COVID-19 cases rise in India. But here's why no one needs a booster shot just yet

The Print

6 days ago

As of 26 May, India had 1,010 active COVID-19 cases—up by 753 compared to last week, when active cases stood at 257, according to statistics provided by the health ministry.
However, the minor spurt in cases, epidemiologically and clinically, is not significant, say most experts, including those guiding government health policies. There is no need for booster shots against the virus for any population group so far, they say.
New Delhi: COVID-19 cases in India have spiked over the last few days, with SARS-CoV-2 Omicron sub-lineages, which appear highly transmissible, driving the trend. Asian countries, such as Singapore, Thailand, and China, among others, are also seeing an uptick in cases.
In one week, the country has also recorded six COVID-19 deaths, with further reconciliation of mortality figures ongoing in states like Kerala.
The government has not yet shared any data on patients hospitalised with COVID-19, but it has stated that most cases are mild, requiring only home-based care. Kerala, Tamil Nadu, Maharashtra, and Karnataka have reported most of the new cases, according to the government.
The Centre has maintained that its pan-India system for surveillance of respiratory illnesses has, so far, not flagged any signs worth worrying about. This surveillance also includes the pan-India respiratory virus sentinel surveillance network under the Integrated Disease Surveillance Programme (IDSP) and the Indian Council of Medical Research (ICMR).
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Only Omicron sub-lineages in circulation
The genomic sequencing carried out in the western and southern states to identify virus strains in circulation has found all Omicron sub-variants. Besides LF.7, XFG, and JN.1, Omicron sub-lineage NB.1.8.1 has also cropped up in a few cases.
'All these variants are not causing severe disease in other countries, according to the World Health Organisation (WHO) database,' said ICMR Director-General Dr Rajiv Bahl, sharing a statement by the ministry, in an interview with a government-run news channel.
In India, most reported cases are also mild, involving the upper respiratory tract only and showing severe symptoms only in a few who have a history of several pre-existing comorbidities, Bahl added.
Omicron, the SARS-CoV-2 virus strain that triggered the last significant COVID-19 wave between late 2021 and early 2022, though more transmissible than the Delta strain, the lineage that caused an earlier devastating phase, was known to cause mild disease in most infected persons.
Public health specialists and clinicians who ThePrint spoke to underlined that since 2022, there have only been various Omicron sub-lineages in circulation, and no virus strain has, since then, been called a 'Variant of Concern' or 'VoC'—a possible warning sign—by the WHO.
Senior biologist Dr Anurag Agrawal, associated with Ashoka University, said that at this point, specific Omicron lineages do not matter much since they are clinically very similar.
'That is why there is no new name. The genomic lineage names are just for surveillance so we can track spread,' he said.
Even though the COVID-19 pandemic is over, the virus is now a part of the community, experts maintain.
'And like other respiratory viruses, it will keep causing seasonal spikes due to mutation,' said public health expert Dr Chandrakant Lahariya.
'In the case of SARS-CoV-2, the seasonality, however, has not been established yet, unlike for other influenza viruses, and hence, we are seeing an erratic and somewhat unpredictable spike in cases every few months,' he stressed.
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Arsenal of vaccines, none against current strains
As of now, most people with COVID-19 are reporting mild symptoms involving the upper respiratory tract. Some patients are experiencing abdominal pain or diarrhoea along with fever—symptoms similar to the common flu, said Dr Ujjwal Parakh, a senior consultant of chest medicine at Sir Gangaram Hospital in the Capital.
Experts say that considering the likelihood of previous infections with related variants, some level of partial immunity naturally conferred or induced by vaccines—particularly more recently—will likely protect most of the previously infected.
Most of the population in India—nearly 1 billion—remain covered by two of the most-used COVID-19 vaccines, Covishield and Covaxin. Out of them, 22.7 crore had also taken booster or precautionary shots.
In addition, there are five other vaccines approved against the infectious disease, including Sputnik V, Corbevax, Covovax, iNCOVACC and GEMCOVAC-OM.
Yet none of these vaccines work against JN.1, which has been circulating the last year and a half, or other Omicron sub-lineages causing the current cases.
Insisting that there is no need for any population group to receive additional booster doses, Bahl said, if required, India could quickly develop and produce an effective vaccine.
'In my understanding, there is no need for it (booster dose) at this time … we have developed and made many types of vaccines, and we have made them on many platforms,' said the ICMR DG.
'If God wants us to use a vaccine in the future, India can make that vaccine, and we can make it fast,' he said.
Since most symptoms in patients are mild, with vaccination guidelines against the variants in circulation currently kept fluid, there are no clear indications for the need to administer booster doses to the general population, Parakh said.
Some patients with immunocompromised states or comorbidities, however, might be considered for a booster dose, but the current guidelines do not mandate it, he pointed out.
Lahariya said that most COVID-19 vaccines protect from disease severity, not the infection itself. As such, there is no benefit from additional boosters for anyone, he said, explaining that any respiratory virus is capable of causing disease in those with compromised immunity. They could instead benefit from the common flu vaccine, which ensures the body does not have to fight multiple infections in cases where several viruses infect such patients simultaneously.
Gautam Menon, professor of biology and physics at Ashoka University, said that older adults, like before, should be more careful and wear masks, and that would be a good idea if, at any time, cases rise steeply. Such precautionary measures might be more workable than new vaccines for the moment, he said.
But some, such as the small fraction of cancer patients on chemotherapy post-transplant, might benefit from the recent, updated boosters, Agrawal opined. As specific COVID-19 vaccines for this small group are unavailable, Agrawal called for their procurement from other countries. He said that though India could make such a vaccine, the demand remains too low for such a project.
(Edited by Madhurita Goswami)
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