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In the state of Maharashtra, one of the first places affected by the devastating second wave of Covid-19 in India earlier this year, scientists are eagerly looking for signs of a third.
New labs in the financial capital, Mumbai, and the city of Pune are looking for dangerous new variants. They have stepped up testing, to more than 3,600 samples per month, up from 134 in December last year, as they look for mutations that could make the virus even harder to stop.
India is still a long way from its goal of increasing genome sequencing nationwide. As Covid-19 cases and deaths have plunged, official figures show the virus continues to spread in parts of the country. Low vaccination rates and other factors have made India particularly vulnerable to variants like Delta, the strain that helped fuel India’s second wave last spring.
“We have to follow new variants to prepare for the next wave, because the waves will continue to occur, much like the flu or the common cold, which continue to reproduce because the virus mutates or recombines,” said the Dr Vinod Scaria, Principal Scientist at the Institute of Genomics and Integrative Biology in New Delhi. “You can’t really prevent this. But you can still prepare for it.
The second wave, which exploded across the country in April and May, revealed both the increased communicability of the Delta variant and India’s inability to cope. Official figures show around 430,000 people have died since the virus struck early last year, although the figures are widely regarded as unreliable and experts say the true toll could run into the millions. . The second wave pushed the country’s medical system beyond its limits and sparked anger over the government’s inability to deal with the crisis.
For now, the disaster seems to have ebbed. India’s daily official case count has fallen to around 40,000 from more than 300,000 at the height of the crisis. Hardest-hit urban centers like New Delhi, Mumbai and Pune have seen dramatic declines in the number of cases. Covid-19 services in many large cities have emptied.
Some hope that the sheer contagiousness of the Delta variant means that many people have already caught it and have developed a protective measure. A recent investigation by the Indian Council of Medical Research, a government agency that funds and evaluates studies, found that two-thirds of blood samples studied contained anti-coronavirus antibodies, up from around a quarter in December and January. In some states, up to three-quarters of the samples examined contained antibodies.
But scientists have warned that the survey, with a small sample size of 36,000, should not be taken as an indication that India is out of the woods. Such tests can be prone to false positives. Also, the survey does not represent all areas, said Giridhara Babu, professor of epidemiology at the government-affiliated Public Health Foundation of India, although it may help Indian authorities better target testing areas. and vaccination.
Even if the figures are correct, they suggest that 400 million people in India remain vulnerable to Covid-19.
“What is going to happen now is that areas with low serological prevalence and low vaccination will have more cases and more people will be hospitalized and higher deaths,” Dr Babu said, referring to serology. , or antibody tests.
The potential for new variants further complicates the picture. Places like India with low vaccination rates and other risk factors are particularly vulnerable to the new strains.
After a chaotic and slow start, India has stepped up its vaccination campaign, regularly delivering five million doses per day. About half a billion doses have been administered so far and more than 100 million citizens are now fully immunized. Indian medical experts hope the increased vaccinations will help lessen the impact of a third wave, as even a single hit can reduce the severity of the infection.
Yet only 8.5 percent of the population is fully immunized. It remains to be seen whether the country can meet its goal of vaccinating the entire adult population of around 900 million by the end of the year.
Another factor is the low test rates. India now administers an average of about 1.2 tests per thousand people per day, according to the University of Oxford’s Our World in Data project, well above levels at the start of the year. But its rate remains much lower than that of richer countries, for example standing at a little more than half of the level of the United States.
These low test rates make it difficult to map the evolution of the virus. Currently, a large number of positive tests come from southern states like Kerala, which typically perform more tests than in other parts of the country. This state accounts for almost half of the total active cases. Infections in areas with lower test rates would be difficult to detect.
Understanding the state of vaccine and mask mandates in the United States
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- Mask rules. The Centers for Disease Control and Prevention in July recommended that all Americans, regardless of their immunization status, wear masks in indoor public places in areas affected by epidemics, a reversal of guidelines it offered in May. . See where the CDC guidelines would apply and where states have instituted their own mask policies. The battle for masks has become controversial in some states, with some local leaders defying state bans.
- Vaccination rules. . . and bfactories. Private companies are increasingly imposing coronavirus vaccines on their employees, with different approaches. Such warrants are authorized by law and have been confirmed in court challenges.
- College and universities. More than 400 colleges and universities require students to be vaccinated against Covid-19. Almost all of them are in states that voted for President Biden.
- Schools. On August 11, California announced it would require teachers and staff in public and private schools to be vaccinated or tested regularly, the first state in the country to do so. A survey released in August found that many American parents of school-aged children are opposed to mandatory vaccines for students, but were more in favor of mask mandates for students, teachers and staff who don’t. don’t have their vaccines.
- Hospitals and medical centers. Many hospitals and large healthcare systems are requiring their employees to be vaccinated against Covid-19, citing an increase in the number of cases fueled by the Delta variant and stubbornly low vaccination rates in their communities, even within their hand -work.
- new York. On August 3, Mayor Bill de Blasio of New York announced that proof of vaccination would be required from workers and customers for indoor meals, gyms, shows and other indoor situations, becoming the first city America to require vaccines for a wide range of activities. . Employees of the city’s hospitals must also get vaccinated or undergo weekly tests. Similar rules are in place for New York State employees.
- At the federal level. The Pentagon has announced that it will seek to make coronavirus vaccination mandatory for the nation’s 1.3 million active-duty soldiers “no later than” mid-September. President Biden announced that all federal civilian employees should be vaccinated against the coronavirus or undergo regular testing, social distancing, mask requirements and restrictions on most travel.
Researchers are particularly watching Kerala, which was hit later by the second wave than other parts of the country. Better prepared health infrastructure has reduced the number of deaths. But the virus has circulated so smoothly that it offers an opportunity for mutation.
“It’s a cause for satisfaction, in a way, that the mortality is not high,” said Dr VK Paul, who heads the Indian government’s Covid-19 task force. “But when there is so much virus replication, there are problems – variants can appear, other areas can be infected and the vulnerable population in any part of the country remains susceptible.”
Kerala has increased its early genome sampling, testing around 1,400 per month since December. Proactive genome sequencing has helped Kerala and Maharashtra in recent months identify districts where a variant known as Delta Plus has emerged and respond immediately to contain the spread.
But overall, India’s sampling effort is lagging behind. As part of an initiative organized by the Indian SARS-CoV-2 Genomics Consortium, or Insacog, a group of national laboratories, each state was initially supposed to test 3-5% of samples. Currently, the country samples only about 0.1% of Covid-19 tests.
If a third wave were to emerge, Indian officials say they did not drop a raised guard in the second wave. In New Delhi, which was the epicenter of the second wave, more than 95% of regular Covid beds as well as intensive care unit beds remain available. The state chief minister said 27 oxygen plants had been added and tankers were being procured, to avoid the oxygen shortage of the last wave. In Mumbai, around 85% of regular Covid beds and almost 70% of intensive care beds remain vacant. The number of vacant beds in Pune remains at around 77 percent.
Whether a third wave or other variant emerges will ultimately depend on human behavior, said Dr Scaria, of the Institute of Genomics and Integrative Biology. Testing may find the variant too late, as was the case in Wave 2, when the spread of the Delta variant only became apparent in limited genomic testing nationwide until April. Masks, vaccinations, social distancing and other precautions will be crucial in preventing the emergence of new variants.
“A variant by itself cannot cause a wave, because variants can be addressed if you have the information in advance,” said Dr Scaria. “Human behavior is as important, if not more, in creating a wave. If the right variant reaches the right population, it will create a wave. “
Hari Kumar | contributed report.
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