|Year : 2022 | Volume
| Issue : 1 | Page : 1-2
The future of COVID-19: The game of variants
Departments of Research and Infection Control, Laboratory Services, Artemis Hospitals, Gurugram, Haryana, India
|Date of Submission||08-Jun-2022|
|Date of Acceptance||13-Sep-2022|
|Date of Web Publication||12-Nov-2022|
Dr. Namita Jaggi
Artemis Hospitals, Sector-51, Gurugram - 122 001, Haryana
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Jaggi N. The future of COVID-19: The game of variants. J Patient Saf Infect Control 2022;10:1-2
Most of us are aware that in the near future, there will be some inevitable changes in the way we work, live, travel and behave and the extent of change would depend on how SARS-CoV-2 evolves over the next few months. Will the mutations the virus is acquiring make it into a seasonal flu virus, or will it morph into something more dangerous? Will it fizzle out completely or transform into a virus disease in children?
SARS-CoV-2 like other RNA viruses is prone to genetic evolution through mutations while adapting to their new human hosts. Mutations are changes in the genetic structure which, if relevant could change its character. These mutations are more of a hit-and-trial method for viruses. Some mutations occur in favour of viruses, while others in favour of the host. The first time a virus jumps from one species to another, it encounters with the more susceptible people with no immunity against the virus, and there is likely to be less evolutionary pressure on the virus to increase transmissibility. This is what happened to SARS-CoV-2 in the early phase of the pandemic. Initially, people did not have immunity against this novel virus, but once people started developing immunity by natural infection or by vaccination, the virus started mutating itself to overcome a host's immune response and to become more transmissible. In the course of 2 years, SARS-CoV-2 has been mutated into multiple variants of concern – Alpha, Beta, Gamma, Delta and Omicron.
So what would be the forward journey of the virus? It could mimic the fate of influenza A or influenza B. Influenza A changes its genetic code very slightly every year, therefore, an annually updated vaccine in the form of boosters is required against the circulating strain. Another scenario is if SARS-CoV-2 evolves to evade immune response more sluggishly, it might come to resemble influenza B which is transmitted largely by children or who have weak immunity. A more likely parallel path for SARS-CoV-2 is the respiratory syncytial virus (RSV). RSV is a leading cause of hospitalisation of children in the first 2 years of life. Waning immunity and viral evolution together allow new strains of RSV to sweep across the planet each year, infecting adults in large numbers with mild symptoms, thanks to childhood exposure. If SARS-CoV-2 follows this path, aided by vaccines that provide strong protection against severe disease, 'it becomes essentially a virus of kids or unvaccinated and immunocompromised individuals.'
SARS-CoV-2 could also develop a deletion in its genetic instructions that ultimately leads to a weakened strain of the virus similar to what happened in the 2003 SARS outbreak. Furthermore, in a worst-case scenario, SARS-CoV-2 could become fully resistant to protective antibodies by acquiring a set of mutations to fully evade our immune response.
What can we do at our end to lessen morbidity and mortality? At a global level, the scientific community must focus on developing broadly protective pan-coronavirus vaccines that could fight any COVID variant or even any future coronavirus. The past 20 years have witnessed three fatal coronavirus outbreaks – SARS in 2003, Middle East respiratory syndrome in 2012 and now COVID-19. It will most likely emerge again in the future because of the presence of angiotensin-converting enzyme-2 receptors on human cells. The US Army is developing a spike ferritin nanoparticle COVID-19 vaccine also known as SpFN-shaped like a soccer ball with 24 faces. Scientists can attach the spikes of multiple coronavirus strains to each of the different faces allowing them to customise the vaccine for any new COVID variants that arise. It has successfully completed animal testing and Phase 1 human trial and will soon start Phase 2 and 3 human testing. With this pan-coronavirus vaccine in process, we have a torch of hope in our hands. At a national level, the government must set protocols which enable the economy to boom, schools and colleges to run and leisure and entertainment activities to carry on but with appropriate policies in place. Furthermore, India must scale its genomic sequencing capabilities for early identification of the variants by involving more private laboratories in its multi-agency consortium Indian SARS-CoV-2 Genomics Consortium (INSACOG), a network of 38 laboratories. As per the INSACOG weekly bulletin (last released on 25 April), the total number of samples sequenced was 243,957 which is around 0.56% of COVID-19 cases reported in the country on 29 April 2022. Amongst sequenced samples in our country, 4266 were of Alpha variant, 220 Beta variant, 3 Gamma, 43928 Delta variant, 5607 B.1.617.1 and B.1.617.3, 45359 were of Omicron variant (highest amongst all) and 1 XE variant. Rests were either variants of interest or others. Ever since the COVID-19 pandemic took off, India has not been able to sequence even 1% of all positive samples at any point, whereas the UK, US and European countries are doing a lot better. As of 10 May 2022, the USA has shared 3,237,222 sequences through Global Initiative on Sharing All Influenza Data, 12 times of what India has sequenced so far.
At a community level, individuals would have to follow COVID-appropriate behaviours to manage the pandemic. These traits include diligent and thorough hand washing, following government communications related to vaccinations, mask-wearing (especially when you know you are sick), following social distancing, cleaning high-touch surfaces frequently, etc., Health care facilities also play a big role in the containment of any outbreak. The hospitals should have a pandemic plan akin to a disaster plan and must implement a robust infection control programme, set recommendations for surgeries and make vaccine boosters available to all health care workers. Other sector which is severely impacted by the containment measures during the current pandemic is the tourism industry. Governments will need to take balanced, measured and coordinated policy action at the local, national and international levels to protect the people from catching the virus as well as to address the immediate impacts on the sector. Countries must cooperate with each other to boost travel and tourism.
There is a constant state of play between the virus and the immune armamentarium of the human. However, armed with the second-generation vaccines, newer antivirals, COVID-appropriate behaviours and, equitable vaccine rollouts in low and high-income countries, we would be on the right path to success.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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