Reports from India appear to show the world’s second-largest population is experiencing a significant crisis as both SARS-CoV-2 positive tests and deaths associated with Coronavirus Disease 2019 (COVID-19) have explosively surged over the last 45 days.
Reports across major media outlets have shown concerns of a mutation dubbed the “Indian Variant,” which some speculate is behind the sudden ramp in pandemic severity. The variant, classified as B.1.617, was first identified in October 2020. It is unique compared to the South African, Brazillian, and UK Variants because it possesses two separate spike protein mutations.
The two mutations, L452R and E484Q, have been dubbed “escape mutations” because they may allow the spike protein, which gives a coronavirus both its distinct crown-like shape and its ability to enter and infect human cells, to easily evade antibodies either created in response to experimental mRNA and adenovirus vector vaccines, which use gene therapy to instruct the human body’s functions to synthesize the original SARS-CoV-2 spike protein, or inactivated virus vaccines that are using the original pathogen.
The Communist China-friendly World Health Organization has classified B.1.167 as a “variant of interest” on suspicion it may be either more deadly, more contagious, or both.
Parabolic third wave statistics
According to data from Google, citing the John Hopkins University (JHU) repository, India’s COVID-19 positive tests (“cases”) 7-day moving average has gone parabolic. On March 10, the curve was at 18,377 cases and has since increased daily, peaking at 321,623 on April 23.
Meanwhile, according to Google, which cites Our World in Data, the country was running approximately 725,000 tests per day on March 10 with an average positivity rate of 2.5 percent. By April 24, the number of tests per day has more than slightly doubled at 1,603,886 but the positivity rate has exponentially increased to nearly 20 percent.
According to Google, which cites JHU, death count statistics on March 10 show India suffered 126 casualties associated with COVID-19 and had a 7-day moving average of 108. This curve has also increased daily, reaching as high as 2,812 deaths and a 7-day average of 2,336 on April 25.
For vaccination rate, also provided by Google citing Our World in Data, on March 10, slightly more than 21 million citizens had received at least one dose of a vaccine and 4.65 million had been counted as fully vaccinated. By April 25, these statistics have increased to almost 118 million at one dose and slightly more than 19 million counted as fully vaccinated.
Data from the repository appears to indicate the numbers consist of Indian-made Covaxin, an inactivated virus vaccine, and the notorious AstraZeneca adenovirus vector vaccine variant. Both vaccines are manufactured in India, who also manufactures Russia’s Sputnik V adenovirus vector.
Too early to link mutation to surging numbers
According to local authorities, the number of samples being sequenced is far too low to draw any meaningful conclusion. In the Indian state of Maharashtra, some reports have said almost 60 percent of recent infections have been linked to the new variant.
However, in a thread on Twitter, Dr. Jeffrey Barrett, Director of the COVID-19 Genomics Initiative at the Wellcome Sanger Institute in the UK, cautioned against jumping to conclusions on the contribution the variant is having in India’s situation, “A few thoughts on the B.1.617 variant, first seen in India in late 2020, recently seen in >100 cases in the UK, and very much in the news here. TLDR: we should watch carefully, but I don’t think any of our best lines of evidence on variants are yet cause for concern.”
He continued, “So what about spread? Well, I don’t think we really know yet. B.1.617 has become more common in India at around the same time as the recent huge & tragic wave of cases, but <1000 sequences have been reported in GISAID out of ~4M cases since mid-February.”
“I don’t know much about the sampling strategy of INSACOG, the group doing the sequencing, but with these numbers, lots of different biases could paint an inaccurate picture, and I would definitely not draw conclusions about cause and effect of the current wave without more data.”
Oxygen in short supply
Although India’s statistics have become scary, many deaths may have not been directly tied to the pathogenicity of the SARS-CoV-2 virus. Instead, some reports have said a severe shortage of oxygen has been a major factor contributing to the loss of life. In the capital city of Delhi, the local government is struggling with positive test rates as high as 36 to 37 percent according to The Times of India.
The capital is currently under lockdown and is in urgent need of 700 tons of oxygen, of which 490 tons have been supplied by the central government. The government has also set up an online portal where oxygen manufacturers, suppliers, and hospitals have been asked to update data regularly so that bottlenecks can be swiftly resolved.
In some places, local authorities have disrupted oxygen supply chains in order to retain stock for themselves. The Delhi High Court has warned officials who intentionally block the movement of oxygen may face criminal liability.
In another incident, relatives of infected COVID-19 patients stole oxygen cylinders from a hospital, according to a report by Insider.
Meanwhile, the central government is airlifting imported oxygen tanks from countries such as Singapore and Germany. It has instructed railways to move oxygen tankers from refilling plants to places where the gas is urgently needed. The administration has also deployed the armed forces to ensure delivery.
Prime Minister Narendra Modi announced that he will set up 551 Pressure Swing Adsorption Oxygen Generation Plants at public health facilities and government hospitals across the nation, according to an April 25 Press Release.
The worsening pandemic situation in India and the high demand for vaccines have also created a diplomatic crisis for the United States government. Delhi has asked Washington to remove the block on the export of raw materials needed to produce vaccines. However, as of April 23 the Biden administration had refused to do so, arguing that they are currently prioritizing the needs of American citizens. Many experts have warned that the decision could be a diplomatic blunder.
Jeff Smith from The Heritage Foundation pointed out that when America was facing a pandemic emergency in late 2020, it was the Indian government that supplied the pharmaceutical ingredient hydroxychloroquine by removing their export ban, even as many locals criticized the move. “The number of surplus vaccines available after every American has been vaccinated is estimated to be around 70 million…US has adequate supplies and more. It is now time to relax the prioritization measures and products that fall under the purview of the DPA (Defense Production Act),” Smith told Business Standard.
However, on Sunday, April 25, the Biden administration changed its position after a call between U.S. National Security Advisors Jake Sullivan and his Indian counterpart Ajit Doval. A Statement issued by the White House summarizing the call said, “Just as India sent assistance to the United States as our hospitals were strained early in the pandemic, the United States is determined to help India in its time of need.”
The administration said it had “identified sources of specific raw material urgently required for Indian manufacture of the Covishield [AstraZeneca] vaccine that will immediately be made available for India,” while also pledging PPE, testing supplies.
Washington also says it is “pursuing options to provide oxygen generation and related supplies on an urgent basis.”
The Release also stated the U.S. Development Finance Corporation will be financing an increase in manufacturing capability for Indian manufacturer Biological E, which is creating a new type of protein subunit COVID-19 vaccine.
According to the National Institute of Allergies and Infections Diseases, “Instead of the entire pathogen, subunit vaccines include only the components, or antigens, that best stimulate the immune system. Although this design can make vaccines safer and easier to produce, it often requires the incorporation of adjuvants to elicit a strong protective immune response because the antigens alone are not sufficient to induce adequate long-term immunity.”
Adjuvants are defined by the Institute as “substances formulated as part of a vaccine to boost immune responses and enhance the vaccine’s effectiveness,” which notes that most adjuvants are “Aluminum-containing adjuvants, collectively termed alum,” and “have been safely used in vaccines since the 1930s and are still widely used today.” However, they say “technologic and scientific advances” in recent history “have led to the identification of new adjuvants and many promising adjuvant candidates.”
Additional reporting by Neil Campbell