Covid has made a comeback again this winter. The identification of a novel coronavirus variant, JN.1, has raised alarms among medical professionals, experts, authorities, and the general public worldwide. The World Health Organization has designated it a “variant of interest,” though it emphasizes that, based on current evidence, the public health risk is considered low.
This subvariant of Covid-19, descended from BA.2.86, has contributed to a spike in India’s active caseload. On Tuesday, India recorded 142 fresh cases of Covid-19, leading to an increase in the active caseload to 1,970, as per data from the Union Health Ministry.
The data from the Health Ministry indicated six deaths until Monday, with five reported in Kerala and one in Uttar Pradesh. However, the death toll has now risen to seven following a new Covid-19 fatality reported in Karnataka on Tuesday.
Health on Air (HoA) spoke with a diverse panel of experts to assess the implications of the new variant. While some experts advocate against panic, there is a consensus that proactive preparedness is crucial to prevent the situation from escalating into a full-blown public health crisis, particularly given the strain on already overloaded hospitals.
The primary goal is to avert hospitalizations among the immunocompromised population- older population, or population with co-morbidities, ensuring the health system remains resilient. Additionally, experts unanimously acknowledge the added burden from seasonal flu and respiratory disorders with symptoms akin to Covid, complicating clinical detection processes.
Excerpts from the interviews with Dr Rajeev Jayadevan, co-chairman, National Indian Medical Association Covid Task Force, Professor GC Khilnani, India’s leading pulmonologist and Dr Nikhil Modi, Senior Consultant, Respiratory and Critical Care Medicine, Apollo Hospital.
Q: The World Health Organization has classified this strain as a “variant of interest.” What does that mean?
Dr Rajeev Jayadevan
Dr Jayadevan: Designating it a “variant of interest” indicates that it needs close monitoring. Similar to a cricket match, continuous risk assessment is essential to understand the evolving situation. Recent data, such as a sudden increase in positive test rates, necessitates ongoing evaluation of data at multiple levels, and cautious decision-making.
Q: How does the new variant differ from and spread compared to older variants? And how seriously do we need to take it?
Dr Jayadevan: The new variant, JN.1, is not as individually dangerous as the Delta variant. However, the assessment of danger differs when considering the impact on the community. Viewing the risk at an individual level might seem fine, but the community consists of individuals with various underlying risk factors and age groups. For vulnerable individuals, an unrestricted spread of this variant can destabilize and lead to hospitalization, incurring significant health and economic consequences.
Professor GC Khilnani
Prof Khilnani: This variant is a sub-lineage of the Omicron virus. It was first detected in September of this year in the United States and has subsequently spread to several countries. Singapore has reported 56,000 cases, and in France and the U.S., 15 to 29 percent of cases are attributed to the JN1 virus.
This virus has the advantage of evading pre-existing immunity, meaning that even if you are vaccinated or have had a previous infection, there is still a risk of infection. Thankfully, it typically results in mild illness, resembling influenza-like symptoms, and rarely leads to severe outcomes. In summary, there is no cause for panic.
Dr Nikhil Modi: New variants are expected due to the evolving nature of coronaviruses and changes in genetic material. The current concern arises from a sudden rise in cases, indicating potential faster spread compared to older variants. Fortunately, serious complications have not been observed yet, but vigilance is necessary.
Prof Khilnani: Even though it spreads quickly, it causes mild illness. The vulnerable population must be wary. However, there’s no need for panic because, as observed, there seems to be a level of panic in the community and the entire country that COVID is making a comeback. Caution is essential to prevent excessive spread, but panic is unnecessary.
Dr Nikhil Modi: Preliminary data suggests that the JN1 variant may spread faster, though the number of cases hasn’t reached significant levels. The observed increased spread could be attributed to a decrease in precautionary measures, such as mask-wearing and sanitization, contributing to faster flu transmission, a lesson learned from the earlier stages of COVID.
Do we need to go back to COVID protocols?
Prof Khilnani: While COVID protocols from the pandemic era may not be universally required, individuals aged 60 to 70 and those with underlying health conditions, who are at higher risk of severe illness even with the JN1 virus, should exercise caution. Adhering to COVID-appropriate measures, including hand hygiene, mask usage, and avoiding crowded areas, is advisable for this vulnerable group. Other individuals can proceed with normalcy.
When discussing the increased risk of hospitalization and the potential burden on hospitals, are we primarily referring to the vulnerable age group?
Dr Jayadevan: Yes, the immediate risk pertains primarily to the vulnerable age group. Healthy individuals, regardless of age, often manage at home. However, this poses a secondary issue as a large number of people being off work can result in decreased productivity. Additionally, long-term consequences like long Covid need consideration. Repeated Covid infections, even if mild, may increase the risk of cardiovascular complications in the long term due to its effect on the endothelium of blood vessels.
Dr Nikhil Modi: The government has issued advisories, officially recommending the resumption of precautions. This includes wearing masks to curb the potential spread of the JN1 variant, especially as complacency has set in.
Q: In your clinical practice, have you observed a heightened number of influenza cases? How does one differentiate Covid from general flu?
Prof Khilnani: In our practice in Delhi, the number of respiratory cases, including influenza-like illness, asthma, and Chronic obstructive pulmonary disease (COPD) cases, has increased in the last month, mainly due to air pollution rather than COVID. It’s challenging to clinically differentiate between COVID and pollution-related symptoms, but COVID patients may exhibit higher fever and body aches.
Dr Nikhil Modi: Symptoms from the new variant include sore throat, dry cough, runny nose, body aches, fever, and headache, resembling those of a regular flu. It’s challenging to differentiate between the two solely based on symptoms. Persistence of symptoms, particularly a cough with high fever, may signal a need for medical consultation.
Q: Does vaccination protect against this new variant? What about people who are doubly vaccinated or have taken booster shots?
Dr Jayadevan: India is well-vaccinated. Although based on the older version of the virus, these vaccines provide long-term immune memory, covering the basic structure of the virus. Although some antigenic targets are changing, the immune system as a whole, consisting of various components beyond antibodies, still offers protection against severe disease. Unfortunately the continuing mutations enable the virus to evade previously made antibodies especially when levels drop over time. Thus the virus can infect individuals again and again.
Prof Khilnani: Vaccination prevents infection to a certain extent, reducing the severity during COVID time. The same holds for this virus. The JN1 virus, with a mutation in the spike protein, can escape immunity. While vaccination may not fully protect against infection, it is believed to reduce the severity. There is no need for revaccination in India.
Q: Does the new variant affect children, and is there any data available?
Prof Khilnani: The new variant affects all age groups. Regarding clinical tests, the currently commercially available RT-PCR and home tests can confirm whether it’s COVID or not, but they do not provide information about the specific sub-variant.
Q: Now the strain has spread to several countries across the world. Do we need travel restrictions?
Prof Khilnani: No, they never work.
Dr Jayadevan: Travel advisories have been proven ineffective and are not scientifically sound. The focus should be on comprehensive planning, preparedness, and ongoing risk assessment.
Q: What should be the government’s policy response to this new variant?
Dr Jayadevan: Early action and preparedness are crucial. Preparations include, for instance, ensuring an adequate supply of oxygen, standby ventilators, and personnel for potential hospital surges. Clear guidelines for individuals at home, monitoring systems, and plans for changing health statuses are essential. A balanced approach and clear communication, avoiding panic, is vital in dealing with the evolving situation.
