The ongoing spike in COVID cases in India since early March has been linked to a new variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) called XBB.1.16, according to the Indian SARS-CoV-2 Genomics Consortium (INSACOG), set up by the Government of India. The presence of the variant in different parts of the country has raised concern although the cases are not said to be severe requiring hospitalisation for all infected people.
As per the recent INSACOG data, detection of XBB.1.16 variant was seen in 11 states of India in March, with a total of 610 cases being linked to the new variant. The genomic sequencing (process used to detect the circulating variant) showed that 164 COVID-positive samples each in Maharashtra and Gujarat were linked to XBB.1.16. This was followed by 93 detections in Telangana, 86 in Karnataka and 66 in Tamil Nadu.
COVID spike linked to XBB.1.16
Speaking to Happiest Health, Dr V Ravi, virologist and chairman of Karnataka Genomic Surveillance Committee, said that XBB.1.16 is a variant of the Omicron lineage of SARS-CoV2 virus which has some additional mutations compared to Omicron. “It has some immune escape properties but does not cause severe infection or death. However, if infected, people will experience flu like symptoms. Like all other sub lineages of Coronavirus, it will cause an outbreak and one must be careful to prevent the spread,” said Dr Ravi.
A communication circulated by the union health ministry to all the states on 25th March mentioned about a gradual but sustained increase in trajectory of COVID-19 cases in the country since mid-February 2023. As on March 25, the most active cases of COVID-19 are being reported by a few states like Kerala (26.4 %), Maharashtra (21.7 %), Gujarat (13.9 %), Karnataka (13.6 %) and Tamil Nadu (6.3 %), the health department data said. “While the rate of hospitalisation and death due to the condition remains low, largely because of the significant coverage achieved in terms of COVID vaccination rates by states and union territories, this gradual rise in cases needs reinvigorated public health actions to contain the surge,” said the letter.
The letter by Dr Rajiv Bahl, secretary, department of health research and director general, Indian Council of Medical Research (ICMR) and Rajesh Bhushan, secretary, ministry of health and family welfare said that the states must keep a close watch on the evolving aetiologies (causes of the diseases) regarding cases of influenza-like illnesses and severe acute respiratory illness (SARI).
Dr R Rajeev Jayadevan, co-chairman of the Indian Medical Association’s Covid-19 taskforce, said that there was no doubt about India experiencing a rise in COVID-19 cases. However, he added that the infections are not turning out to be severe and hence the hospitals are not directly impacted. “With a disease as contagious as COVID, we know the impact it can cause in just a few week’s time. Hence, the containment measures have to be taken early to slow down the spread,” he said.
Timeline of XBB.1.16 infection and current situation
Dr Ravi said that sewage surveillance showed the presence of XBB.1.16 variant six weeks ago (in mid-February) and the spike in cases linked to the new variant is being observed since the last month.
During an active infection, the infected people shed the virus through body fluids. Hence, the untreated sewage or waste-water surveillance can detect the presence of a virus.
Dr Jayadevan said that there are several sub-lineages of the Omicron variant and the current surge in India is due to XBB.1.16. “The sub-lineages of omicron are not vastly different from the Omicron variant itself. The third wave in India was caused by Omicron variant in early 2022,” said Dr Jayadevan. While the Delta variant (which led to the second wave in mid-2011) largely affected the lungs, Omicron infected the upper respiratory system. While the spread was rampant, the cases were not severe, he added.
According to Dr Shobha Subramanian Itolikar, consultant internal medicine, Fortis Hospital, Mulund, Mumbai, the situation is not alarming at the moment. “However, we cannot let our guard down. Although COVID cases are being detected, they are not severe, and the number of cases is not large. There is public awareness,” said Dr Shobha.
Not every fever is COVID
Not everyone with flu or COVID-like symptoms are getting tested in hospitals unless they have breathlessness, low oxygen saturation and fever persisting more than three to four days. “While the symptoms of influenza A (H3N2) infections and COVID are similar, we are not conducting tests, but giving symptomatic treatment. We are not prescribing anti-viral and antibiotics,” said Dr Shobha. She added that follow-up visits are a must if the symptoms do not subside or the person develops breathlessness, acute fever and persisting cough.
COVID tests are being done only for those who are suffering from comorbidities and those admitted to hospitals for a different cause and developing an infection.
Dr Shobha adds that using masks, maintaining physical distance and avoiding crowded places are required given the spread. “I recommend the public to avoid crowded places and going to gatherings. Instead of attending a birthday party, one can send a wish,” said Dr Jayadevan.
A recent directive issued by the Government of India emphasises the need for awareness and adherence to hygiene protocols in order to prevent the spread of COVID:
- Avoiding overcrowded and poorly ventilated settings particularly for the elderly and those with comorbidities.
- Staying protected by wearing masks, especially for healthcare workers and those being treated in the hospitals along with their attendants.
- Wearing masks in crowed and closed settings.
- Using handkerchief/tissue to cover nose and mouth while sneezing or coughing.
- Maintaining hand hygiene/frequent washing of hands.
- Avoiding spitting in public places.
- Promoting testing and early reporting of symptoms.
- Limiting personal contact if suffering from respiratory diseases.
Takeaways
- The current spike in COVID cases in India has been linked to the new variant XBB.1.16.
- While the spread is noticed, the infections are not severe.
- Experts advice using masks and avoiding crowded places to prevent further spread.
- Once an individual develops symptoms of COVID, isolation and seeking treatment is a must.
