Double mutant B.1.617.2 variant driving the second wave of Coronavirus in India

December 2019 marked the beginning of the global COVID-19 pandemic, with its initial cases being diagnosed in Wuhan, China. The virus outbreak began as pneumonia due to an unidentified cause and had soon spread to different countries in Asia, Europe, and the US. On the 30^th of January 2020, the COVID-19 outbreak was declared as a Public Health Emergency of International Concern (PHEIC) by the World Health Organisation (WHO). On 11^th March 2020, WHO announced the coronavirus outbreak as a pandemic.¹ 

COVID-19 is an infectious disease believed to be caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)² belonging to the family of Coronaviruses known to infect mammals, including humans and bats3,4. SARS-CoV-2 is an enveloped positive-sense single-stranded RNA virus known to enter the host cell through its binding to ACE2 receptors. ACE2 receptors are found on the cell membranes of certain human tissues, including those in the respiratory and GI tracts.^5,6 

Progress of the COVID-19 pandemic in India

The first COVID-19 case in India was reported on 30^th January 2020 in the state of Karela; a student who was studying at the Wuhan University had traveled back to India and had tested positive for the virus.7 The virus then began to spread in the towns of Thrissur, Alappuzha, and Kasargod, all in Kerala, from students traveling back to India from Wuhan. By May 2020, India had the largest number of confirmed Coronavirus cases in Asia. To the relief, 10th June onwards, the number of recovered cases in India started exceeding the active cases. By September, infection rates started to drop.10 Mid-September onwards; the infection rates started to increase again, peaking to more than 90,000 confirmed cases daily. The infection rates dropped again to only 15,000 daily cases by January 2021.¹¹ 

India commenced its vaccination program on the 16^th of January 2021 and administered 3-4 million doses a day by April.^12,13 India had authorized the British Oxford–AstraZeneca vaccine, the Indian BBV152 (Covaxin) vaccine, and the Russian Sputnik V vaccine for emergency use. As of 15^th May 2021, around 40,298,750 people have been fully vaccinated, with a total of 181,201,743 doses administered.14,15 Parallel with the nationwide vaccination program, India saw the second and much larger wave of COVID-19 beginning in March 2021. Subsequently, there occurred nationwide shortages of vaccines, hospital beds, oxygen cylinders, and medicines.16 By late April, India had become the first country in the world to report over 400,000 new cases in one day.17,18 As per the data from May 2021, India holds the second-highest number of confirmed cases globally (after the USA), with 25.4 million reported COVID-19 cases and 283,248 deaths.¹² Despite the nationwide mass vaccination program, why has India been terribly hit by the second wave of COVID-19?

The double mutant (Indian) COVID-19 variant and the second Coronavirus wave in India

Multiple factors have been at play in causing a sudden spike in the number of COVID-19 cases during the second Coronavirus wave in India. One of the most suspected reason has been the emerging of the new Coronavirus variant lineage B1.617.2, first identified in Maharashtra, India, during October 2020.19,20 The former has been named as the double mutant variant by the Indian SARS-CoV-2 Consortium on Genomics (INSACOG), a group of 10 national laboratories under India’s health ministry which carried out genomic sequencing on samples collected from western Maharashtra state. A double mutation has been seen in the Coronavirus spike protein, which is believed to potentially increase the virus’s infectivity and its ability to escape the human immune system. 

It is worth mentioning that the virus spike protein (shown in figure.2) is the part of the virus through which it penetrates inside the human cells.²¹ These virus mutations are suspected to result in re-infections in people already recovered from COVID-19, although with milder symptoms compared to primary infection. Hence, this would allow the virus to penetrate the herd immunity and reach the most vulnerable people at higher risk of developing severe disease.²¹ Despite the reports of the virus’s increased infectivity, there is still a lack of enough evidence to conclude the double mutant variant of COVID-19 as the main cause of India’s deadly coronavirus situation. Hence, a significant number of further studies generating more data are needed to confirm these speculations.  

Apart from the virus’s mutated variant, several other factors have significantly contributed to a sudden spike in India’s number of COVID-19 cases. Lack of “preparedness” for dealing with the second wave of the virus in dismantling the temporary hospital faculties once the cases began to decline, poor implementation of health and safety precautions during weddings, festivals such as the Holi celebrated on the 29th of March. In April, the Haridwar Kumbh Mela plus poor adherence to COVID-19 standard operating procedures (SOPs) during sports events like the Indian Premier League (IPL) and during the ongoing local elections inside several states have majorly contributed towards the grim numbers23-30. Reports are linking the Haridwar Kumbh Mela to at least 1,700 positive COVID-19 cases in a period of 4 days only, between 10^th-14^th of April.^31,32 

The political rallies being held for local elections have also been massively backlashed for being responsible for the sudden rise in COVID-19 cases inside the country.33-35 To make things worse, vaccination supply issues also started to occur due to the temporary suspension of Oxford-AstraZeneca vaccine export by the UK to help meet their domestic demands. Moreover, vaccine hesitancy and lack of knowledge among poor and rural communities (accounting for about 68.4% of India’s total population) had also burdened the country’s vaccination program, aiding the spread of the deadly virus. 36-38 Hence, the combined effect of the mentioned factors allowed the deadly second wave of COVID-19 to prevail all over India, taking many lives.  

Conclusion

India accounts for being the second largest in Asia concerning its population.39 About 68.4% of India’s population accounts for the rural population, whereas the urban population stands for only 31.1% of India’s total population. Currently, India is recording the highest number of new COVID-19 cases per day, reaching 400,000 new cases every 24 hours. Various factors, including lack of awareness and knowledge regarding the virus itself among rural communities plus the countrywide poor implementation of safety and health precautions, have massively contributed to these grim statistics. Insufficient knowledge and hesitance towards the vaccination program shown by the rural and poor communities have also been a major constraint in overcoming the deadly pandemic.

Moreover, the emergence of the double mutant Indian variant of the coronavirus is also believed to be potentially at play behind the peaking COVID-19 cases due to its increased infectivity and ability to escape the neutralizing antibodies naturally produced human immune system. It is noteworthy that the double mutant coronavirus variant found in India plus the primary Coronavirus itself are novel viruses. There remains a lack of sufficient knowledge to conclude these new virus strains being the primary cause of this pandemic not ending. It is important to note that there have been no reports of the Indian variant of COVID-19 being more lethal or increasing the disease mortality rate. Hence, strict implementation of COVID-19 SOPs and health and safety precautions, plus successfully running countrywide vaccination programs, remain the most effective approach towards fighting the global pandemic.  

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Zoya Zahid Chaudhry

A BSc Human Genetics and MSc Clinical Trials graduate from University College London. An ambitious clinical scientist who is interested in the field of cancer research and keen to promote cancer awareness and improve its therapeutics through her work in the field.

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