Watching Covid-19 as we welcome 2023
We are into the New Year but the pandemic, it appears, will follow us into 2023. If the world thought this would be the first Covid-free year since 2019, when Covid-19 became an everyday word, then the current suffering in China sends us a reminder that it may not be so easy.
Once again, China was playing hide and seek with information during the winter months of 2022
This is where it all began in China in late 2019 but the true picture of the epidemic was never fully shared with the rest of the world. It was reported that Italy had the SARS-CoV-2 infection (then called just novel coronavirus) during the last quarter of 2019, but it was discovered only after the RT-PCR test became available in January-February of 2020. Details about the origins of the virus and time sequence are still unknown. The geo political challenge was that many doors were closed to investigators looking for clues in China.
The current spread is mostly Omicron BF-7 variant, which has been found earlier in isolated pockets in India
Once again, China was playing hide and seek with information during the winter months of 2022. Worldometer (using government-released data) showed a wave during November-December that peaked in the second week of December with just over 4,000 daily cases steadily declining to less than 3000 by Christmas, slowly climbing to a little over 3,000 as of 26 December. Other sources, particularly foreign news agencies, reported an epidemic raging in the whole country with Beijing and Guangdong the worst affected. The New York Times reported on Christmas Day: “a picture is emerging of the virus spreading like wildfire.” The current spread is mostly Omicron BF-7 variant, which has been found earlier in isolated pockets in India.
Unfortunately, WHO has once again been unable to lead the world about this outbreak, mirroring the delay seen in January 2020 when there was an obvious pandemic with the virus detected in many countries in three continents plus Australia. WHO announced the pandemic only in the second week of March 2020. A new WHO investigation accepts this – a panel headed by Helen Clark (former prime minister of New Zealand) and Ellen Johnson Sirleaf (former president of Liberia) asked why WHO waited until Jan. 30 to declare an international health emergency (which is still short of calling it a pandemic), a surprising and costly delay that came due to apparent Chinese efforts to stop the announcement.
All we need to do today is to keep watching the daily numbers of diagnosed infections, the pressure on our health-care system in various States, and make slow but deliberate conclusions. So far there is no signal of any new wave in India
India’s preparedness and response were also weak and poor. Many deaths have gone unreported. So, it is understandable that India is now worried, as shown by high level meetings chaired by the Prime Minister and the Health Minister, and some clear steps taken to prevent or at least retard, another virus entry from China.
During 2020-21-22, the world has moved on, scientists and epidemiologists, India included are past the learning curve and quite well-informed. India has no cause to panic. All we need to do today is to keep watching the daily numbers of diagnosed infections, the pressure on our health-care system in various States, and make slow but deliberate conclusions. So far there is no signal of any new wave in India.
India had three major waves of COVID-19 – in 2020 spread over ten months, caused by the original, slow spreading Wuhan virus and a small proportion of the Alpha variant that emerged in the UK; in 2021 spread over March-July, about five months, caused by Delta variant that had emerged in India; in 2022 spread over just two months, January-February, due to the Omicron variant. In epidemiological terms, a wave is an epidemic spread, and the valley, if sustained over a long period, is an endemic spread. India has been in an endemic pattern since March 2022, with a slight increase in daily numbers in June-July-August, partly due to the BF-7 variant, not quite a wave.
Millions of Chinese are getting their first infection with BF-7 and that would explain the current scenario in China with severe disease
The Omicron variant defied predictions – it spewed out many sub-variants; all of them defied immunity from previous infections or from two or even three doses of available COVID-19 vaccines. Reinfections were common, in some once, in others more than once. We have already seen the BF-7 sub-variant. So, what should India be afraid of?
True, the SARS-CoV-2 has not followed the rules made by virologists, and caution is the watchword. Panic is certainly not called for.
Full facts will take time to be known. But we know that there was a ruthless lock-down in Wuhan District in early 2000, obviously as they had a calamitous wave, spreading fast and putting immense pressure on health-care, and causing very high mortality. While preparing for the lock-down, they let foreigners leave, and medical students returning to Kerala, even in January 2020, had famously carried the virus. The strict and ruthless lockdown was imitated by India in March as soon as WHO declared a pandemic, but even before the virus had begun spreading.
China had consistently been ruthless when it came to slowing the spread of the virus, yet kept up the image that all was well in the country. The Chinese even went through the winter Olympics 2021. Then they had the ‘Zero-Covid’ policy in vogue up until the end of November 2022.
It is advisable to be masked up in crowded areas. The practice helps prevent other infections, and puts in place civic discipline as a simple and easy layer of protection that can be made mandatory should the situation turn out different
All in all, many Chinese were protected from the infection and disease during 2020 and through the last quarter of 2022. But nothing can stop the transmission of BF-7, as the Chinese have learned. Their indigenous vaccines turned out to have low efficacy. Their killed-virus vaccine is with aluminum salt as the adjuvant, but the Indian adjuvant for killed virus vaccine is a novel one called alhydroxyquim – a combination of aluminum to strengthen antibody response and a special, innovative, molecule to markedly enhance cell-mediated immunity. What high immunity does is to protect from severe disease in spite of reinfection.
On account of earlier infection prevention interventions under the Zero-Covid policy, a large proportion of Chinese were immunity-naïve. Now, millions of Chinese are getting their first infection with BF-7 and that would explain the current scenario in China with severe disease. Omicron disease is not a killer in the immune-population – except in the elderly, the immunosuppressed due to malignancies, organ transplants, immunosuppressive therapies, and particularly in the non-immune.
At present it is reasonable to predict that India is not anywhere near as vulnerable as the Chinese. We had our share of mortality during 2020-2021, the scale of which is disputed, The unmistakable fact is that we had no ‘Zero-Covid’ policy but let the virus spread at its will, we let re-infections happen too, and we have much more efficacious vaccines. Omicron (known sub-variants) cannot do much harm in India in 2023. The advice of the experts is: Be cautious, not anxious. Be alert, not in panic. Keep watching daily numbers and events to see the trend.
That’s as good as it can get for 2023. It is advisable to be masked up in crowded areas. The practice helps prevent other infections, and puts in place civic discipline as a simple and easy layer of protection that can be made mandatory should the situation turn out different.
(Dr T Jacob John is retired Professor of Clinical Virology, CMC Vellore, and past President of the Indian Academy of Pediatrics. Jagdish Rattanani is a journalist and faculty member at SPJIMR) (Views are personal)