Because the Covid emergency in India is a problem that affects all countries

More than 300 thousand new cases a day and over 2 thousand victims every 24 hours: these are the dramatic figures of the Covid-19 emergency in India which, since the outbreak of the pandemic, has been recording daily figures never touched by any country. The surge in infections, which arrived a few months after the second wave in other states, effectively brought the Federal Republic to its knees, prompting Prime Minister Narenda Modi to turn to the nation to reassure the efforts of the government and the pharmaceutical industry in giving a response to the lack of hospital beds, the shortage of oxygen, tampons and vaccines. The reality, on the other hand, highlights the government’s lack of determination to enforce public health measures. “Although the usual guidelines have been issued – explained the Indian epidemiologist and doctor Chandrakant Laharyha in a recent article for India Today – they were elected politicians and leaders to tacitly encourage crowding on religious holidays (Holi at the end of March 2021), electoral demonstrations in five states (March-April 2021) and congregations in sacred cities (Kumbh Mela in Haridwar in March-April 2021)”.

Errors similar to those made in many countries which, after the first wave, suggested a return to some degree of normality at a time when it was clear that new waves would come. Among these is the United Kingdom which, after the price of a first summary management of the pandemic, has however shown that a combination of lockdown, vaccination and surveillance are the best answers to curb the contagion. And, in the last week, among other things, it has reported an increase in cases due to a new variant of the coronavirus present in the country, called B.1.617 and also known as “Indian”, precisely because it was isolated and sequenced for the first time in India. The same variant that is suspected is bringing the health system of the Asian country to collapse and which, like the other variants identified so far, is believed to have originated with the uncontrolled increase in viral transmission.

The risk of Covid variants

The fear that revolves around the Indian variant is represented by the consequences of its spread. Although the effects of individual mutations are not yet known in detail, its changes suggest two notable exceptions compared to the version of Sars-Cov-2 more widespread globally. It is in fact a “double mutation” variant, that is, it has two substitutions at the level of the coding sequence of the viral Spike protein: the first is a mutation called L452R, a modification found in the Californian variant (B.1.427) which, some laboratory experiments, show that it can improve the binding capacity to the cellular receptor ACE2 and decrease the recognition by antibodies (both those present in the plasma of the cured and some neutralized monoclonals). Other studies have indicated that it could even make the virus resistant to T lymphocytes, which are a type of cell that can intercept and eliminate those infected with the virus.

The second mutation is instead called E484Q. Other variants of concern (such as the Brazilian, South African and mutated version of the English variant) also present a modification involving the amino acid at position 484 (E484K), which is believed to help the virus at least partially evade the immune response induced by the natural infection and current vaccines. However, compared to lysine (K), the Indian variant has a glutamine (Q) in this position, a substitution for which there is still limited evidence of immune escape.

More research is needed to understand the exact role of these mutations, but it is clear that the emergence of variants with mutations that give the virus greater transmissibility or the ability to escape the immune response, it poses a threat to health not only in India, but also in the rest of the planet. For this reason, pharmaceutical companies are already working on “updated” vaccines, therefore in third doses or extra doses able to combat the variants of greatest concern. A solution with which we still risk keep chasing the virus and which clearly is not the only road that can lead us to the end of the pandemic. Rather, we should photograph in more detail the situations that risk fueling the infection and act with the appropriate actions.

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