India’s Worsening COVID Crisis & the B.1.617 Variant: April Podcast Transcript

Updated: May 1

Written by LisaMichelle Pecaro, Edited by Courtney Coleman

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Originally discovered in October 2020, India’s B.1.617 SARS-CoV-2 variant has recently generated a lot of interest. The variant has since spread to the UK and US in late February 2021, and has been discovered in more than 20 countries. Recent concerns are mostly due to claims that the second wave of COVID, which is currently raging in India, is spreading much more quickly than the first wave that India faced last year. On April 25th, India posted nearly 353,000 new COVID cases (despite poor testing capacity), setting an all time world record in new daily cases for any nation since the pandemic began. For reference, on the same day, the US posted only 33,662 new cases. Deaths for that day in India were a whopping 2,812, which is also grossly underreported, but still sets a record for that nation. Unfortunately, India's COVID-deaths are projected to continue climbing into mid-May and may increase 4-fold to more than 13,000 new deaths per day, according to the University of Washington’s Institute for Health Metrics and Evaluation. Even before the pandemic, it is estimated that India’s poor public health infrastructure only reports 86% of the nation’s deaths, with only 22% of registered fatalities receiving an official cause. Bhramar Mukherjee, professor of biostatistics and epidemiology at the University of Michigan, feels that, for this reason, India’s COVID death toll is likely 2-5 times higher than the reported total of 198,000 and could be close to 1 million. Surprisingly, Indian Prime Minister Narendra Modi, has ruled out another national lockdown in his address on April 20th, although certain Indian cities have imposed their own stay-at-home orders.

Many of these fatalities are due to hospitals being overwhelmed, with many citizens dying before they can be admitted. In fact, India is also suffering from severe shortages of oxygen, vaccines and ventilators, as nations around the world send supplies to aid India during this crisis. The second wave is also fueled by what many Indians consider to be irresponsible government policies, including permission for nearly 3 million people to partake in the Maha Kumbh Hindu festival in the Ganges River in mid-April, which has already been linked to thousands of positive COVID tests. In addition, vaccination has been slow, and it could take years to fully vaccinate India's population of 1.4 billion.

The World Health Organization (WHO) released a statement on April 27th, regarding their preliminary viewpoint and plan for the situation. WHO spokesman Tarik Jasarevic, concurred that the recent, disastrous COVID wave occurred due to a combination of mass gatherings, increased contagion of the B.1.617 variant, as well as insufficient rates of vaccination. He also claimed that many hospitals are becoming overwhelmed due to over-admission of patients that are not in need of hospitalization, and should instead seek care at home.

The WHO has been stepping up support for India, with more than 2,600 stationed WHO workers providing assistance in the nation. The WHO is also coordinating with India’s government to supply 4,000 oxygen concentrators, as well as the supplies necessary to build field hospitals and ramp up lab testing capacity. In addition, many other nations are offering aid in the form of equipment, oxygen tanks, etc., with the United States supplying PPE and raw materials for the manufacture of vaccines.

As far as the B.1.617 variant is concerned, it is difficult to determine whether it is the main driver of the record numbers of new COVID cases in recent days, due to a lack of SARS-CoV-2 sample sequencing in India. Maharashtra, the second most populous state in India, did conduct genomic sequencing of some SARS-CoV-2 infections between January and March 2021. It is worth noting that Maharashtra has been reporting over 50,000 new COVID cases per day, and it contains half of India’s COVID burden. According to the results of a small sample size of 361 cases, the B.1.617 variant was found in 61% of sequenced samples in Maharashtra. This strain reportedly contains 13 mutations, including at least two mutations occurring in the spike protein. Therefore, using the common moniker of “double mutant” is an inaccurate descriptor and unadvisable, according to Sharon Peacock, director of the COVID-19 Genomics of the UK. Unfortunately, India is currently sequencing less than 1% of its COVID cases.

In regard to immune evasion, there is very limited evidence thus far. The B.1.617 variant’s E484Q spike protein mutation has been shown to reduce neutralization by a group of convalescent plasma samples in an in vitro laboratory study. This mutation is similar to the E484K mutation seen in the P1 Brazil and B.1.351 South Africa variants, which are on the CDC’s list of variants of concern, due to evidence of increased transmissibility and/or decreased neutralization by vaccines, monoclonal antibodies, or convalescent plasma.

B.1.617’s L452R mutation is also present in California’s B.1.429 variant, which exhibits decreased neutralization and increased transmissibility. However, there is not much definitive evidence of antigenic evasion at this point in time for the India strain. The UK, which has detected over 100 cases of the variant as of April 19th, is currently studying this variant to determine if there is evidence of greater transmissibility or vaccine evasion.

The United States has not banned travel from India yet and has also not seen as many cases of the B.1.617 variant as other nations; however, the CDC has advised against all travel to India, even amongst vaccinated individuals. We feel this variant is worth watching in upcoming weeks as more details emerge from India and the rest of the world. The WHO has already deemed it a variant of concern, and will certainly be providing more guidance and data soon.

Results from ongoing research and the current understanding of COVID-19 are constantly evolving. This post contains information that was last updated on April 27th, 2021

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