CME INDIA Presentation by Professor Shibendu Ghosh, Vice-President API headquarters, Kolkata.

Analysing the declining trend of COVID-19 cases.

What is happening in India right now amazes the scientists. In Brazil, UK and South Africa, newer variants, newer mutants of the virus keep the life at stand still. The mystery of declining trend of new COVID-19 cases and death in India is unfolding with new research?

• India witnessed 270 million of exposure percolating the rural population.
• It is not a disease of town only – as lots of Indian people think. Its prevalence has been found from 5.2% to 19% in recent survey from rural India.
• India vs world: Case fatality rate as on 3rd February in India – 1.4% whereas in U K – 2.8%, South Africa – 3.1%. Death rate per million population: India 112, UK 1362, Italy 1486, Belgium 1831…
• India vs South Asia (case fatality ratio): Less than that of Bangladesh (1.5) & Pakistan (2.1) whereas much higher than Bhutan (0.1%), Nepal (0.7%), Maldives (0.3%), Sri Lanka (0.5%). Death rate per million population: Bangladesh (50), Pakistan (54), Sri Lanka (16), India (112) Much higher in India.

The extract of a Research

(H P Ghosh Research Centre, Bandhan-Konnagar, Kolkata headed by JVR Prasad Rao, Ex-Health Secretary, Government of India, assisted by Amartya Chowdhury)

• India has got political & administrative will from the highest level which help out to…to screen the International travellers…restricted inbound traffic from the severely affected countries …isolating people who are coming from abroad particularly who are positive. Lastly and probably first country for imposing Lock down in a stringent way.
• But India needs to revisit its disease control.
  • Surely, the Digital India could be utilised in a more robust way, given the computer superpower role of India. Better strategies, more transparency in the COVID management involving digital health information system needed.
  • The IDSP (Integrated Disease Surveillance Program) – the framework of the National Disease Surveillance tangible at all.
  • The role ICMR – not up to the mark as the sero surveillance of the people of India was limited to Metropolitan Cities & that too in an irregular way, creating more guesswork rather than the real story of herd immunity in the society i.e., how much percentage of people infected (cured, hospitalised, asymptomatic carrier or died).
  • The smooth running of program to counteract the pandemic depends on integrity & cooperation of the Central and State Government. It is lacking in all sense – which is needed in the Federal Structure particularly to handle this type of Pandemic.

There is one ray of hope at the end of the tunnel…

• The development of vaccine in our country is the game changer. But, still a large number – even health care workers – are reluctant to take the Vaccines.
• The carelessness of the healthcare industry professional could be detrimental as they are at increased risk of the disease.

What we have learnt so far…

1. We require more integrated network regarding health information.
2. The media & more integrated learning and teaching program should be there to enlighten the medical and common people about the pandemic.
3. Whether the immunity which is acquired during our childhood in a developing country has anything to do?

CME INDIA Alerts

Two main characteristics in any new mutant of the virus

1. Whether the mutation makes it more transmissible?
2. Whether the new variant is able to evade the immune response acquired either through natural infection or through vaccination?

Indian Variants

• In India, one particular mutant, called E484, has been found in at least one genome sequence developed from an infected person in India.
• This mutant was first reported in Brazil.
• There is strong evidence to suggest that this E484 mutation might help the virus in evading the immune response.

Scientists at ACTREC–Tata Memorial Centre has tried to study the prevalence of new variants of SARS-CoV-2. 

• They studied more than two lakh genome sequences of the virus (About 3,300 were from India), reported from around the world, and found over 2.58 million mutations in these sequences.
• More than 51% of these were non-silent mutations. On an average, every genome sequence contained 6.6 non-silent mutation and five silent mutations. (known as mutation rate).
• They have also identified hotspots in the genome sequences.
• If a particular region is found to have mutations in more than 40,000 sequences, it has been identified as a hotspot.
• Interestingly, they have found unexpectedly high number of silent mutations in these hotspot areas.
• But they have not been able to identify any hotspot areas in genome sequences collected from Indian patients. That is because, of the more than two lakh genome samples we studied, But the hotspots identified for the total sequences were found in several Indian samples as well. In the Indian samples, more than 35,000 mutations were found. On an average, 5.17 non-silent mutations and 4.39 silent mutations were found in every sample.
• They opined that it is extremely important to step up the genomic surveillance to look out for newer variants of the novel coronavirus in India.
• As, presently, we do not seem to be doing enough to identify viral variants the risk for the emergence of new variant is very high.

(Inputs by Dr Amit Dutt is a scientist at (ACTREC) at the Tata Memorial Centre in Mumbai)

Biological reason behind slow spread of mutant strain in Asia: NIBMG study

(study published recently in the international journal ‘Infection, Genetics and Evolution)

• National Institute of Biomedical Genomics (NIBMG) in Kalyani, Kolkata has pointed to a biological reason behind the slower spread of the D614G mutant in Asia compared to Europe and the USA.
• Speculation about the higher temperature in Asia not congenial to the spread of the coronavirus, seems to be a myth.
• Scientist at NIBMG believed the cause had to be biological, rather than physical or social in Asia.
• This factor is related to the additional ‘gate’ of entry into the human cell that the mutation creates.
• Creation of a ‘gate’ by a mutation of SARS CoC-2 does not suffice for actual entry. The gate needs to be opened. The opening is done by a protein of the host, that is, a human protein, called neutrophil elastase which is plentifully available in the lungs.
• When the level of neutrophil elastase is high in an individual, the additional gate created by the mutation in the coronavirus opens up in a larger number of cells.
• Then the virus enters a larger number of human cells enabling it to make many more copies of itself and helps it spread better from one infected individual to another uninfected individual.
• Humans produce a protein called alpha-1-antitrypsin (AAT) that inhibits the production of neutrophil elastase and keeps its level in check.
• Some naturally-occurring mutations in the AAT-producing gene results in deficiency of the AAT protein.
• AAT protein deficiency results in higher levels of neutrophil elastase and because of this the coronavirus is then able to enter many more human host cells and spread itself better.
• ATT deficiency could be one plausible reason.

COVID viruses are losing parts of their genome

• It looks a good new that again and again, the new coronavirus has been sloughing off small chunks of its genome.
• It leads to changes in a viral protein that is frequently targeted by antibodies.
• Scientists at University of Pittsburgh School of Medicine in Pennsylvania and their colleagues searched a database of SARS-CoV-2 genome sequences.
• They have identified more than 1,000 viruses with deletions in the genomic region that encodes a protein called spike.
• The virus uses the spike protein to invade cells.

CME INDIA Tail Piece

(Shared by Dr AK Singh, Kolkata)

Consensus emerging that these 2 Vaccine can be given in pregnancy and lactating mother:

Consensus emerging that these 2 Vaccine can be given in pregnancy and lactating mother despite absence of studies ☝🏻JAMA.

Dr H D Sharan Ranchi:

1. The CFR is lower in under developed and developing countries when compared to western advanced countries.
2. I strongly feel that innate immunity has a big role in this.

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