'Lowering of guard against Covid-19 bigger threat than newer strains'

India has been witnessing a second wave of Coronavirus cases. Even as the threat from newer variants of the virus is getting stronger by the day, experts believe that the sudden surge in cases could be more possibly linked to lowering of guard by the people as far as covid-appropriate behaviour is concerned.

Here's what Dr Sachin D, consultant for interventional pulmonology, critical care and sleep medicine at Manipal Hospitals in Old Airport Road, Bengaluru, told Asianet Newsable.
 

How are the new Coronavirus strains more dangerous than the existing strains in the country?
 

Viruses constantly change through a process known as mutation. New strains of Covid-19 are basically the genetic variants that are emerging due to mutations and circulating across the globe during this pandemic.

Covid-19 variants have been classified into 2 categories by the WHO:
 

1) Variant of Interest: B.1.526/B.1.525 (US), P.2 (Brazil) -- there are associated with specific genetic markers which might result in increased infectiousness, decreased neutralization by antibodies, decreased diagnostic and treatment capacities and possibly more virulent.
 

2) Variant of Concern: B.1.1.7 (UK), P.1 (Brazil), B.1.351 (South Africa), B.1.427/B.1.429 (California) -- These are associated with evidence for increased transmissibility, more virulence, decreased neutralization by antibodies, affecting diagnostic and treatment capabilities.
 

While a cluster of few cases of variants like the UK, Brazil and South Africa strains have been identified, more recently 2 new variants of interest have been identified in India -- Double mutant strain (with 2 mutations- E484Q and L452R) and mutant of unknown origin.

Around 15 per cent of samples showed this double mutant strain which might be capable of producing more severe disease and might be highly infectious, along with a decreased response to antibodies produced by natural infection/vaccines.
 

Although new strains are expected to be a part of the natural evolution of the virus, it is not directly linked with the current surge in cases happening across few states. The path to the second wave could be more possibly linked to lowering of guard by the people as far as covid-appropriate behaviour is concerned. 
 

However, what is concerning is that whether the available covid-19 vaccines will be able to completely neutralize these new strains is yet to be determined, although there is some evidence that few vaccines are not completely able to neutralize the South African variant.

So it is true that the vaccines may not necessarily be effective against new strains...
 

Few of the new strains, especially the South African variant, have been found to escape neutralization with vaccine-induced antibodies to a significant extent. However, its clinical relevance and effect by cell-mediated immunity is being studied. 
 

What is more concerning is that with the emergence of new strains the available vaccines might not be sufficiently able to neutralize all of these variants and might require modifications in the future.

What is causing the surge in cases once again?
 

Although we are seeing new strains of the virus in few samples across India being subjected to genomic sequencing, these numbers are not significant to cause the current surge in cases across few states being observed. Possible reasons for the surge and heading towards a second wave could be due to 3 factors:
 

1) Lowering of guard down by the people as the covid cases start to decline. Covid appropriate behaviour such as masking, sanitization, social distancing and cough hygiene are not being strictly followed by the public resulting in increased transmission chance for the virus.
 

2) Social gatherings and functions bring people closer together from various parts of the nation resulting in a cluster of cases seen among those who attended functions/weddings/parties. Avoidance of such gatherings is not being strictly practised.
 

3) Unnecessary travel (Interstate and International) should be restricted as far as possible to prevent the new strains emerging across the globe from seeping inside the country. Proper checking, early detection and isolation of such cases should be the priority.
 

All the above factors along with the vaccine-hesitant behaviour of the public results in the surge of the cases currently being witnessed in India.

Masks and social distancing are the new normal in our lives. Is there anything else that should become a part of our normal lives?
 

During the covid pandemic, new normal will have to be implemented. Mask, social distancing and frequent hand sanitization are the new normal. Avoidance of social gatherings and unnecessary travel should be the new norm. 
 

Early reporting of covid symptoms and prompt isolation and getting appropriate early diagnosis and treatment should be encouraged without fear and hiding. This can significantly decrease the spread of infection and thereby prevent viral multiplication in different hosts which in turn could lead to a decrease in the number of mutations and hence the development of new strains.

How has the response to the vaccination drive been?
 

Covid-19 vaccination drive has been the biggest vaccination programme across the country. Although we have seen a huge success in the vaccination drive across some states, mixed response due to vaccine hesitancy is also observed in few others. 
 

The main reasons for this are that the public is not clearly informed and helped to make a proper decision to get vaccinated. It should be made clear to the public that both the vaccines available in India are proven safe and have been found to be 100% effective in preventing severe disease/Hospitalization and deaths due to Covid. 
 

However, efficacy in preventing mild and asymptomatic disease varies between 70-80%. Hence, people need not go by the efficacy data but by the more important clinically relevant data on preventing severe disease and deaths.

Are hospitals equipped for ramping up vaccination?
 

We at Manipal hospital have equipped ourselves to vaccinate a large group of people at the same time with facilities for ramping up the scale to 3 times the current if the need arises.
 

It is also important to provide monitoring facilities and proper counselling ad treatment measures for adverse events if any following vaccination. All these facilities and a pre-vaccination doctor check are also made available which shall decrease the vaccine hesitancy and boost the confidence of people to take the vaccine and join hands towards ending this pandemic.