This article is written by Vanya Verma from Alliance University, Bengaluru. This article talks about the Delta Plus variant, recent reports on the variant that covers symptoms, the effectiveness of the vaccine against the variant, Indian states that have been affected by the variant and can this variant trigger the third wave in the country and finally is India prepared to fight against the variant and to tackle the third wave.
Table of Contents
Introduction
It’s too early to say whether India is on the verge of witnessing the third wave of novel coronavirus infections because the number of daily COVID-19 cases recorded in multiple states has never dropped to a level that would ease fears even momentarily.
However, a new surge in COVID-19 cases has renewed concerns in areas like Maharashtra, which had been making headway on the pandemic front recently. When the second wave of infections hit India, Maharashtra was one of the first states to see an exceptional increase in COVID-19 cases daily.
After the dreadful second wave, the state learned a lesson and began preparing for a possible third wave early, as some health experts projected that the western state would be the first to face a surge in infections once again. Since June 22, everyday, COVID-19 instance have been on the rise in Maharashtra, as have deaths from COVID-19-related complications. To make matters worse, Maharashtra’s Health Minister, Rajesh Tope, has stated that the state has seen many cases of a new mutant COVID-19 strain known as the “Delta Plus” variation.
Regardless of weekly positivity rate or oxygen bed occupancy, the state administration has placed all administrative units under a minimum of ‘level 3’ limitations. Doctors, epidemiologists, and health experts are concerned that the Delta Plus variant may be responsible for the third wave of cases in India.
What is Delta Plus
The Delta Plus variation, like Delta, has a mutation in the virus spike protein region of RNA, which could make it more transmissible. The variant, known in India as “Delta Plus,” was originally reported by a Public Health England bulletin on June 11. It has acquired the spike protein mutation K417N, which was also found in the Beta variant first identified in South Africa.
The Indian Council of Medical Research (ICMR) to release vaccine efficacy against Delta Plus variation soon. ICMR Chief Dr Balram Bhargava announced that the results of the vaccination effectiveness trial against the Delta Plus variant would be released soon.
He further said, “Delta Plus has been found in 12 nations; 48 cases have been found in India, but they are quite localised. This virus has been identified and is in the process of being cultivated. Laboratory studies to assess the vaccine’s effectiveness are ongoing, with findings expected in seven to ten days.
Experts blamed a triple mutant of the novel coronavirus of the B.1.617.2 lineage, which was discovered in India at the end of last year, in part for the second wave of COVID-19 that hit India earlier this year. On May 31, 2021, the World Health Organization (WTO) designated it as Delta.
Later, the highly transmissible Sars-CoV-2 variation transformed into the AY.1 lineage’s Delta Plus. According to scientists, there is no urgent cause for concern because the disease’s prevalence in the country is still minimal.
The spike protein of the novel Delta Plus strain possesses a K417N mutation, which has been formally termed B.1.617.2.1. The National Chemical Laboratory (CSIR-NCL) is currently investigating the Maharashtra specimens Ratnagiri and Sindhudurg for the occurrence of the Delta Plus variant. In India, these two locations have the largest proportion of active infections.
Symptoms of Delta Plus variant
The newest variant is still being researched, and scientists are trying to figure out what distinguishes COVID-19 symptoms from those caused by the Delta Plus mutant. Apart from the usual dry cough, fever, tiredness, aches and pains, skin rashes, toes and fingers discolouration, sore throat, conjunctivitis, loss of taste and smell, diarrhoea, and headache, chest pain, breathlessness, shortness of breath, and speech loss, preliminary studies appear to suggest that Delta Plus patients also experienced stomach ache, nausea, appetite loss, vomiting, joint pains, and hives hearing impairment, etc.
The Delta Plus variant of COVID-19 has a greater affinity for lung tissues than other strains, according to Dr N K Arora, Chairman of the COVID-19 working group under the National Technical Advisory Group on Immunization (NTAGI), but this does not mean it will cause severe disease or be more transmissible.
Arora told the Press Trust of India (PTI), “Delta Plus has a higher affinity for the mucosal lining of the lungs than other variations, but it is unclear whether this causes injury or not. It also doesn’t imply that this variety will produce more severe sickness or be more contagious”.
Resistant to monoclonal antibodies
Experts are currently investigating how this unique variant impacts sickness progression and whether it causes severe COVID-19 infection. Preliminary findings suggest, however, that this unique mutation of COVID-19 may be resistant to monoclonal antibody cocktail therapies. The treatment consists of a combination of two drugs: casirivimab and imdevimab, which was recently approved in India.
Another potential problem that medical professionals are still looking into is whether the new version would be able to overcome the protection provided by both immunizations and prior COVID-19 infections.
Effectiveness of vaccines on Delta Plus variant
Vaccines have yet to be tested on the Delta Plus variant, but Dr. Scott Gottlieb, the former commissioner of the Food and Drug Administration (FDA), was quoted on cnbc.com as saying that vaccines appear to be successful.
The mRNA vaccine appears to be very efficient against the Delta variation, with an 88 per cent success rate. He added that the viral vector vaccines from Johnson & Johnson and AstraZeneca appear to be roughly 60% effective. mRNA technology is used in the vaccines developed by Moderna and Pfizer/BioNTech.
According to the Study, the Pfizer and AstraZeneca vaccinations were only 33 per cent effective against symptomatic cases of the Delta variation three weeks after the first dosage, compared to 50 per cent effective for the Alpha variant.
Covaxin also “demonstrates a protective response” against the Delta and Beta versions, according to Bharat Biotech. This was confirmed by a study conducted by the National Institute of Virology in Pune, the Indian Council of Medical Research, and Bharat Biotech.
However, a research of 63 people conducted by AIIMS (All India Institute of Medical Sciences) found that neither Covishield nor Covaxin were effective against the variation. The ‘Delta Plus’ variation of COVID-19, which is more lethal than the ‘Delta’ variant, is predicted to cause a third wave of the pandemic in India. The second COVID wave, which wrecked the country’s healthcare infrastructure, was largely caused by the Delta strain of the coronavirus. And now, as experts and policymakers discuss the likelihood of a third wave and what might cause it, Delta Plus is emerging as a risky gamble for both healthcare specialists and legislators.
Delta, the ‘most transmissible’ COVID-19 variant identified so far : WHO
Meanwhile, the WHO stated that the Delta form of COVID-19, which has been found in at least 85 countries, is the “most transmissible” of the variants discovered so far and is spreading rapidly among unvaccinated populations.
“I’m aware that the Delta variant is causing a lot of anxiety around the world, and the WHO is concerned as well. Delta is the most transmissible of the variants discovered so far, having been found in at least 85 countries and spreading rapidly among unvaccinated populations”, according to WHO Director-General Tedros Adhanom Ghebreyesus.
Has the third wave begun
The worry of a third wave of wreaking devastation in the country has consumed our minds, especially given how reasonably effective vaccination campaigns have done little to prevent a COVID-19 outbreak in Europe. Top experts have raised alarm about a third wave breakout in the West, speculating that the Delta strain may be to blame for the resurgence of infections.
Professor Adam Finn, who advises the Joint Committee on Vaccination and Immunisation (JCVI), told Radio 4’s Today programme that the third wave has already begun in the UK and that the country is now in a tight race between vaccines and the Delta variant, which was first found in India.
“It’s going up; we may be a little optimistic that it’s not going up much faster, but it’s going up anyway, so this third wave is underway,” Finn said. This makes it clear that India, with just roughly 31 crore adults half vaccinated, cannot succumb to pandemic weariness at this time, as the third wave is expected to be significantly more devastating, according to specialists.
Views of the experts
If India unlocks completely by July 15, a team of academics from the Indian Institute of Technology – Kanpur (IIT-K) constructed a prediction model that predicts the third wave will peak between September and October 2021.
In the worst-case scenario, daily COVID-19 cases during the third wave might reach more than five lakh in September, according to the IIT Kanpur experts. This could be due to the introduction of a new, more virulent/transmissible strain of SARS-CoV-2, the virus that causes the disease, scientists suggested.
The Susceptible Infected Recovered (SIR) epidemiological model, for example, does not take into account the effect of immunizations, which could help break the transmission chain. When it comes to the novel SARS-CoV-2 strains, the Delta Plus is the only one that is now emerging as a “variant of concern” (and its lineages).
Can the Delta Plus variant trigger another wave
The Delta Plus variant was created by a mutation in the B.1.617.2, or ‘Delta’ variety, which was first discovered in India and is thought to be one of the drivers of the country’s devastating second wave of infections. It is a sub-lineage of the Delta variation (B.1.617.2.1 or AY.1) that has acquired the ‘K417N’ spike protein mutation. The mutation K417N has piqued curiosity because it is found in the Beta variety (B.1.351 lineage), which has been linked to immunological evasion, according to the Union Health Ministry.
The Indian SARS-CoV-2 Genomic Consortia (INSACOG), according to the Health Ministry, has designated the Delta Plus strain as a “variant of concern” due to characteristics such as increased transmissibility, stronger binding to lung cell receptors, and a potential reduction in monoclonal antibody response or antibody cocktail treatment used to treat mild to moderate COVID-19 cases in India.
The World Health Organization, on the other hand, stated: “For the time being, this variant (Delta Plus) does not appear to be prevalent, accounting for only a small fraction of Delta sequences. Delta and other circulating variants of concern continue to pose a greater public health risk due to increased transmission.”
“The mutation itself may not lead to the third wave in India — it also depends on COVID-appropriate behaviour,” Tarun Bhatnagar, a scientist at the Indian Council for Medical Research (ICMR), told Reuters, “but it could be one of the reasons.”
The variant has also been seen in the United Kingdom, the United States, Portugal, Switzerland, Poland, Japan, Nepal, China, and Russia, to name a few. However, no country has yet expressed concern about a third wave as a result of the strain.
Even in India, there have been roughly 50 cases documented (including minors), with three patients dying — one in Maharashtra (an octogenarian with comorbidities) and two in Madhya Pradesh (both unvaccinated).
If and when the third wave arrives in India, central government district public health officer Dr. Abir Mazumdar told Moneycontrol: “Considering all expert opinions and studies in India and elsewhere, it is unlikely that this sub-strain could wreak havoc in a possible forthcoming third wave.”
“When we look at the data showing Delta Plus variation prevalence as the primary source of an ongoing wave in the nine other nations, it is still minimal. “I’d rather attribute the widespread disdain for COVID-19 acceptable behaviour to complacency and ignorance as to the fundamental cause of the third wave,” Mazumdar said.
Will the third wave affect children more
Concerns that more youngsters would develop COVID-19 during the third wave grew after coronavirus cases in the 0-9 and 10-19 age groups increased dramatically during the second wave.
Since then, several government officials and health experts have expressed concern that the third wave may disproportionately harm youngsters. Many others, on the other hand, have dismissed this evaluation as “unfounded assertions.”
“The Indian Academy of Paediatrics has said unequivocally that this variation is unlikely to disproportionately affect children in a third wave scenario. The Union Health Ministry, on the other hand, is taking a cautious approach, especially because such facilities aren’t as reliable as India’s existing adult hospital care facilities,” Mazumdar added.
According to a recent serological survey undertaken by the All India Institute of Medical Sciences (AIIMS), the upcoming wave of COVID-19 is unlikely to disproportionately affect children aged two years and up.
Seroprevalence was discovered in 55.7 per cent of samples obtained from persons aged 2 to 17 years, and in 63.5 per cent of samples collected from adults, according to data gathered by AIIMS between March 15 and June 10, 2021, from over 4,500 participants across four states.
According to the AIIMS study, “there was no statistically significant difference in prevalence between adults and children.” Though child health experts say there’s no need to panic, it’s still a good idea to be prepared, especially given India’s 2-17 age group is still unvaccinated. With that in mind, the Ministry of Health issued a circular on June 5 ordering all hospitals to set aside 20% of their beds for children.
States in India with Delta Plus variant cases
According to the Union Health Ministry, the Delta Plus variant of COVID-19, which is a sub-lineage of the highly transmissible Delta variant that was a major contributor to the second wave of infections that peaked in April-May, has been detected in 48 samples from ten states out of 45,000 samples sequenced so far in the country. Maharashtra has the most examples of this variation, with 20, followed by Tamil Nadu (9), Madhya Pradesh (8), Kerala (3), and two each from Punjab and Gujarat.
In India, four people have died as a result of this new variant. Tamil Nadu is a state in India. According to the state health department, the Delta Plus form caused the first death on Saturday, with a person from Madurai succumbing to it. The death of an 80-year-old woman in the Ratnagiri area on Friday marked Maharashtra’s first mortality from the Delta Plus variety. So far, two similar deaths have been documented in Madhya Pradesh.
“Of the 48 instances of Delta Plus in ten states, Maharashtra had 20, followed by Tamil Nadu (9), and Madhya Pradesh (7),” said Dr Sujeet Kumar Singh, Director, National Centre for Disease Control (NCDC). He did clarify, however, that there was no proof at the time that the Delta Plus variation was much more harmful than the Delt variant.
The Delta Plus version of the coronavirus, also known as B.1.617.2.1, was classified as a Variant of Concern (VOC) by the Health Ministry, and states were ordered to adopt rapid containment measures in clusters where it had been found. There are concerns that Delta Plus would cause another wave of illnesses in India, which has only recently recovered from the world’s worst outbreak.
The classification came after the centre was informed by INSACOG, a consortium of 28 Health Ministry laboratories involved in genome sequencing, that the Delta Plus variant has three concerning characteristics: increased transmissibility, stronger binding in lung cell receptors, and a potential reduction in monoclonal antibody response.
Status of Indian States affected with Delta Plus variant cases so far
Tamil Nadu
Tamil Nadu has documented nine such occurrences, with the first death being on June 30, 2021, when a person from Madurai succumbed to it. Minister for Medical and Family Welfare, Ma Subramanian stated that “There are 14 centres in India that identify Delta Plus variants, and all of them are under the federal government; they are being carried out following ICMR recommendations. To conduct those tests in our state, we need specific permissions. We’ve begun the process of obtaining those permits, and we intend to open a testing centre in Chennai. This is being done to eliminate delays in receiving results, and it will cost approximately two crore rupees. We’ve found a handful of locations, and we’ll be able to open the centre in Chennai in another 20-25 days.”
Maharashtra
Twenty COVID instances of the Delta Plus-type have been reported in Maharashtra, with one death. On Friday, Maharashtra, which has 20 instances of the Delta Plus type, reported its first death. On June 13, an 80-year-old woman died in Ratnagiri district, officials said. On June 20, they received formal notification that she was afflicted with the Delta Plus variety. Ozarkhol in Sangameshwar taluka, where she lived, was declared a containment zone earlier this week, more than 20 days after she tested positive. Only after it was discovered that she had the Delta Plus variant did contact tracing begin.
“We started taking containment measures as soon as we found out she was infected with the Delta Plus variant,” a district official said.
The state government stated in a statement that the Delta Plus version has become a source of concern (VOC). As a result, regardless of weekly positive rate or oxygen bed occupancy, all administrative units will be subjected to a minimum of level 3 restrictions, it stated.
Haryana
2 Delta Plus cases in Punjab and 1 in Haryana have been reported. According to genome sequencing results from the Indian SARS-CoV2-Genomics Consortium, the Delta Plus variation has been detected in two COVID samples from Punjab and one from Haryana, according to the Ministry of Health and Family Welfare (MoH & FW) (INSACOG).
Both states have been ordered by the Union ministry to begin rapid containment measures, including “preventing gatherings” and “intermingling of persons.”
Gujarat
Gujarat had two Delta Plus cases, both of which were successfully recovered. The Gujarat government announced that no new Delta Plus variant coronavirus infections had been discovered in the state and that the two patients who had been infected with the variant in April had recovered. “The Delta Plus variation was detected in two people in April,” said Manoj Aggarwal, Additional Chief Secretary, Health, in a press conference in Gandhinagar. One patient was from Surat, while the other was from Vadodara, and they both recovered from the infection.
The official stated that there were no new occurrences of the Delta Plus variation at this time. Aggarwal, on the other hand, stated that the state administration has been put on high alert to deal with the crisis and that testing is being done to discover this variety.
Madhya Pradesh
Eight Delta Plus variant cases have been reported in Madhya Pradesh, with two deaths. Two additional COVID-19 patients were infected with the Delta Plus strain of the virus, bringing the total number of people infected with the variation to eight in Madhya Pradesh, two of whom died.
A 30-year-old guy from Bhopal was one of the instances discovered. “I only had a minor fever,” he told The Indian Express. Because my entire family, including my parents, wife, and two children, had suffered symptoms and recovered in home isolation, I was immediately examined and admitted. I was placed in home quarantine for ten days after being released from the hospital. I only discovered today that I was positive for the Delta Plus variant. The COVID-19 vaccine had not been administered to the man.
Kerala
In two Kerala districts, three occurrences of the Delta Plus variation were discovered in samples. Officials said that samples gathered from two Kerala districts, Palakkad and Pathanamthitta, revealed at least three instances of the SARS-CoV-2 Delta Plus variant. A four-year-old youngster from the district’s Kadapra panchayat was detected infected with the novel Delta-plus type, according to Pathanamthitta district collector Dr Narasimhugari T L Reddy.
Karnataka
In Karnataka, Mysore reported the first instance of the Delta Plus form of COVID-19. According to Health Minister K Sudhakar, Mysore has reported the first incidence of the Delta Plus strain of COVID-19 in Karnataka. The infected person is asymptomatic, and none of his contacts has contracted the virus.
“In Mysuru, we have isolated one patient who is infected with the Delta Plus form, but he is asymptomatic, and none of his primary or secondary contacts is afflicted. Sudhakar told reporters, “That’s a fantastic sign.”
Conclusion
If we talk about whether India is prepared for the fight against Delta Plus variant and the third wave, the Centre has not yet published any changes to its health advice, but it has asked all states and Union Territories to follow COVID-19 appropriate behaviour and increase efforts to closely monitor the Delta Plus strain.
Prime Minister Narendra Modi has asked that data on COVID-19 transmission among children and youth be collected by district magistrates and field officers in ten states for further research.
The states have also implemented the sentinel surveillance system, in which 15 samples of COVID-positive people are routinely sent to designated regional genome sequencing laboratories (RGSLs) by five laboratories and five tertiary care hospitals identified as sentinel sites at the request of the Union Health Ministry.
A study will also be conducted by the ICMR and the National Institute of Virology (NIV) in Pune to determine the potency of the ‘Delta Plus’ variation.
Apart from that, if the third wave occurs, the Delhi government plans to send a special task force to protect youngsters. In preparation for the third wave, Chief Minister Arvind Kejriwal has pushed for the establishment of appropriate beds, the provision of liquid medical oxygen, and the provision of vital medicines.
In Karnataka, identical paediatric COVID-19 care centres, as well as orphan rehabilitation centres, would be established in all districts.
The Brihanmumbai Municipal Corporation (BMC), Mumbai’s civic government, is also establishing paediatric COVID-19 care facilities, as well as a crèche network for children whose parents have COVID-19 and are seeking treatment in a hospital. The Maharashtra government is working on a dashboard that would provide real-time updates on COVID-19 patients, as well as bed and oxygen availability. The state’s oxygen output is being expanded from 1,200 MT per day to 3,000 MT per day.
Mamata Banerjee, the Chief Minister of West Bengal, has declared a priority vaccination programme for mothers of children under the age of 12. She’s also striving to improve the state’s health system in anticipation of a third wave. It is planned to open 1,300 paediatric intensive care units (ICUs) and 350 sick neonatal care units (SNCUs) for the purpose. In addition, 10,000 general beds for paediatric and female patients will be added to all government-run hospitals.
The Tamil Nadu government has begun educating paediatricians about COVID-19 treatment protocols and management in preparation for a probable third wave that would disproportionately affect youngsters. In paediatric wards, infrastructure is also being improved.
References
- https://www.moneycontrol.com/news/trends/health-trends/in-depth-COVID-19-third-wave-will-delta-plus-variant-trigger-it-will-it-affect-children-more-experts-weigh-in-7091081.html
- https://www.moneycontrol.com/news/india/centre-says-coronavirus-delta-plus-variant-its-lineages-are-of-concern-7076391.html
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