the pipeline; however, it's still uncertain when these drugs would be available for large-scale use. Meanwhile, the US has pulled out the GSK drug, Sotrovimab, as it is no longer effective against the Omicron subvariant BA.2 (WebMD, April 6, 2022). Omicron now accounts for the majority of new cases in the US.
On the other hand, a Pfizer drug called Paxlovid has successfully treated around 30,000 patients in the UK (Bloomberg News, April 9, 2022). This antibody-based drug was approved for use in the UK in December 2021 and has since been shown to cut down hospital admissions and deaths by about 88 per cent.
Another drug, Molnupiravir, made by Merck & Co. was approved in November 2021 and was shown to slash hospital admissions or deaths by about 30 per cent.
An interesting story is that of Dr Cathy Mary who is a professor of stem cell biology at Nottingham University. She became seriously ill with COVID-19. A clinic at Royal Derby Hospital administered her Paxlovid. Her symptoms dramatically eased within 4 hours of the treatment. The treatment stops the virus from multiplying in human cells, helping patients fight the infection and get better faster.
Persistent post-COVID symptoms
A study by scientists at the University of Oxford claims that even a mild infection of COVID-19 leads to cognitive decline due to 'brain shrinkage' (The Print, Mar. 9, 2022). It was found that among COVID-infected people, there was a higher reduction in grey matter thickness, greater tissue damage in regions of the brain related to smell perception, and an overall decrease in the size of the brain. These findings have been published in the leading science journal, Nature.
If symptoms persist in individuals for two months or longer after recovery from COVID, it will be treated as LONG COVID. Many debilitating symptoms persist in such cases, of which 3 most common ones have been listed as:
- Fatigue,
- Difficulties in breathing, and
- Cognitive decline.
Among these, cognitive decline is the most serious complication. Those who contracted COVID had difficulty performing cognitive tasks that they used to perform easily before, e.g. memory of events, matching pairs, and other tasks. This decline may be due to atrophy of parts of the cerebellum, which is involved in cognition. Such decline may result from inflammation of the spinal cord, or sensory deprivation due to not using the olfactory (smell) complex.
Some other long-COVID symptoms include brain fog, loss of concentration, sleep disturbances, heightened anxiety, and intense back pain etc.
Scenarios of COVID ending
There may be three scenarios for a possible COVID ending: medical, political, and social (Business Standard, Mar. 10, 2022). Nobody knows for sure how COVID-19 will end. But past epidemics can provide some clues. According to Dr. Erica Charters, University of Oxford, there could be different types of endings that may not all occur at the same time.
A medical end may happen when the disease retreats. A political end will take place when the government stops preventive protocols. A social end will occur when the people (society) move on despite the pandemic. There is ample reason to believe that the end is near in the US-65 per cent Americans are fully vaccinated, and about 29 per cent are both vaccinated as well as administered booster doses.
We may look at the trajectories of some past pandemics. The 1918 Spanish flu killed about 500 million people globally and came in three waves. Another flu pandemic of 1957 killed about 116,000 Americans and another pandemic in 1968 killed 100,000 more. Another flu pandemic in 2009 didn't turn out to be as serious as it was anticipated; it fizzled out quite soon and quite unexpectedly.
WHO declared COVID-19 as a pandemic on March 11, 2020 and it has raged across the glove for 2 years now. The global health agency will monitor the global decline in cases, hospitalizations and deaths before deciding if the international health emergency is over. Covid cases are waning in US and dropped globally by 5 per cent in the past week. However, cases are seen rising in some other places such as the UK, Hong Kong, and New Zealand.
Poor people in many countries still are in dire need for vaccines and medications. In Latin America and the Caribbean alone, over 248 million people have not had their first vaccine dose. Countries will low vaccination rates will still see surges in illnesses, hospitalizations and deaths. Dr Ciro Ugarte, Director of health emergencies, PAHO says that we're still not out of the pandemic and we still need to tackle this raging pandemic with a great lot of caution!
Possible Measures for Manipur
We need to assume that there may be a fourth wave in Manipur too. Even if that may turn out to be a wrong anticipation, it's better to err on the side of caution. Accordingly, we must initiate measures to squarely face a possible fourth wave in our state. These may include:
- Vigilant monitoring of arrival of XE in Manipur, testing and tracking it meticulously, and administering booster shots to all eligle people aged 18 and above.
- Death audits, genomic tracking combined with tweaking of treatment protocol (as deaths due to COVID remain high in Manipur, logging an average of 1 or more daily deaths, for the past few weeks of Jan-Feb 2022); we need to ascertain if deaths are due to Delta, Omicron or both; or, is there a need to fine-tune the COVID treatment procedures; regular genomic surveillance, death audits, and tweaking of hospital admission, treatment and monitoring procedures will be helpful in mitigating deaths.
- Preparations for administering vaccines to kids in Manipur & booster shots to high-risk people (elderly, healthcare workers and people with weak immune systems).
- Conducting immediate seroprevalence studies to understand what percent of population in Manipur and in its different districts are still susceptible to the coronavirus.
- Speeding up vaccinations in a big way; aggressive vaccinations with monthly targets to cover all eligible populations with first doses in the next few weeks (4-6 weeks); and targeted vaccinations of all adult population with second doses in the next 2-3 months.
- Regular & repeated COVID testing in hotspots.
- Enhancing the ratio of RT-PCT to Rapid Antigen Testing (RAT).
- Weekly "awareness messaging" about the pandemic to the public by a designated healthcare official.
- Genomic sequencing of a subset of positive cases and surveillance of the variants including the delta and omicron variants: which COVID strains are there in Manipur, where are they, and where are they moving towards; and whether any new variants are emerging.
- Contact tracing and government-monitored isolation of positive cases, wherever feasible.
- Boosting up healthcare provisions such as medical oxygen plants, tankers and cylinders; steroids, antifungal drugs, oxygen concentrators, ventilators, oximeters, masks, PPEs, sanitizers etc.
- Strengthening of healthcare infrastructure such as construction of new COVID hospitals.
- Provision of more COVID care centres (CCCs), more Covid beds and ICUs in existing hospitals
- Constitution of a special taskforce for the third wave; a separate taskforce for pediatric COVID is also highly recommended.
- Special provisions for kids such as pediatric hospitals, wards, and ICUs, pediatric oximeters, concentrators, and ventilators and strengthening of staff such as pediatricians and pediatric nurses and paramedical workers etc.
- Conducting, at least, part of the election campaign in the online mode, limiting crowds in public spaces, and minimising crowds in offline cultural, political, and political events; as far as feasible.
We all owe it to the common people of Manipur to religiously adhere to the standard SOPS to help prevent/mitigate a possible new wave in Manipur; and, help save our people from possible hospitalizations and deaths.
