This time last year, theories about India’s astonishingly low rates of COVID-19 infection included hot weather, natural immunity and the country’s high proportion of young people; some also attributed it to the country’s harsh lockdown. India was doing so well that in megacities like Mumbai and Delhi, officials had begun dismantling temporary COVID-19 facilities. Fast-forward to now, April 2021, and cases and deaths are soaring, leaving hospitals running out of oxygen. The shortage of beds and space is so acute that people are dying in car parks waiting to be admitted. Daily rates are currently over 300,000, the world’s highest-ever daily infection rate.

India isn’t the only country seeing rising cases, with several countries in Europe now seeing spikes in numbers, but these are related largely to the easing of restrictions and increased mobility.

The extraordinary surge in cases had been unexpected given that, by some estimates, as much as 20% of the population were thought to have antibodies to COVID-19, with this figure rising to 50% in large cities (although the researchers acknowledge this could have been an over-estimate). In addition, India started its vaccination drive on 16 January and by the start of April had declared that it had given more than 100 million vaccines in a record 85 days, compared to 89 days for the USA. But this number is a drop in the ocean for a population of 1.4 billion people, and there is a long road ahead.

New variants, new trouble

So, what happened? Several factors seem to have come together in a perfect storm to create one of the worse COVID-19 outbreaks the world has seen so far.

Of great concern is a new ‘double mutant’ B1617 variant, identified in India last year, that is spreading across the country. Although scientists are still investigating whether or not the variant is more deadly, it does contain the L452R mutation that affects the virus' spike protein. This protein is key to the way the virus hooks on to our cells. Early research suggests that this mutation makes the virus more infectious. This doesn’t necessarily mean that the variant will be any more deadly, but it means that more people are at risk.

More worrying is the way that the mutation could change the shape of the spike protein. As most COVID-19 vaccines target this protein, with antibodies being produced to recognise and attack it, any change to the shape could make vaccines less effective.

B1617 carries a second mutation called E484Q, and this also changes the spike protein. Laboratory research suggests that similar mutations are less vulnerable to antibodies, which could again reduce the potency of vaccines. 

Some Indian scientists are now attributing a new anecdotal observation that a single case is leading to entire households becoming infected due to this increased infectiousness.

Relaxing restrictions amid slow vaccine uptake

India isn’t the only country seeing rising cases, with several countries in Europe now seeing spikes in numbers, but these are related largely to the easing of restrictions and increased mobility.

India went from a strict lockdown, that was imposed so suddenly that people from villages were left stranded in cities, to increasingly large crowds gathering for political rallies, religious celebrations, weddings and funerals.

COVID-19 vaccines have been rolled out in India for months now, but initial uptake was sluggish. This seemed in part to be due to hesitancy and the perception that vaccine development was rushed. But it may also relate to a feeling of complacency stemming from the belief that the pandemic was waning in India.

We now need to watch carefully for the India variant to emerge elsewhere. While some countries have banned travel to India, largely because of the B1617 variant, travelers may have already unknowingly carried the new variant on flights out of India. People infected with COVID-19 were found on all 27 outbound flights between India and Canada between 4 and 14 April. While most planes are now grounded in India, it may already be too late to contain a highly transmissible new variant.

TOPICS: Country storiesCOVID-19

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