27-05-2025
JN.1 is more contagious than previous variants but there's no need for school closures or WFH
Byline: Mini Thomas
A sudden surge of Covid-19 cases across India has prompted various states to strengthen their monitoring systems. While most new cases are owing to Omicron sub-variant JN.1, other strains such as NB 1.8.1 and LF.7 are also under observation.
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Dr T Jacob John, an expert in virology, vaccines, and public health, talks to Mini Thomas about the factors that might be driving the current spike, and whether vulnerable groups should get a booster shot
When exactly did the current outbreak begin in India?
It's difficult to pinpoint at that owing to lack of testing. The current attention to Covid stems from testing initiatives in Hong Kong and Singapore. India initiated testing after a substantial increase in Covid cases that were reported internationally.
In India, many may have got infected in the last one month and a lot of them would have mistaken it for the common cold. One way to distinguish between both is that while common cold usually manifests as nasal discharge, Covid typically presents with a dry cough.
What would you attribute the spike in cases to? Does it indicate waning immunity from vaccines and seasonal factors?
The pandemic ended in 2022 after the Omicron wave.
Thereafter, SARS-CoV-2 is endemic globally, just like the H1N1 swine flu infection. Fortunately, the Omicron version alone has survived as endemic, not the Delta variant of 2021. Endemic respiratory diseases tend to show fluctuations in incidence, like endemic flu which shows up as seasonal flu. We haven't observed the post pandemic scene long enough to learn about seasonal factors.
Upsurges are surely due to new birth cohorts without immunity joining the population, as well as waning immunity in those previously infected or vaccinated.
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What makes JN.1 so contagious? What about its mutations?
The reason why Omicron first became an epidemic and then endemic, replacing all earlier variants, is because it's more easily transmitted. Same goes for JN.1, which became the only surviving variant among all Omicron strains. It's more contagious than previous variants because it affects the upper respiratory tract (nose, throat). Oral secretions that come out as droplets contain a good viral load, further spreading the infection.
When more of the virus comes out in aerosols (tiny solid particles and droplets in the air), more people get infected. As for JN.1 mutations, their genes vary a bit but properties are the same. It's basically the same virus.
Schools are reopening after the summer break but parents are worried about sending their wards amid Covid concerns. Should schools be shut?
Certainly not. No purpose is served by school closures. There's no evidence that schools amplify coronavirus infections.
Besides, schoolchildren are not any more vulnerable to the infection than others. Even corporates don't need to allow their employees to work from home. There's a surge in cases no doubt, but it's not an epidemic. There is no serious morbidity or significant mortality yet. While there's no need for social distancing, vulnerable individuals should continue wearing masks in crowded places.
People can attend social events freely but must maintain proper hand hygiene practices.
What other safety protocols would you suggest?
A booster dose of the Covid vaccine is a good idea for those who are at high risk. There is a JN.1 specific mRNA vaccine available in India and physicians must consider its use in people under immunosuppression. Injected adenovirus vector-based vaccines are no longer permitted. Masking is certainly recommended as long as the infection is on the rise. No vulnerable person must mingle in crowds when there is a seasonal outbreak of Omicron or flu.
Which are the groups at higher risk for serious symptoms?
The elderly (those above 65-70), those with chronic lung disease, and cancer, people undergoing post-organ transplant and immunosuppressive therapies, those with uncontrolled diabetes, high blood pressure and its complications, chronic liver or kidney diseases and so on may have severe disease both with flu and with SARS-CoV-2 infection.
How long will the outbreak last? Is India prepared to manage it?
India can manage even large epidemics.
The current outbreak will not become one. Only a few states are going to face significant challenges. Hopefully, it will die out in a couple of months.
What does our healthcare system still lack?
Had there been a systematic approach of diagnosis before treatment, this outbreak could have been detected a month earlier. In India, healthcare providers often prescribe antibiotics without proper testing for diseases, including viral infections where antibiotics are ineffective.
It ultimately leads to increased healthcare expenses. Poor coordination between public and private healthcare sectors remains a significant challenge.
Both central and state governments should have official periodic bulletins published with authentic data.
Will Covid ever be eradicated? Do we need better vaccines?
Covid-19, even in its Omicron version, is not eradicable, just like influenza. But Omicron did eradicate the Delta variant. Better vaccines are always a good idea but once the pandemic is over, vaccines will not be widely used.
