"Hospitalisations Will Go Up As Covid Burden Increases": Soumya Swaminathan

Over a year-and-a-half after India witnessed the Omicron wave, two eminent health experts have sounded a warning over the increasing Covid-19 cases in India in the wake of the JN.1 sub-variant of Omicron being detected in the country.

In an exclusive interview with NDTV on Wednesday, Dr Rajeev Jayadevan, Co-Chairman of the National Indian Medical Association Covid Task Force, said 30% of all patients with influenza-like illnesses who were tested have turned out to be Covid positive in the Kochi region in a span of about 24 hours. He also said that Covid cases have spread into the community and that his neighbour has also tested positive.

Dr Soumya Swaminathan, former WHO chief scientist - who also spoke exclusively to NDTV - has cautioned against dismissing Covid as a common cold, not just because of the people who fall severely ill, but because of the disease's long-term effects, including increased risk of heart attacks, strokes and mental health problems.

Both experts, however, emphasised that the variant, while more transmissible, may not cause a high number of hospitalisations, partly because of India's high vaccination rate. Dr Swaminathan also pointed out that India's health systems have come a long way from how they were during the first wave in 2020 and the deadlier Delta wave in 2021, and the country is well prepared to handle an uptick in cases.

Dr Swaminathan also listed out the precautions that people can take and stressed on the need for the elderly and those with poor immunity to start masking up.

Entered The Community?

According to official data, India has seen 21 cases of the JN.1 sub-variant so far - 19 in Goa and one each in Maharashtra and Kerala.

On the spread of Covid, Dr Jayadevan, who posted a chart on X illustrating the rise in cases since November, said, "Over the past month or so, the number of Covid cases has been creeping up. But, as you know, testing in our country is quite low, close to zero in many places for many reasons... But if you look at the statistics as I posted on the graph from September, October, November and December, there is a sharp uptick sometime in November."

"Before November, it is only around 1% of influenza-like illnesses showing positive for Covid, which is practically zero. But, from November onwards, we have had about 9%. And, in December, after the meeting that concluded last night, it was 30%. And this data is from multiple hospitals in the (Kochi) region. So this shows that Covid is taking a greater share of what we call influenza-like illness, which basically means things like respiratory problems, breathing trouble, cough, fever and body ache," the doctor added.

Dr Jayadevan said that while JN.1 is considered the fastest-rising variant, it does not necessarily mean more cases but that it is "dominating the Covid landscape". He also pointed out that while cases are increasing, people are being able to treat the symptoms at home.

To a question on whether there is a community-wide spread of the JN.1 variant, the Covid Task Force co-chair said: "It is very much in the community. My neighbour has tested positive just this evening. So it is everywhere... But it is not causing a huge surge in hospitalisation. So that's different."

'Waves of Infection'

When Dr Soumya Swaminathan was asked about 30% of pneumonia cases in Kochi hospitals turning out to be Covid positive and the likelihood of this being replicated in other parts of India, she said, "We've been through this many times before, as you know, over the last four years. This is what we expected and this is what the WHO had talked about. Even when WHO Director-General Dr Tedros Ghebreyesus announced the end of the global public health emergency in May this year, he did say it is still a global health threat."

"And that's what we are seeing now. We're seeing a new variant, the JN.1, which is a sub-variant of Omicron. So hopefully it behaves like Omicron, which was relatively mild. But what happens is that every new variant gets some properties of being more transmissible. It is able to evade or avoid the antibody responses that we already have in our system. And therefore it is able to create these waves of infection where it infects people who've already been infected before," Dr Swaminathan added.

The former WHO chief scientist pointed out that the global health body has classified JN.1 as a variant of interest.

"Now, coming to India, as you mentioned, we've just started increasing the testing. So over the next few days, I think we will see more data coming from many states. Right now, it looks like a few states like Kerala, Karnataka, Maharashtra, perhaps Tamil Nadu, they are reporting an uptick of cases and high positivity," she said.

Symptoms, Time To Mask Up?

Dr Jayadevan said vaccines may have helped keep Covid at bay since the last wave, but a concern arises when a variant is markedly different.

"For example, JN.1 is not like a one-step ahead variant. This is a multi-step ahead variant. We call it the saltation event in genetics, which basically means a pile of mutations suddenly occurring at one go," he said.

On masking up, the doctor advised, "I would say if you are trapped in a situation where it's ventilated, closed, crowded, you feel the air is still and there are people around you, it's safer to wear a mask. If you are travelling in a vehicle with multiple people who you don't know, wear a mask or at least roll your windows down."

He also recommended wearing a mask in closed spaces with many people, especially for those who are elderly and immunosuppressed.

Dr Swaminathan said the symptoms of the new variant are fever, cough, loss of smell and loss of taste. She also pointed to persistent high fever, breathing difficulties, fatigue, inability to eat and a tendency to vomit as the warning signs.

She recommended masking up in a crowded place if people are vulnerable to infections and also stressed that people who are sick should wear a mask to protect others. For the vulnerable population, she recommended using pulse oximeters.

Not A Common Cold

For people comparing the newer variants of Covid with the common cold, Dr Swaminathan had a warning: "It's very different from the common cold, not just because of people getting severely ill with acute Covid pneumonia, but also because of the long-term effects of Covid.

"And I think we have enough data now from around the world to know that people who have suffered from Covid and, particularly those who have repeat infections, are more likely to get, for example, heart attacks, strokes, diabetes, dementia, depression, mental health problems, prolonged fatigue and muscle pain... inability to go back to their usual state of functioning," she said.

Dr Swaminathan added, "This is the big difference between a common cold and Covid. So I would say let's not take it lightly. If you can avoid the infection, much better to avoid it than to get it and risk the after-effects of long Covid."

Spread Pattern

Dr Jayadevan said India is unlikely to witness a uniform spread. Pointing to the current cases of the new variant, he said, "Typically, Covid spreads in high travel zones, which are travel hubs, Kerala is a travel hub, so is Maharashtra, Mumbai area, Goa is a travel hub. We got 18 sequences of the JN.1 from Goa. So I would imagine it will spread in these zones first and then slowly trickle into the other areas as people travel more and more."

Dr Swaminathan pointed out that by the time variants are detected, they are usually already spreading in the community.

"And so it's likely that it's everywhere; and the more we test, the more we're going to find. In fact, wastewater surveillance being done in many countries suggests that this is going to become the dominant variant globally within the next week or so. So I think it is to be expected. I think what is important is for us to keep a close eye on what the clinical manifestations are. At the moment, it doesn't appear that it's causing any more severe illness than the previous Omicron variant," she said.

Emphasising the need to stay prepared, she said, "However, I think what happens is if you get a thousand cases, there will be a percentage of people, even if it's 1%, who get very ill, who are in in the hospital. If you get 1,00,000 cases, that many more people are going to get very ill and in the hospital, particularly those over the age of 65 and those who have other comorbidities.

"So it's a good idea to be prepared, to take precautions so that we can at least protect those who are at highest risk of getting sick and prevent them from getting pneumonia and getting into the hospital," she added.

Vaccines Working

Dr Jayadevan said India is a well-vaccinated country and uses different vaccines than in the West, so data from those countries may not directly apply.

On the need for boosters, Dr Swaminathan said, "From what we are seeing around the world, I think vaccines are still working. It is very remarkable that they are still providing a high degree of protection, especially against severe disease... But again, for those who are very old, for those who have poor immunity, there is a possibility that their immunity would have waned, that boosters might be needed at some point."

India Prepared?

Dr Swaminathan said doctors know how to treat Covid now and things are very different from how they were in 2020.

"I think the preparation of the hospitals is important. I think mock drills have happened in many states to test the responses as well as to test the adequacy and functioning of the oxygen, the ventilators, all those things that we had prepared. So, in a way, it's a good test for our system to do this once in a while, to be absolutely ready and prepared and not have any nasty surprises when we actually need to use all of those things that we have invested in," she said.

"So I believe that we are very well prepared, but that every state must exercise these precautions as well as mock drills and make sure that, even in remote parts of the country, we are able to provide oxygen to people who need it," she added.