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Journalism of Courage
Although the new sub-variant of COVID-19, JN.1, has so far not shown any unusual or severe signs of infection, masking up and social distancing help in keeping any unknown virus at bay.
“One has to take a nuanced approach when an all-new variant like JN.1 is in circulation. For instance, in a crowded, indoor, ill-ventilated setting, wearing a mask is a good idea, at least until the present surge dies down. However, it is not necessary while walking alone on the beach,” ss Dr Rajeev Jayadevan, Co-Chairman, national Indian Medical Association (IMA) Covid task force.
Although Indians have been well-vaccinated based on the ancestral strain of COVID-19, many of them have survived natural infection with other Omicron variants in 2022 and 2023. “This affords a basic level of protection against severe illness,” says Dr Jayadevan.
Dr R Gangakhedkar, former head of epidemiology and communicable diseases of the Indian Council of Medical Research, cautions against panic, saying there is no evidence that this sub-variant increases hospitalisation and deaths. “It is important, however, to exercise caution especially for people with chronic co-morbidities. They should protect themselves,” he adds.
Heading the research cell in Kerala, Dr Jayadevan has been seeing an unusual increase in respiratory illnesses in Kerala over the last two months. “This was primarily driven by influenza in the beginning, with COVID being only infrequently found in October. However, since November, the proportion of COVID-19 among these patients has been steadily increasing, which is typically what happens at the beginning of a COVID wave. Most people do not test for COVID and this affects the accuracy of community-level data. The seven-month gap since April is a typical interval between waves in cyclical viral illnesses such as COVID-19,” he adds.
Dr Jayadevan says JN.1 is different compared to the dominant variants of the recent past, which were all minor variations of the ones that existed before them. “Hence the extra concern about JN.1,” he adds.
On the good side, the clinical profile of symptoms caused by JN.1 does not appear to be any different. What is less clear though is the extent to which it will infect entire populations. “We saw what happened with Omicron that was first reported in November 2021 in South Africa. Within six weeks it had covered the entire planet. Fortunately, Omicron was a relatively mild variant, a trait it shares with JN.1,” says Dr Jayadevan.
What is also not clear is the amount of immune evasiveness, which is the ability of the virus to leap past or overcome existing immune protection resulting from multiple doses of vaccination, natural infections or both. Early indications from Sato Lab, Japan, and Yunlong Richard Cao’s work indicate that JN.1 is more immune evasive than any other recent strain. More research is needed to understand the full extent of its transmissibility, immune evasion and severity.
According to Dr Jayadevan, this means it has theoretically the ability to infect people who contracted the virus naturally or were vaccinated. “Useful clinical data will emerge over the coming weeks and this will guide us about the level of precautions that need to be taken locally. For example, if the wave dies down quickly, that’s the best-case scenario. However, if a large number of people are infected, then many will fall ill at once, even while not hospitalised. Second, if it spreads to vulnerable populations, serious outcomes can be expected in some of them,” he says.
Whatever the nature of the virus, it is one among many circulating microbes around us that will mutate and evolve. “We just have to learn to live with it,” says epidemiologist Dr Jayaprakash Muliyil.
