What changed between March and April?

Source: Johns Hopkins University Via Our World In Data

While the Government has maintained that no significant mutant strains have been found here in J&K, doctors believe that the exponential surge cannot take place without a major change in the circulating strain.

The COVID19 case graph in J&K has moved sharply upwards in the past six weeks, after remaining flat over two months. In the previous year, the peak was reached around the middle of September, the values reaching 1698 new cases at that time. Post this, the cases started declining gradually, and plateaud in January 2021. From the third week of March, a sharp rise in cases was witnessed. In less than six weeks, the daily case tally has risen from around 150 to around 3500 – 20 fold increase.

Prof Parvaiz A Koul, pulmonologist and influenza expert said it was “inconceivable” that the current surge was not related to a variant. He said the behavior of people had not changed overnight to trigger the case rise. “In February, March, people adopted the same practices that they had in the previous few months. What happened in April then to cause such a flare-up?” he said. Prof Koul said the argument that only one  sample had a variant in Kashmir and very few had in Jammu is “technically flawed”. “With so many travelers positive and a high prevalence of variants in rest of India, we can safely infer that the situation is same here,” he said.

He expressed concern over the low number of samples that had undergone genome sequencing in Kashmir. “If we test more, we will surely find more,” he said.

Prof S Saleem Khan, head department of Social and Preventive Medicine at GMC Srinagar said the surge after the previous high sero-prevalence in Kashmir was an indicator that the immunity had “either waned out or was not there for this virus”. Moreover, he said, there was a high rate of re-infections pointing towards a change in the circulating strain. “There may be many strains circulating presently. Viruses change often and mutations are quite common, especially in influenza causing ones,” he said. He however said that there was no recent sero-survey that could help in assessing the immunity levels in the community.

Prof Naveed Nazir Shah, head department of Chest Medicine at GMC Srinagar said there was “delay” in getting the reports of samples that they send for genome sequencing. “We do collect samples, routinely and on suspicion also but probably due to the load on the labs, it takes very log to get a report,” he said.

As per J&K Government figures, last released on 22 April, 118 samples had been tested and reported in Kashmir division since November 2021. Of these, only 1 had been found positive for a mutant variant. The mutant, N440K, has recently made headlines across India. A joint study by Centre for Cellur and Molecular Biology Hyderabad and Academy for Scientific and Innovative Research Ghaziabad found that this variant was 10 times more infectious than the strain that was circulating before. It also found that the virus had a shorter incubation period and the progress of disease is much rapid. In Jammu division, Government had said, 28 samples were found to have mutations, three of them N440K.

By this measure, out of the 1.1 lakh positive cases from Kashmir division, 1 percent samples have been investigated for mutations. The picture is too myopic at the moment.

As per a J&K Government order, 5 percent of all positive samples were required to be sent for genome testing in order to have a better surveillance of the virus here. SKIMS Soura was designated a Sentinel Site for the purpose. However, in April, the new directions, as per an official, were that only 150 positive samples be sent for genome sequencing “in order to reduce load” on the testing labs. The shrinking sample size, according to many, is another setback to the quest.

Head department of Microbiology at SKIMS Soura, Dr Bashir Ahmed Fomda says the virus changes are “natural”. “When you put pressure on the virus, it tends to mutate… for more transmissibility,’ he said. He said such organisms mutate for increased propagation rather than increased mortality. He said the viruses that have very high mortality don’t usually have high transmissibility. “Because when the host dies, it is the dead end,” he says. While citing examples of Ebola and MERS, the viral diseases that have been a concern in the past due to high mortality, he said, “These viruses didn’t spread much whereas H1N1 spreads more without that much of mortality.”Long term transmissions are low in lethal viruses and do not cause pandemics. He said the SARS-CoV2 “could also mutate” and a new strain could dominate the circulation.

Why is important to have a better picture of the circulating strains? According to Prof Koul, “It will not change the way the disease is managed. That probably will remain the same.” However, he feels, it was significant for a better understanding of the pandemic and the strategies that could help in combating the subsequent waves. Prof Shah feels genome sequencing could help the doctors with more thorough understanding of the disease. “Medicines are same for all variants,” he said. Vaccine efficacy is another area where knowing genome type of the virus could be of concern.

However, what will significantly change is the perception that a previous infection has rendered a person immune. A mutation means the virus can infect you again. It may bring about more compliance to SoPs. It may create a scare too, no doubt. However, whatever the ramifications of knowing whether our surge is related to a mutation, we have a right to know what caused our number of cases to spike like this.