As the Covid surge continues unabated in parts of India, this column addresses the latest Covid situation, reasons for the surge and possible ways to prevent a new wave of the pandemic, symptoms of the new variant (“Arcturus”) in adults, children and the elderly; and the urgent need for enhancing administration of second dose and the booster shot (3rd shots) to the elderly and comorbid individuals.
Latest COVID Scenario
India logged 10,753 Covid cases in the past 24 hours (Express News, Apr. 15, 2023). The active caseload in India has crossed 50,000 and the daily positivity rate is estimated to be 6.78 (approaching 10, unless the surge takes a downward turn).
The worst-affected states include Kerala, Maharashtra, Delhi, Haryana, and Tamil Nadu. The daily cases (7-day average) in these states were 2,139, 774, 741, 445, and 356 respectively (ET, Apr. 14, 2023).
Reasons for the Current Surge
The Indian Medical Association (IMA) has given three possible reasons for the current COVID surge. These are easing of Covid-appropriate behaviour, low testing rates, and the rise of a new Covid variant (XBB.1.16). The IMA has suggested that people should get tested, if they have Covid-like symptoms (ET Online, Apr. 13, 2023).
Those with symptoms such as fever, cough, sore throat, headache, body ache, anosmia (loss of smell) and ageusia (loss of taste) and breathlessness must promptly get tested for Covid. In addition, people must strictly adhere to hand hygiene protocol. They must avoid crowded and poorly ventilated places. People must now wear masks in public places.
Eligible people must immediately go for the second dose of the Covid vaccine. There is the urgent need for enhancing full vaccination rates in many parts of India including Manipur. Moreover, the elderly (people over 60), comorbid individuals (e.g., diabetic patients) and the immunocompromised (for example, people who have had organ transplantations) must go for the 3rd dose (booster/precautionary dose) on a priority basis.
There is divided opinion about whether certain categories of people need to be administered the second booster or precautionary shot.
Symptoms of the New Covid Variant
The COVID variant XBB.1.16 is considered to be the agent triggering the recent rise in cases across the world especially India. According to WHO, a total of 712 XBB.1.16 sequences have been detected in 21 countries including India. XBB.1.16 (also called “Arcturus”) is a recombinant Omicron variant that emerged in late 2021 and has since then replaced Delta as the dominant Coronavirus variant around the world (HT, Apr. 15, 2023).
As it carries additional mutations in the spike protein of the virus (the part that’s involved in infecting human cells), the Arcturus strain is considered more transmissible as well as more immune-evasive than the earlier variants and may thus escape immunity provided by prior infections or vaccinations. Though most of its symptoms are identical to those of the earlier strains, it may manifest slightly different symptoms in vulnerable populations such as children and the elderly.
Some common symptoms in adults include fever, sore throat, runny nose, cough, body ache, myalgia (muscle pain), fatigue, diarrhea, and shortness of breath etc. Loss of taste and smell are less common with this variant compared to Delta strain. An alarming development is that of slightly increased infections in children of age 12 or less (for whom we don’t have any approved vaccines yet), especially in Delhi.
A new symptom is seen in such children: conjunctivitis or pink eye besides other symptoms such as sore throat, runny nose, fever, cough, and blocked nose etc. The elderly, comorbid patients (diabetes, respiratory or cardiovascular conditions) and immunocompromised people (cancer, transplant, and cancer patients and those on steroids) are likely to develop severe disease from the Arcturus strain.
Prevention Strategies against XBB.1.16
Most experts opine that there is no cause for worry yet. Though the new variant is triggering a surge in infections, there are no signs of severe infections or increased hospitalizations so far. They say that the pandemic is now moving towards the endemic stage, with occasional surge in cases in certain pockets of populations which will subside again in some days or weeks, to again surge in other pockets later. However, we must not take things lightly before the scenario unfolds completely.
We must still take certain precautions so as to preclude a fresh wave of Covid infections in parts of India. These preventive steps include increased testing so that the infected can isolate themselves, genome sequencing to ascertain the trajectory of the spread of Arcturus, mandatory use of masks in public spaces, adherence to hand hygiene, social distancing, and enhancing the rates of booster administration in the elderly (those of age 60 and above) and comorbid or immunocompromised individuals. Most experts agree that there is as yet no need for a 2nd precautionary (booster) dose (The Indian Express, Apr. 15, 2023).
Rise in Pediatric Covid Cases
One concerning development is that of the rise of infections in children of age less than 12 especially in Delhi (TOI, Apr. 10, 2023). While these cases have been mostly mild, doctors caution parents of children with obesity, asthma, or other immunocompromised conditions not to take the infections lightly. There has also been a rise in hospital admissions for children under two years of age suffering from adenovirus infections (quite similar to Covid infections).
There is a thin line that separates infections by these two viruses (adenovirus and Covid virus). Preventive steps are also similar: hand hygiene, masking while coughing or sneezing, avoiding touching of eyes, nose, and mouth; avoiding contact with sick persons, and isolating yourself if you are sick etc. Only an RT-PCR test can determine if your kid is infected with adenovirus or the new COVID variant.
For kids manifesting symptoms such as high fever, cold & cough, runny nose, and non-purulent, itchy conjunctivitis (red/pink sticky eyes), it’s advisable to undergo Covid testing. These symptoms may be due to flu, adenovirus, or rhinovirus but they could also be due to COVID. The line of treatment for Covid, flu, rhinovirus, and adenovirus illnesses are almost the same.
The daily caseload in India has crossed 10,000 for the past few days. The positivity rate in the country has soared above five per cent and the number of active cases is now above 50,000. The worst-hit states include Kerala, Delhi, and Maharashtra etc.
The surge may spread to other states due to crowding in election rallies and other public gatherings. Moreover, there has been no guidelines for travel restrictions or other fresh Covid protocols. Also, the rate of full vaccinations and administration of booster doses remain low in many parts of the country.
In order to prevent a possible new wave of infections, we all must abide by the usual Covid-appropriate behaviour. These include masking in public places, avoidance of crowded or poorly ventilated settings, observance of hand hygiene and social distancing etc.
In addition, we have to ramp up testing so that infected individuals can isolate themselves, increase genomic surveillance to track the spread of the new variant, and enhance the rate of full vaccinations in eligible populations, and increase the rate of administration of booster doses in the elderly, the comorbid, and the immunocompromised.
In addition, close medical attention must be given to sick children under 12 as there is as yet no vaccine for this age group. Let’s remember that the world is still not free from the clutches of SARS-CoV-2 virus.
