BF.7 omicron variant posing  new medical challenges 

Three years after the first outbreak of Covid-19, China is struggling to contain a coronavirus resurgence. The partial unlocking that began recently following widespread protests against Beijing’s draconian zero-Covid policy has overwhelmed the healthcare system, with hospitals running short of beds and medicines. 

The official Chinese death toll ever since the pandemic began is an improbable 5,200-plus, which is minuscule compared to the corresponding figures of India (over 5.3 lakh) and the US (more than 11 lakh). 

Countries such as Japan, South Korea and Brazil are also recording a spurt in Covid cases. India, which was ravaged by the second wave in April-May 2021, has asked states and UTs to send samples of all Covid- positive cases to designated genome sequencing labs to track new variants, if any.

The   outbreak of Chinese virus has caused the world to go into panic mode again, exactly three years after the first episode of SARS-CoV-2 was reported in December 2019.Intense winter and vulnerability of elderly with comorbidities and declining immunities is providing an environment for Omicron sub-variants to keep mutating, eventually bypass vaccine immunity so far achieved in the populations. Keeping note of this a fresh Covid-19 pandemic is emerging the world over with new medical challenges.

ANOTHER PANDEMIC?

The rapid replacement of Covid-19 strains is raising the spectre of yet another wave of the pandemic in the days ahead. It is indeed alarming that the virus continues to evolve and evade.  The pandemic has not come to an end as yet. China, Japan, USA and South Korea are in the middle of a surge in Covid-19 cases. 

The current surge in China is caused by the BF.7 variant and alarmingly, cases of BF.7 have already been detected in India.

A recent  study published in the International Journal  Cell is scary and worrisome. The study concluded that four Omicron sub-variants, BQ.1, BQ.1.1, XBB and XBB1 are resistant to Covid-19 vaccines, even after booster doses. The findings of this study indicate that these sub-variants present a serious threat. The study also concludes that monoclonal antibodies, a very common treatment for Covid-19, are completely ineffective against these sub-variants.

BQ.1 and BQ.1.1

BQ.1 and BQ.1.1 currently account for 70 per cent of circulating variants worldwide. The four sub-variants in the study have successfully replaced BA.5, which was the common Omicron variant over the past year. Today, BA.5 accounts for only 10 per cent of Covid-19 in the world. In the USA, in the past week, hospitalizations and deaths due to Covid-19 are up 18 per cent and 50 per cent respectively, yet another worrisome statistic.

Twenty- two Indian genomic surveillance centres could be proactive with early warning signals of new mutants. The entire world is at a loss with regard to credible information on the Chinese Covid-19 outbreak such as daily numbers, deaths, disease symptoms, and if it was caused by the ancestral or mutating sub-variants of Omicron, like the BF.7. Anecdotal information suggests that sub-variant BF.7 is highly transmissible with observed transmission rate (Ro) of infecting 16-18 persons from one patient. That places BF.7 transmissibility at par with the rate of spread of measles! If this is true, a model suggests that China will have 800 million new cases and one million deaths in the next three months. As it was established during the past waves that the immunocompromised or the elderly continue to be at a greater risk of illness and death.

Any virus has the potential to mutate and pose new threats, particularly if the mutated strain is more virulent. Genome sequencing, thus, becomes a scientific priority in order to suitably address new and mutated variants. Having learnt from past experience, particularly the ‘worst’ second Covid wave, our systems are now better prepared to deal with the challenges. However, it is vital that we do not let our guard down.

THE APPROACH

Systemic efforts by the government are only one part of the solution to the Covid conundrum. As stakeholders ourselves, all of us need to contribute by following Covid- appropriate behaviour and habits, which have been emphasised since the beginning of the pandemic. 

The most important, of course, is the use of masks, particularly in closed spaces, crowds and when having close contact with an infected person. Anyone visiting a hospital as a patient or an attendant must wear a mask. Besides, the maintenance of social distancing, wherever possible, proper hand-washing and avoiding crowded gatherings are some of the other practices to which we should revert.

People who have not yet taken the precautionary or booster dose must get one immediately. Vaccines have been found to be the most effective way in preventing severe symptoms and serious infection. It is saddening to find that nearly 70 per cent of the eligible persons have not taken the booster dose. 

Further, a holistic assessment of our healthcare system is absolutely necessary. The Covid-19 pandemic in the recent past in India has exposed the sad neglect of our public sector medical and healthcare institutions, particularly in rural and suburban areas. These institutions need to be bolstered in terms of manpower and infrastructure. Special attention needs to be given to primary and community health centres. While the private sector has to some extent contributed to the healthcare sector in urban areas, its reach in rural and semi-urban areas is inadequate.

(Dr Naresh Purohit  is Executive Member, Federation of Hospital Administrator. He is also advisor to the National Communicable Disease Control Programme. Dr. Purohit is also Advisor to six other National Health Programmes. He is visiting Professor in five Medical Universities of  Southern India including Thrissur based  Kerala University of Health Sciences.  The views and opinion expressed in this article are those of the author)

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