Former Chief Scientist of World Health Organisation (WHO) and chairperson of MSSRF, Chennai, Soumya Swaminathan says
On the present surge:
The current surge is caused by the XBB series of Omicron lineages with new mutations that have advantages in transmission ability. The concern is that every time infections go up, there is a chance of more people falling sick and some of them needing hospitalisation or dying of severe infection. There may also be some waning of antibody responses a year after the last vaccine dose which could be fuelling this rise; however, we believe that T cell-mediated immunity that protects against severe disease is longer lasting.
The new XBB lineages have some new mutations that allow antibody evasion and better binding to receptors, especially in the upper respiratory tract. There does not seem to be any data indicating increased clinical severity.
What the State should focus on:
All States should ensure that the health system has enough resilience to be able to cope with an increase in hospitalisations due to severe lower respiratory infection or pneumonia (due to a number of different viruses circulating now), without affecting routine care and essential services. Diagnostic services should be made widely available through government clinics and data on hospitalisations due to influenza-like illness and severe acute respiratory infection regularly analysed and reported.
Daily numbers being reported are currently under-estimates as a lot of testing is happening in homes with no reporting. A subset of samples should be sequenced to keep track of virus evolution — this genomic data needs to be correlated with clinical and epidemiological trends. Communication to the public is key — when people should test, where they can go, what precautions to use, what drugs to take or not to take. There is a lot of misuse and overuse of antibiotics. Hopefully, we will not see the misuse of corticosteroids we saw last time, especially in the private sector and by self-prescribing.
Recommendation on vaccination:
A third dose is advised for all who have received a primary course, but especially for people over 60 years, with underlying co-morbidities or immunosuppression.
Advisory for the public
We now know what can protect us — masking, hand and respiratory hygiene, being vaccinated, controlling underlying blood pressure, sugar and staying home if sick so you do not spread the infection to others. Attention must be paid to ventilation, especially in offices, educational institutions and other crowded places. Outdoor meetings are preferable to indoor, especially when there is a surge. These precautions will reduce the risk of all respiratory infections, not just COVID-19.