These statistics hide innumerable stories of despondency and desperation. Take for example Mohammed Nisar, a 60-year-old, who fell ill on April 14. Unable to get a hospital bed in his native Azamgarh, UP, his family drove him to Lucknow. With no luck there, he was driven to Aligarh, where they got him admitted in a small private hospital. He is critical and all his co-passengers have tested positive.
In early February, Sir Jeremy Farrar, an infectious disease expert and director of Wellcome Trust, told me: “There will be another phase/peak in India I am afraid — don’t let people get into a sense it is finished…it is not!” What did he see that I didn’t? Perhaps I was blindsided by false narratives doled out daily. Distance often brings the objectivity that science demands.
The 1918 ‘Spanish’ flu had a mild first wave but returned later in the year to cause havoc. In India there were an estimated 12 to 20 million deaths in the second wave. Bombay, then with a population of 1.1 million, reported about 15,000 deaths just in the month of October 1918. What happened to the flu virus in 1918 is happening to the Covid-19 virus in 2021. It’s called mutation and its normal for a virus.
Every time a virus multiplies, random errors are introduced in its genome. While most errors are deleterious and are never seen, some offer advantage by allowing that variant to multiply faster, transmit better or evade pre-existing immunity. More spread means more hosts, more virus multiplication, more errors and more mutants. This is how viruses evolve and with close to 140 million cases globally, there is enough opportunity. Mutations can also accumulate into lineages and some variants become variants of concern (VOC).
By the end of 2020, India had over 10 million cases but only about 5,000 viruses were sequenced. Such low sequencing density can only catch major variants already circulating in the population. But it is the minor emerging ones that inform what is to come. One such variant was first reported on October 5, 2020, followed by isolated sightings in December and January, before it broke loose in February, around the time when daily cases started rising in India. Maharashtra led the way with about 15% to 20% cases there showing this ‘double mutant’, also called the Indian variant, and now the B.1.617 lineage.
Around the same time other VOCs were also increasingly seen in Indian patients. These include viruses of the UK variant lineage (B.1.1.7), the South Africa variant lineage (B.1.351) and the Brazil variant lineage (P.1). While Punjab is now taken over by the UK variant, Maharashtra is showing increasing presence of the Indian variant, Delhi has the UK and Indian variants, and West Bengal has all the VOCs. All these viruses have acquired mutations that allow them to be more ‘infectious’ and partially evade pre-existing immunity. Not surprisingly then, there are increasing reports of re-infections in those vaccinated.
Would vaccines available in India still work? We know from studies elsewhere that the Oxford/AstraZeneca vaccine (Covishield in India) does well against the UK variant, but poorly against the South Africa and Brazil variants. Covaxin also does well against the UK variant, but has not been tested against the others. The Indian variant has not yet been tested against any vaccine. Since vaccines work by raising antibodies and T cells to multiple targets, they still remain a powerful control strategy.
Pandemics are caused by germs but spread by people. Even in the face of overwhelming evidence, those in denial of the disease and the utility of vaccines are also variants of concern. This attitude prevented high rates of vaccination at a time when the daily cases were low and significant protection could have been achieved. Now it’s an uphill battle.
Those in responsible positions attribute the second wave to people not following “Covid appropriate behaviour”. After a year of false narratives on how Indians are somehow special, for an average person, the private cost of illness is very low. As a result, masks are inconvenient and crowded places cannot be avoided if one is to make a living. The daily scenes of crowded election rallies addressed by the tallest leaders and crowded religious festivals endorsed by them have further diminished this private cost of illness. Together, these human variants of concern are responsible for what awaits us in post-election West Bengal and the rest of India when pilgrims return home.
An election, just like a war, has a victor, but a pandemic has only the vanquished. Their stories will again get buried in the numbers and the lies. Both the viral and human variants of concern will win again.
Shahid Jameel is a virologist, and director, Trivedi School of Biosciences, Ashoka University