The variant that threatens the British summer has already done far more damage in India. In October last year a sample from the western state of Maharashtra containing what would later be identified as the B.1.617.3 variant was sequenced and uploaded to Gisaid, a global database of Covid-19 samples from across the world. The variant had multiple mutations located on the virus’s spike protein that binds it to receptor cells in the human body. Some of these mutations were present in other variants, or seemed capable of evading immunity. All of this should have set off alarm bells in India and led to increased surveillance across the world.
Instead, India’s genome sequencing project continued to flounder through the rest of 2020. For most of last year, India did virtually no genome sequencing, Dr Gagandeep Kang, one of India’s leading virologists, told me. While other countries submitted thousands of sequences to databases such as Gisaid for scientists across the world to study, India submitted only a few hundred. This was partly due to a lack of funding. It was also possibly the result of a lack of interest; last year, India’s Covid curve appeared to be falling.
At the end of 2020, the Indian government announced it was setting up the Indian Sars-CoV2 Genomics Consortium (Insacog) to increase genomic sequencing through a network of 10 laboratories. Its aim was to sequence 5% of all new detected cases. By Tuesday, India had submitted a little under 13,000 sequences – 0.05% of its total reported cases. Despite reporting about 400,000 new confirmed cases every day through the first half of May, India collected and submitted just 280 sequences over the last 30 days. Again, it’s worth putting these numbers in perspective: according to Gisaid data, India has submitted 2,247 sequences of the variant first identified there in October 2020; the UK, where cases of the B.1.617 variant were first detected in February 2021, has submitted 3,706 to date.
Epidemiologists across India have suggested the variant is driving the country’s virulent Covid curve. This is also supported by data from Gisaid, which shows this variant has become dominant in badly hit states such as Delhi, Maharashtra, Karnataka and Tamil Nadu. The World Health Organization has classified the strain as a “variant of concern” because of its potentially increased transmissibility. But the question of whether this variant is linked to more severe cases of Covid-19 is more complicated. Experiments on hamsters suggest that infections with this variant result in a greater loss of body weight, higher viral load in people’s lungs and pronounced lung lesions.
The real-world evidence from India is harder to parse, in part because the sheer number of infections has overwhelmed India’s health systems, leading to countless deaths from a lack of simple life-saving measures, including oxygen supply. In the western Indian city of Pune during the early days of the second wave, when there weren’t shortages of beds and oxygen, there was no apparent increase in the death rate, the leading Indian immunologist Vineeta Bal told me.
The question of whether this variant leads to more severe cases of Covid-19 is also closely related to vaccines. Over the last few weeks, at least three Indian states and two cities, including Pune, have shown signs of a vaccine effect – a decline in infections and deaths among elderly people, 40% of whom have now been vaccinated.
Although some scientists and the WHO have suggested that antibodies acquired either from vaccines or from past infections might have reduced success in neutralising the new variant, the current consensus appears to be that the two vaccines being administered in India – the Oxford/AstraZeneca vaccine and the Bharat Biotech/Indian Council for Medical Research’s Covaxin – remain largely effective against the new variant as well.
This new variant played a significant role in India’s overwhelming second wave. But the suffering was also caused by India’s costly mistakes. Religious and political mass gatherings such as a month-long election campaign and the Kumbh Mela festival went ahead. Such large gatherings resulted in increased social mixing and reduced adherence to distancing measures. The delays in genomic sequencing were potentially catastrophic, and not just for India. Meanwhile the country’s vaccination drive, which already seems to be having a positive effect on the number of Covid cases, has been impeded by a combination of shortages stemming from insufficient planning, and hesitancy stemming from poor communication.
There are already signs this wave could be peaking in India. To prepare for the next public health crisis, the country must learn the lessons from its second wave. In particular, the government must stop hiding behind a veil of nationalism. On Tuesday, one of India’s most respected virologists, Shahid Jameel, resigned from his position as the chair of the scientific advisory group of the Insacog. Just days earlier, Jameel had written in the New York Times about the “stubborn resistance to evidence-based policymaking” that Indian scientists were facing, warning that “decision-making based on data is yet another casualty, as the pandemic in India has spun out of control”.
In place of data, there has been patriotic bluster. In January, India’s health minister famously declared that India had contained the pandemic. By the middle of May he was being pilloried for responding to a sober Lancet editorial on India’s handling of the second wave by sharing a childishly written blog post complete with a cat photo. One would expect politicians and leaders to have shown empathy when the second wave hit. Some of this suffering could have been prevented: unfortunately, there’s little reason to be hopeful the government will reflect on this before the next wave hits.
Rukmini S is a data journalist based in Chennai, India
— Courtesy The Guardian