We’ve been going through a Greek alphabet soup ever since they started naming SARS-Cov-2 mutants. The gallows humor was that, as we tolerated the Alpha, Beta, Delta, Omicron and their sub-versions, the WHO deftly avoided the Xi letter – so as not to offend the Chinese. But the unpredictable rhythm of the COVID assembly line has brought us closer this time around: the new version amongst us is called the XE. It is from the Omicron family and it is suspected that it is more contagious than anything else that COVID-19 has thrown at us. Health experts and epidemiologists are casting doubts – to predict, if it is possible, whether humanity will bounce on one of those waves that have risen and ended unevenly across the globe since 2020. are gone.
Some schools in Delhi-NCR have seen an increase in Covid infections; (Photo: Francis Mascarenhas)
Mood Mute is one of the alarms, with good reason. Despite the decline in Covid cases in India and other countries, the pandemic has not lost its bite, as indicated by data and reports from Europe and China. In Europe, 1.5 million new cases are being reported daily due to a fresh wave attributed to an Omicron sub-variant. In China, the increase was so severe that the country opted to put the 26 million residents of its financial hub, Shanghai, on an indefinite lockdown. More than half of the cases are occurring in the elderly and illiterate people.
On 9 April, UN Secretary-General Antonio Guterres drew attention to the frequency of COVID peaks in Europe and Asia, largely blaming COVID-appropriate behavior, unrelated populations, and the exemption of sub-versions of the current major variant, Omicron. was imposed. For example, in the UK, 57 percent of cases are due to a BA.2 sub-version of the original Omicron version BA.1, which began to spread rapidly as the country began to loosen COVID restrictions from late January. , The XE variant is composed of genetic material from both BA.1 and BA.2. So far, no death from XE has been recorded.
AAfter months of being bogged down by Covid protocols, India is also witnessing a certain laxity – masks are no longer mandatory in Telangana and Delhi, and states like Maharashtra, West Bengal have eased Covid restrictions in public places. There has been a significant increase in new infections in the last one week in Delhi, Haryana and Gujarat. Delhi reported 943 fresh cases, an increase of 26 per cent over the previous week, while Haryana saw an increase of nearly 50 per cent with 514 new infections. And, with the commencement of physical classes in schools, there has been a spurt in Covid cases among students in the NCR regions of Noida and Greater Noida in recent days, causing concern. However, hospitalizations are low, with only 0.48 per cent beds occupied in the capital as on April 11.
However, with Omicron’s new XE version gaining momentum globally, Union Health Secretary Rajesh Bhushan has written to Delhi, Maharashtra, Kerala, Mizoram and Haryana warning of cases that are ignoring the COVID protocol.
XE is already suspected to have originated in India, with two possible cases reported—one in Gujarat and the other in Maharashtra. Mild symptoms were reported in both patients. However, INSACOG, a pan-India consortium of 38 laboratories tasked with monitoring the variants, is still validating the sequences to confirm the presence of XE. NK Arora, head of the National Technical Advisory Group on Immunization (NTAGI), says, “Omicron variants are giving rise to new variations, and we are taking steps to monitor and manage the infection.”
Will XE trigger a wave?
Dr Rohan Aurangabadwala, a pulmonologist at Apollo Hospitals explains, “Sometimes a person may be infected with two strains of different variants or two sub-strains of the same type, and a new variant emerges with symptoms of both. – those are called recombinants.” Delhi.
According to the WHO, three hybrid or recombinant COVID strains have been identified so far – variant XD, variant XF and the current variant XE, which contain mutations from ba.1 (the original omicron variant) and ba.2 (its more infectious sub). Is. -Filtrate). According to the UK Health Protection Agency (UKHSA), XE has three mutations that are not present in all BA.1 or BA.2 strains, making it 10 percent more transmissible than BA.2. However, the WHO report dated 5 April suggests that further studies are needed to confirm this figure.
The first known case of XE was detected this 19 January in the UK and has since been detected in India, Thailand, Israel and Japan. There isn’t enough data to judge the severity of the disease caused by XE, but doctors expect it to be no worse than Omicron. “We haven’t looked at the delta’s oxygen requirements in over a year, but we don’t know if it’s due to vaccination or a weakened virus,” says Aurangabadwala. The general symptoms reported with XE are the same as with Omicron – fatigue, fever, headache, body aches, palpitations, and upper throat symptoms. “XE is of less concern in a fully vaccinated population,” says virologist Dr. Gagandeep Kang. According to UKHSA, more than 600 cases of XE have been identified so far—less than one percent of the total sequenced strains of Covid cases. Unlike Omicron, which turned deltas globally in five-six weeks, XE has a much slower spread.
It’s an encouraging sign, but experts are hesitant to rule out the possibility of a future wave, especially as the effectiveness of vaccinations and immunity gained from past infections begins to fade. However, experts expect that we will not experience another deadly wave as seen in India as the delta variant spread in 2021.
“Unlike humans, who have DNA as their genetic material, coronaviruses contain RNA, which is less stable and allows them to survive and replicate to create new strains and variants. So far, XE has not seen a rapid spread like BA.2. Also, with a large percentage of India being fully vaccinated, the risk of the new variant is low,” says Dr Rakesh Mishra, director, Tata Institute for Genetics and Society. “But the COVID restrictions must remain in place because there is much more to learn about the new version and there is no guarantee that other versions will not come in the future.”
While most Indians are fully vaccinated against COVID, the question is how long will their immunity last and how effective will it be against the XE variant. Recent surge figures in the UK and Denmark suggest that re-infection with XE is possible in 60 days. Conversely re-infection with Omicron is unlikely to occur within 90 days of delta infection. Thus, a renewed fortification may be demanded. Farah Ingle, Head of Internal Medicine, Fortis Hiranandani, Mumbai, says, “Booster doses are important to strengthen immunity at this time.”
Why Vaccines Are Important
The Union Health Ministry has announced from April 10 that all adults can take precautionary doses of vaccines at private centers nine months after their second dose. However, the uptake has been slow, with only 9,674 jobs given on the first day. A survey conducted by LocalCircle in April 2022 showed that 42 percent of eligible respondents did not want a third time. Experts say this is largely due to people’s belief that Omicron is mild, or that two doses have them well covered.
“The antibody levels drop after some time and getting a booster will help ensure a strong immune response. Especially since the Covid protocol is being relaxed in many states,” says Dr Sushila Kataria from Medanta, Gurgaon. Dr Kataria was one of the first to treat Covid patients in Haryana in 2020. Those who are eligible should get vaccinated for themselves and the community,” says Kataria. Unlike other countries, India has not allowed separate COVID vaccines for the first and second shots. Results of a preliminary clinical trial reported in The New England Journal of Medicine, which prompted the U.S. Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC) to allow mix-and-match booster shots. serve as the basis for its recommendations. In the US, have shown that various vaccines elicit a strong immune response.
A In a study on 98 people conducted by the Indian Council of Medical Research (ICMR) in Siddharthnagar district of Uttar Pradesh, where 18 people received Covishield as the first dose and Covaxin as the second dose, it was found that: vaccination was safe and that the mix-and-match group was superior in antibody response. However, such studies are limited in size and, according to WHO, there is not enough data on the efficacy of mix-and-match boosters. Although research has shown that mRNA vaccines – where cells are instructed to make coronavirus proteins that trigger an immune response – are more effective as boosters, they are not available in India. Experts also say that applying the vaccine at the same time as the third dose will not reduce its effectiveness. “People read things on the internet or social media and make decisions based on rumours, not medical science. The third dose is important to maintain your immunity,” says Aurangabadwala, adding that unrestricted spread of the virus can lead to more variants, as it has a chance to mutate in every new host. Already, Chinese authorities have identified two new Omicron sub-versions—one derived from BA.1 and one from BA.2—that do not match any existing sequences in China or international databases.
While the XE itself is not a cause for concern, experts are concerned that with a concerted global effort not to make a concerted global effort to restrict the spread of COVID-19, the opportunity for new variants to come out is widening by the day. Their concerns have arisen only with Omicron reporting two significantly more infectious sub-strains. To quell the epidemic, gimlet-eyed prevention, along with quick and universal vaccination, is essential.