COVID-19:  A triple mutant variant and India’s experience

While applauding the various nations of the world on the speed at which mRNA vaccines were produced to help combat and contain the spread of the novel Coronavirus, one can not help but wonder at the devastation a ‘triple’ mutant COVID-19 variant is causing in India – a nation that has been active in the production of COVID-19 vaccines.

LONDON – Though I recognise the efforts of nations in producing the mRNA vaccines, I still hold the view that a complete protein vaccine will serve humanity better with time. However, since the mRNA vaccines are all that the global community has, for now, it is pertinent to review how its production and limited spread have affected the Indian population.

At the backdrop of this write-up is the question – with India as one of the nations actively participating in the production of mRNA COVID-19 vaccines: what percentage of her population has been vaccinated, prior to the huge outbreak of the ‘triple’ mutant variant of the COVID-19 virus?

Listening to a CNN interview featuring Henrietta Holsman Fore, Executive Director at UNICEF last week, her concern was for “the whole world to get behind India, so that the country can get back with the business of vaccine production for the world.” Although I agree with the first part of her statement, I do not accept that the call to support India should be for the nation to simply return to laboratories to produce more vaccines.

The whole world really needs to get behind India at this critical moment where a ‘re-pandemic’ is brewing, to focus the wave of a ‘triple’ mutant COVID-19 variant with its complications, like the resultant mucormycosis now detected in immune-deficient persons.

At the onset of the COVID-19 pandemic, I pointed out why every soul matter as we leap through the COVID-19 storm, noting a steady and serene way out. Indeed, every soul in all the nations of the global economy matters, including India’s population and their survival.

Johns Hopkins University (JHU) COVID-19 statistical data

A review of the COVID-19 cases in India, based on data from John’s Hopkins University (JHU) shows that India recorded a total of 24,010 new cases, with a 7-day average of 27,027 as of December 16th, 2020. Nearly six months after, a total of 366,494 new cases, with a 7-day average of 391,008 was recorded as of May 9th, 2021. Currently, there are 22.7 million recorded cases of COVID-19 in India, with 18.7 million recoveries and 246,000 deaths.

In the last two days, with the aggressive ‘triple’ mutant COVID-19 variant, India has recorded a daily average of 4,000 deaths.

COVID-19 vaccinations in India

It is one thing to be a vaccine-producing nation, but with a different yardstick, let us assess the population that has received the COVID-19 mRNA vaccine in India.

March 20, 2021: A total of 37,125,187 people received at least one dose of the vaccine. This represents 2.7% of the Indian population. Only 7,478,654 people have been fully vaccinated, representing 0.5% of the population.

May 9, 2021: A total of 133,854,676 received a single dose, representing 9.8% of the population. Fully vaccinated persons were 34,450,192 representing 2.5% of the population.

The population of India is estimated at 1.36 billion (2019) and grew to an estimated 1.38 billion people as of 2020. This is quite a large population. While millions have received either a single or full dose of the vaccine, the recipients represent an insignificant percentage of the overall population of India.

It is said that charity begins at home and this principle should resonate. Any developed country outsourcing the production of vaccines to India should appreciate and encourage the need for India to produce even more vaccines to reach the local communities. It is imperative to get many of the Indian populace vaccinated, as indeed, every soul matters!

Mucormycosis complicating COVID-19 in India-

Mucormycosis is a fungal infection. It was previously called zygomycosis. It is a serious but rare fungal infection caused by a group of moulds called mucormycetes. These moulds (or mucormycetes) will not normally attack healthy persons, but when patients are unwell with poor immune response, these moulds become virulent and deadly in such patients.

It is especially aggressive in patients with backgrounds of chronic diseases like diabetes, kidney disease, cancer, poverty, and poor general health conditions.

Symptoms of Mucormycosis are in relation to the part or areas of the body which have been greatly infested with the moulds. Examples include:

• Rhinocerebral Mucormycosis (affecting the sinuses and the brain) and causing one-sided facial swelling, headache, nasal or sinus congestion, black lesions on the nasal bridge (which gave it the name ‘black mould’) and fever.
• Pulmonary or Lung Mucormycosis – symptoms include fever, cough, chest pain and shortness of breath.
• Abdominal Mucormycosis – shows up with symptoms of abdominal pain, nausea, vomiting, gastrointestinal bleeding, and loss of appetite.
• Disseminated Mucormycosis – describes where the footprint of this fungal infestation has spread through many organs of the body, including the brain, and causing coma and early death.

These are a few examples. A look at the presenting symptoms of Mucormycosis shows similitude to the viral COVID-19 symptoms. Thus, it will appear that in the face of mass poverty and inaccess to healthcare services, the population with the most risk of COVID-19 have their situation further compromised by an increased risk to be infested with the mucormycetes.

Isolation and Early Treatment of Patients

Just like isolation for patients who have tested positive to COVID-19, there is a need to increase testing and isolation of immuno-deficient patients with increased risk of contracting the fungal moulds and their infestation.

The triple mutant COVID-19 variant in Indian has also been recently reported in South Africa. If lessons were learnt from how the COVID-19 pandemic began in China, with the speed at which it spread to the rest of the global community, it becomes imperative for all communities to have centres testing of fungal infestation, especially in chronically sick or immune-compromised patients. Cases can be dictated early, and appropriate anti-fungal treatments started in them.

There is no need for countries to wait until a great number of the triple mutant COVID-19 variant are first reported, and in large numbers before the problem is tackled. The world as a global village becomes a reality, even a negative reality to help encourage countries to act faster than later.

The World for India and South Africa

On May 10, 2021, the World Health Organisation (WHO) classified the COVID-19 variant in India as a “global health risk” and called for intensified national lockdown measures. Such lockdown calls should be extended to South Africa, including calls for mucormycosis testing alongside COVID-19 testing. In this way, early fungal infections can be detected, for prompt treatment.

As India had proactively helped in the fast production of the vaccine which served the world, it is expedient that dozes of same vaccines be made accessible to the masses in India, as this will increase the percentage of its vaccinated population. Until a high percentage have been vaccinated, national lockdowns should be closely monitored to contain the spread of both COVID-19 and the variant associated with Mucormycosis.

Early replication of such calls to South Africa, to similarly impose national lockdown and promote mass vaccination as well as testing, will be of great benefit to global communities. A stitch in time does save many. Delays in nations handling the primary outbreak of COVID-19 did cost a lot in both economic and human impact during the year 2020.

Conclusion

A good success story in India will be a situation where vaccines are made available to the masses, with more than 75% of the population receiving a vaccination. We cannot rest in one part of the global community or on localized results until every part of the global community has a significant percentage of the population vaccinated; otherwise, we may enter a phase of ‘re-pandemic’ citing a more deadly triple mutant COVID-19 variant being spread rapidly.

While there is no cure for COVID-19, the best treatment remains the prevention of the infection. We all should remain alert, observing all preventive and personal hygiene measures, including maintaining social distance and the use of face masks. Patients with a background of chronic disease should be routinely and regularly tested for fungal infestation of the nasal and throat regions. These measures will help check the spread of the fungal disease or other complications from COVID-19 in such patients and the population at large.

I also share hopes that humanity will overcome all odds. It may take time, but may we not lose hope, as while the earth remains, the strength of the hope of man will never fail. As we do the right thing by not slacking in relevant preventive measures, we shall overcome COVID-19 and leap through life in good time.

Read more from the author, here.