New Delhi: Is the Omicron sub-variant BF.7, which is causing the current COVID-19 surge in China spreading faster in India than earlier variants, as the officially-driven hype on television channels suggests? And if it is, how long has it been prevalent? And why is it that the Union health ministry’s alerts have only come now?
A study of the trends shows that some Omicron sub-variants, as they wane, are constantly being replaced by others across India – as has been the case with the rest of the world.
Take the case of BF.7, an Omicron sub-variant, which is the subject of the current panic in India. Two cases of this sub-variant were found in the country on June 23 and September 16 this year, both in Gujarat.
This is as per data from covSPECTRUM, a private genome sequencing monitoring website, which, in turn, has sourced sequencing data from GISAID – a global science initiative that provides open access to genomic data of influenza viruses. Now, it is where all countries share genomic data of novel coronavirus also.
A third case has been reported from Odisha. The sub-variant’s movement currently shows a flat graph for India as compared to Europe and the United States – where the virus was on the run but is now waning. All three cases didn’t require hospitalisation and were treated. While such comparisons need to be caveated – the number of tests being conducted and the number of positive tests being sent for genome sequencing are key factors – the official record shows only three sequences belong to the BF.7 sub-variant in India.
BA.2.75, which is another sub-variant of Omicron– the variant which was found in a large proportion of positive samples – made headlines earlier this year in India. The current estimated number of cases belonging to this sub-variant in India is zero, according to covSPECTRUM. Its infections peaked in August this year with a total of 1,2130 cases till now.
The currently dominant sub-variant in India, XBB, is also showing declining trends. As per data available on covSpectrum, its infections peaked in August this year. The WHO said in its October assessment about XBB thus: “There has been a broad increase in the prevalence of XBB* in regional genomic surveillance, but it has not yet been consistently associated with an increase in new infections. While further studies are needed, the current data do not suggest there are substantial differences in disease severity for XBB* infections.”
Of course, all assessments about the proportion of these sequences can be limited due to two key factors – extremely limited testing and genome sequencing – in India.
Incidentally, Maharashtra’s state coordinator for COVID- 19 genome sequencing, Rajesh Karyakarte, says, “Because BA.2.75 was already present in India when the BF.7 sub-variant [current cause of panic] was detected [here], it did not cause a surge. That is because the former has a high survival rate and is fitter for survival in India.”
“In other words, the B.2.75 sub-variant of Omicron was in direct competition with the currently in the new sub variant, BF.7. If this sub variant was so potent (BF.7), it wouldn’t have allowed XBB and BA.2.75 to predominate. The chances are that it won’t allow it now either,” he added
So what does this all mean for the public? It’s clear that despite the many sub-variants of Omicron prevailing at different periods of the year, there has been no major uptick in terms of hospitalisation or a requirement for oxygen as was the case during the Delta variant.
In other words, some of the Omicron sub-variants, for the most part, appear to have run their course in India and been replaced by a few others. Why the government decided to issue an advisory for BF.7 alone is not clear except for a surge being witnessed in China where levels of both natural immunity and vaccination rates are low – unlike India.
The Union government, to borrow a phrase from a certain TV commentary, is in “action mode” now. Visibly enough – health minister Mansukh Mandaviya has chaired a series of meetings. The Union health secretary has sent a letter to state governments to up genome sequencing. Other ministers, including the civil aviation minister, are also holding meetings. The apparent cause is single – BF.7
But where does BF.7 reflect in the weekly bulletins that India’s apex network for genome sequencing, Indian SARS-CoV-2 Consortium on Genomic (INSACOG), which functions under the Union government’s department of biotechnology, releases?
The INSACOG, keeping with its past trend of being erratic with information, has not issued a bulletin after September 12. Nowhere. The bulletin was meant to give weekly updates on which variant or a sub-variant was dominant in the country at a given time.
Not a single bulletin talks about BF.7. To make things clear, BF.7 was indeed found in four samples from June-November but it did not make it to the bulletins of INSACOG.
So why the sudden uptick in interest now with the Prime Minister chairing a meeting on the subject and the health ministry advising that people follow COVID norms and also issuing an international travel advisory on December 22?
Interestingly, BF.7 – the sub-variant which is the subject of Indian government official concern now – made its first known appearance in India in poll-bound Gujarat but did not lead to the kind of advisories now being issued about public gatherings, political rallies and the need for strict adherence to COVID protocols.
This was perhaps because the government knew that Omicron’s various sub-variants had not led to any change in disease dynamics in India in terms of hospitalisation and death. The assumption in the run-up to the elections in Gujarat – the state where BF.7’s sequence was identified – must have been that it too would play out like other Omicron sub-variants. Which of course raises the question of why the Union government has now changed its mind about BF.7.
Congress spokesperson Gurdeep Sappal says, “The scare is being raised now to disrupt the (Bharat Jodo) Yatra… In fact, the new variant was found in Gujarat [earlier] but the Modi government chose to keep it under wraps in view of the Gujarat elections… His government didn’t trace the contacts of the infected patients, didn’t stop inward travel from China, and took no precautionary measures. Rather, the PM himself attended road shows and public rallies.”
Global surge and India
The statements issued by the Union government in the past two days and Indian Medical Association (IMA) say there has been an upsurge in global COVID-19 cases. The World Health Organisation (WHO) issued its global weekly epidemiological update on COVID-19 on December 21, 2022.
“Globally, the number of new weekly cases reported during the week of 12 to 18 December 2022 was similar (+3%) to the previous week, with over 3.7 million new cases reported,” it said about the case trajectory.
“At the regional level, the number of newly reported weekly cases decreased across four of the six WHO regions: the South-East Asia Region (-36%), the African Region (-29%), the Eastern Mediterranean Region (-26%), and the European Region (-16%); while case numbers increased in two WHO regions: the Western Pacific Region (+8%) and the Region of the Americas (+18%),” it added.
The map below, sourced from the WHO latest epidemiological update issued on December 21 clearly shows there has been a very small increase in cases in North America and large parts of Europe, but it has been marked as a “limited change”– less than 10%. Except for South American countries and a couple in Africa, there has been no major surge besides in China.
The disease dynamics of China, as several experts have spoken by now, are different from a majority of the world, including India. In a virtual press conference held on December 21, WHO’s executive director of health emergencies programme, Michael Ryan said.
“The rates of vaccination in China, while on the face of it, are high, they still lag behind in terms of overall coverage, particularly when you look at people over 60, particularly when you look at full vaccination.”
“I think we’re talking protective efficacies [of vaccines available in China] hovering at 50% or less for those two-dose regimes in someone over 60. That’s just not adequate protection in a population as large as the population of China,” he added.
Now contrast this with India’s vaccination rates. According to the Union government’s media note released on Friday, December 23, more than 90% of the Indian population has taken two jabs of the Covid-19 vaccine and 97%, one dose.
Another key difference between China and India, or for that matter, a large part of the world population is the rates of natural infection. China kept its people locked for a very long period of time which didn’t expose them to viruses and acquire natural immunity. India, and many other countries, have had a very large chunk of people infected in Delta and even Omicron waves.
In the said press briefing, the WHO was asked if there were chances of spill-over of infections from China to India. Ryan said since more than 500 sub-variants of Omicron – which itself had the capacity to transmit faster than previous variants – will continue to spread and cause surges.
“The question is the impact and we have seen a decline in the impact of COVID-19 over the last year for sure because we have population-level immunity that is increasing,” he added, asking countries to increase their vaccination rates, where it stands low.
BF.7 has been reported in other countries also. According to this piece published in The Conversation, BF.7 has remained stable almost everywhere it evolved, except in China.
“For example, in the US, it was estimated to account for 5.7% of infections up to December 10, down from 6.6% the week prior,” the piece said. Even the UK health security agency said in its November 25 technical briefing that the monitoring of the new form of Omicron has been de-escalated due to “reduced incidence and low growth rate.”
According to Outbreak.info, another independent tracker of genome sequences and which sources data from GISAID, BF.7 has been reported in 91 countries already. It hasn’t resulted in any major wave overwhelming hospitals causing any substantial alarm, again, except China. The US called the surge in China a global concern “given China’s GDP, given the size of China’s economy.”
The US also warned that currently, raging infections in China can give rise to more mutations, and hence a new variant also. There is hardly any contradiction in this statement because the more the transmission, the higher the chances of the appearance of a new form of Omicron or another variant.
The virus will keep mutating and evolving. Because that is the only way it can survive against the pressure created by natural and vaccine-acquired immunity. But the key question is about the impact – something Ryan spoke about, in the presser.
The case trajectory in India, meanwhile, remains stable. India has been registering between 150-200 new cases for the past 30 days. It last touched the 500 mark in November and 1,000 in October. A rising number of cases in a neighbouring country is a cause of concern and also a renewed cause to adhere to COVID-appropriate behaviour, sans panic.