Opinion There is no need to panic over the new variants of Covid. But don’t dismiss it as a seasonal flu
The emergence and spread of the “stealth” variants are being watched closely; while surveillance and care systems are in place, we should still exercise caution
Liberal leave policies by employers can go a long way in limiting the spread at workplaces in the ascendant phase of a surge.
(File photo/Canva) 
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India is currently witnessing a comeback of Covid. The case count has crossed a thousand with several deaths. The leading states are Delhi, Gujarat, Karnataka, Kerala, and Maharashtra. The government has reassured that there is no need to panic. The deaths were not attributed directly to Covid or its complications but were incidentally detected among patients whose proximate causes of death were linked to other diseases.
How do we interpret this surge? It comes exactly two years after the World Health Organisation (WHO) formally declared the end of Public Health Emergency of International Concern (PHEIC) on May 5, 2023, while cautioning, “This does not mean the pandemic itself is over, but the global emergency it caused is.” It is increasingly being considered that Covid has transitioned to an endemic disease, meaning that it will be present round the year but with seasonal surges which will entail some additional morbidity and mortality. Put differently, “disruptive outbreaks” are likely a thing of the past, but like many infections, endemicity also entails certain costs and consequences.
Many endemic respiratory diseases demonstrate seasonal patterns and surges. While sustained transmission of Covid is predictable, clear seasonal patterns are yet to emerge. A defining feature of the pandemic has been the evolution of the SARS-CoV-2 virus (that causes Covid) and the emergence of myriad variants and sub-variants.
That brings us to an important question: What are the characteristics of the currently circulating variants? The lesson of the last few years has been that specific lineages have been successful (in spreading substantially) in only some, but not all countries. The current/new variants circulating in India include LF.7 and NB.1.8.1, which are descendants or sub-variants of the JN.1 variant. These are currently classified by the WHO as Variants Under Monitoring (VUM) and not as Variants of Concern (VOC) or Variants of Interest (VOI). JN.1 draws its lineage from Omicron, specifically evolving from the BA.2.86 variant (also known as Pirola), which emerged as the dominant strain worldwide with the WHO classifying it as a VOI way back in December 2023. JN.1 has only one additional mutation site compared to BA.2.86 within the receptor binding domain (RBD) region of the spike protein which remarkably alters the binding affinity of JN.1 to the angiotensin‐converting enzyme 2 (ACE2) receptor, resulting in enhanced immune evasion ability. This has made it a “stealth” variant — spreading rapidly, but with relatively milder symptoms.
Different variants/sub-variants exhibit three key characteristics: Transmissibility, immunity, and infection severity. The symptoms of JN.1 may include pharyngitis, fever, nasal congestion, persistent dry cough, fatigue, headache, loss of taste, loss of smell, muscle pain, conjunctivitis, diarrhoea, and vomiting. Muscle fatigue and exhaustion are significantly higher compared to typical Covid cases. The stealth characteristic plus the preponderance of relatively milder symptoms makes this highly transmissible.
NB.1.81 (designated as VUM) has emerged as the dominant strain in China and surges have been reported across southeast Asia. While the Indian experience so far does not indicate increase in hospitalisation, Hong Kong reported “significant increase in emergency room visits and hospitalisations” in April. In mainland China, according to news reports, the proportion of patients going to the ER with Covid has more than doubled in the last month — from 7.5 per cent to more than 16 per cent. The proportion of people in the hospital for Covid in China also doubled, to more than 6 per cent. These statistics notwithstanding, the emerging consensus from Asia and the US suggests that it is in no way more dangerous than previous variants.
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In New South Wales, Australia, Covid notifications have gone up by a third in recent weeks. The Nsp1 M85V mutation (ORF1a:M85V) — considered a major virulence factor that shuts off host mRNA translation to prevent cell production of interferons — has been reported from some NB.1.8.1 genomic sequences from Australia and New Zealand. The XFG variant, also detected from some of the clinical cases in India, exhibits strong immune escape properties. These are developing stories and need to be closely watched.
The Union and the state governments are doing their best in terms of both surveillance and preparedness to cope with any surges. There are no mandated restrictions yet in public life, including the use of masks. Abundant caution should nevertheless be exercised at the individual level, particularly by those who are vulnerable: Properly fitted mask when physical distancing is not possible and in poorly ventilated settings; frequent hand-washing with soap and water or alcohol-based hand rub; covering the mouth and nose with a bent elbow or tissue while coughing or sneezing; and, those developing symptoms or testing positive for Covid should self-isolate until recovery. Liberal leave policies by employers can go a long way in limiting the spread at workplaces in the ascendant phase of a surge.
There is unanimity among experts that there is no cause for panic. At the same time, Covid should not be dismissed as a seasonal infection. It continues to be an unpredictable disease and shall continue to be a potentially severe one for the medically vulnerable.
The writer is chairperson, Centre of Social Medicine & Community Health, JNU and Editor, Indian Journal of Public Health
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