India detects a new ‘double mutant’ variant with the peak of Covid-19 cases, with fears of a second wave

But in early March, it became clear that cases were slowly rising again – and they have exploded in recent weeks.

India has already reported a total of more than 11.7 million cases and 160,000 related deaths, according to data from Johns Hopkins University.

“I would say it is the beginning of a second wave,” said Randeep Guleria, director of the Institute of Medical Sciences of All India, on Wednesday. “It is something that has already been seen in many European countries; it seems that we are following them.”

There are a number of factors – one being Covid fatigue and the possibility that people are being less cautious due to the decline in infections in winter. “You see that in the community, when you go out, the use of a mask is less and less,” said Guleria. “We see crowds developing, partying, many wedding ceremonies taking place in India.”

Another factor could be the increase in “variants that will reach India from other parts of the world,” he said, pointing to the strain first detected in the UK, which has since spread to several Indian states …

Variants and mutations

All viruses evolve over time and sometimes make changes when they replicate, causing mutations. Some mutations have little effect – but others can make the variant more easily transmissible or cause infections with more severe symptoms.

Of about 10,787 samples analyzed by the Indian Consortium SARS-CoV-2 in Genomics from 18 states, 771 cases of worrying variants were detected, most of which were the UK strain, according to the Ministry of Health. Thirty-four were the variant first identified in South Africa and one was the P.1 variant from Brazil.

Although the ministry said that this is not related to the recent increase in cases, the variants were detected mainly in states of “serious concern” that are seeing the highest numbers, including Punjab and Maharashtra. And now double mutations have been reported.

So far this year in Maharashtra, “there has been an increase in the fraction of samples with the E484Q and L452R mutations,” the ministry said in its press release. They were found in 15-20% of the samples and do not correspond to any previously cataloged variant of concern, the ministry said, adding that “such mutations confer immune escape and increased infectivity”.

It is not uncommon to see multiple mutations in one variant. “All of these viruses (variants) that we’re dealing with are already mutants,” said virologist T Jacob John. The strain that became globally prevalent was already different from the first strain that originated in Wuhan, China, he added.

How dangerous a mutation is depends on where it is happening in the virus. For example, the South African variant has mutations that alter the structure of the spike protein, which appears to affect the receptor-binding domain – the part of the spike protein most important for binding and infecting cells. Researchers are now investigating whether this could help the virus partially escape the effects of vaccines.

Guleria warned that a double mutation is not necessarily a cause for alarm, as researchers are still investigating the effect of the mutations.

“They are not clear about what this means,” he said. “Does it have clinical significance or is it just an observation? And it has to be linked to epidemiological data, which is what is being done.”

One question is which variants – and which mutations – can avoid the effects of our existing vaccines.

“If someone has been infected with coronavirus six months ago, that person is immune to the non-mutated coronavirus,” said John. “But is the person still immune to variants? (That has to be) studied.”

Vaccination campaign in India

In the meantime, Indian authorities are working to control the increase, implementing new restrictions and intensifying the country’s vaccine program.

India is administering two vaccines domestically. One is Covishield, a vaccine developed by Oxford University and AstraZeneca and produced by the Serum Institute of India, the world’s largest vaccine manufacturer. The other is the first locally grown coronavirus vaccine in India, Covaxin, jointly developed by Bharat Biotech and the government-run Indian Medical Research Council.

The Serum Institute of India not only produces most vaccines for India, but is also responsible for many of the vaccines distributed to the rest of the world. In September last year, the SII pledged to manufacture and deliver 200 million doses for COVAX – a WHO vaccine alliance established to ensure fair access to Covid-19 vaccines.

But the SII has had to stop or delay its exports several times in the past few months, as global and domestic demand has increased.

On January 4, India restricted the export of the AstraZeneca vaccine produced by the SII until at least March. “We received a restricted license just to give it and provide it to the government of India because they want to prioritize the most vulnerable and needy segments first,” said SII CEO Adar Poonawalla at the time. “The only condition is that we can only supply to the government of India, we cannot sell it on the private market and we cannot export it.”

On Thursday, Reuters reported that India would likely delay delivery of vaccines from AstraZeneca to COVAX, citing UNICEF. India has temporarily suspended all major exports of AstraZeneca shots produced by SII to meet domestic demand, according to Reuters.

CNN has contacted the SII, UNICEF and the Ministry of Foreign Affairs for comment, but has not yet received a response.

The Interior Ministry also introduced new infection control guidelines on Tuesday, which will be in effect by the end of April. Some of the measures include quickly isolating positive cases and tracking your contacts within 72 hours.

Several cities and states, including Mumbai, Delhi and Odisha, banned meetings during Holi, the next festival of colors, on March 28.