Keeping Delta plus variant at bay

The Union Health Ministry tagging Delta plus variant of COVID-19 virus mutant as "a variant of concern" has pressed the alarm bells in India of a possible third wave of the pandemic. Union Health Minister Harsh Vardhan has confirmed that the Delta Plus variant has been observed sporadically in Maharashtra, Kerala, and Madhya Pradesh with around 40 cases identified so far with Maharashtra accounting for 21 cases. Higher genome sequencing might reveal more cases. Experts have cautioned that even though the number of the new variant of the virus is few, its distribution in different states over the past two months indicate that it is already present in some states. Aggressive contact tracing along with intensified surveillance besides prioritized vaccination drive in areas reporting the presence of this variant of concern have been advised as part of the containment strategy. While the Central government has advised these three States to strengthen surveillance and public health measures, all other states need to undertake similar measures to prevent its spread. Some experts have claimed that the Delta plus variant is highly infectious, and its spike proteins display strong binding to receptors of lung cells and a reduction in the ability of antibodies to neutralize it.

The devastating second wave in the country is attributed to the Delta variant of the virus and the new variant is one of the sub-lineages. Kerala government has imposed lockdown in three villages where the Delta plus variant has been detected. These villages also reported many cases of Delta variant infections and it has been suspected that mutations into Delta variant might have taken place locally. This finding suggests the possibility of similar mutation of Delta variant into Delta plus variant locally without any travel history. On Wednesday morning the country's active caseload declined to 6,43,194 while the cumulative death toll increased to 3,90,660. Complacency over the declining active caseload and positivity rate may cloud the potential dangers of Delta plus variant cases going undetected and stoking a virulent third wave. Aggressive testing and contact tracing in states, more particularly in areas reporting falling positivity rates and declining active caseloads can help early detection of the presence of the Delta plus variant. Unlocking in the states like Assam must be followed with such aggressive testing part to complement the massive vaccination drive. Assam still has an active caseload of over 30,000 cases and daily news cases continue to be over 2,800 and lowering of the guard may result in sudden surge and overwhelming of the health system. Surveillance at the airport, railway stations, inter-state transport points and routes through aggressive testing may help isolation of Delta plus cases from outside the state. Crowding at public places will be a potential source of the spread of new variant of the virus and hence unlocking needs to be graded and multilevel so that it does not allow the intermingling of people in large number.

It is advisable to keep the educational institutions to remain closed even in districts reporting a significant decline in positivity and high recovery rates. Educational institutions, when fully functional attract a maximum crowd. Besides, vaccines for school children are still in the clinical trial stage and a large number of unvaccinated children are susceptible to COVID-19 infection. Any spread of Delta plus variant among them will have the potential to rapidly spread the virus in the community stoking the third wave. Intensified awareness drive on COVID appropriate behaviour, double mask-wearing and strictly maintaining physical distances in public places along with mass vaccination drive can help prevent reduce the ferocity of the virus infection in the third wave. The Delta plus variant will also put to test the effectiveness of the new vaccine strategy of giving first doses to more people instead of focusing on fully vaccinating people with double doses. It remains to be seen if a single vaccine dose or double doses will provide more protection in the event the Delta plus variant stokes a third wave in the country.

States like Assam will have to keep issuing new Standard Operating Procedure for unlocking and imposing partial lockdown or other containment measures depending on detection of new cases, positivity and recovery rates and availability of hospital beds, human resources. Adopting a uniform response mechanism for the entire state may not be feasible at this stage with different districts witnessing varying degree of infection and improvement. Detection of the new variant of concern tells us to be more careful in places where restrictions are eased. People in charge of vaccination centres have to ensure that mass vaccination drive does not lead to mass crowding. Much will depend on citizens behaving responsibly and voluntarily leaving such centres if the capacity crowd of beneficiaries, that is permissible for maintenance of the mandatory physical distance, has already gathered at a particular vaccination centre. The Delta plus variant must be kept at bay.