‘India’s double mutant could be considered a variant of concern’

The so-called "double mutation" coronavirus found in India can be considered a variant of concern (VOC) because of its significant spread and how some of the mutations are known to behave, India's principal scientific adviser K VijayRaghavan said in an interview on Wednesday.

VijayRaghavan's remarks represent the first time a top government official has said that the variant, since designated the code B.1.617, is a cause for concern after government officials said last month that it was too early to believe the mutation was driving the surge or causing repeat infections.

"It's reasonable to say that the variant (the "double mutation" variant) is of concern because it has been found in a significant number of people. And it's not just because it's been found in a certain number of people but we know that these particular mutations have (also) got physiological effects on our context," he said, while adding that Indian scientists are carrying out further tests to determine exact biological consequences.

The double mutation refers to specific changes, among some others, that are denoted by E484Q (glutamate is replaced by glutamine at the 484th spot of the spike protein) and L452R (substitution of leucine with arginine at the 452nd position). Both these mutations are being investigated for giving the virus the ability to evade immunity from a past infection, even vaccines.

On March 24, the Union health ministry said the variant was found in over 200 samples sent from Maharashtra, which became the first hot spot region during the second nationwide wave that began that month. Till about April 7, Maharashtra alone was accounting for more than half of the new cases being recorded in the country, prompting experts to suspect that the variant may be to blame.

VijayRaghavan added that vaccines are likely to still offer protection from variants of concern. "The vaccines at hand sometimes offer reduced protection to mild and moderate disease but they still afford protection to severe disease," he said.

The official also spoke on the government's recent decision to make it easier for vaccines developed outside to seek authorisation in India as long as they have been approved by certain western countries, Japan or the World Health Organization.

VijayRaghavan said he expects the single dose vaccine by Johnson & Johnson to become available under this route first. "In practice, given global supplies and commitment, we are going to see in India pretty much very soon the Johnson and Johnson vaccine, and the Novavax, when it gets approval elsewhere, coming in," he said, while adding that the mRNA vaccines by Pfizer-BioNTech and Moderna may face difficulties since they are already stretched on supply commitments. J&J's vaccine has already received approvals in several of these regions, although its use is currently under pause in the US while regulators look into blood clots forming in very few individuals who have been injected with the vaccine.

Once any of these additional vaccines arrive, it will give the government more freedom to allow wider groups of people to seek doses, he added, describing as a dilemma the question whether younger people should now be given doses. "The dilemmas are the following: there are people who are older, who are more vulnerable if they get the disease, and people who are younger, who are vaccinated and can go into the workforce, mingle, and not bring back disease to their homes. Ideally, you'd like to vaccinate both groups, but there's obviously, supply and demand challenge," he said.

The principal scientific adviser said he also believes the current wave of infections may begin to ebb in a week or two as benefits from stricter curbs become apparent. "The intense efforts started a couple of weeks ago, so we should start seeing the beginnings of change very soon, and as those efforts continue you'll start seeing the impact further and further," he said.

VijayRaghavan, who headed the National Centre for Biological Sciences in the past, said the current outbreak in India is the result of multiple factors including Covid fatigue (where people tire of restrictions and break them) and economic compulsion for people to move about more freely.

But health care professionals are better prepared to handle the disease now, he explained.

He added that there is now more understanding related to how the virus behaves, what treatments work and what precautions, in particular, could help.

"We actually have now multiple elements in our kit to deal with the virus which we didn't have at the first wave. We are better ramped up on personal protection equipment (PPEs), oxygen, hospital facilities, ventilators and so on... The second change is the potential of the impact of people's behaviour; we know a lot now which we didn't know earlier. We know now how the virus is transmitted: through droplets, through aerosols, and it gets transmitted in closed rooms for example. So, there are measures like masks and distancing that we know will be very effective."ions such as variants of concern of Sars-CoV-2 in circulation."