Just as India is opening up after the wreckage of the second wave of COVID-19, the possibility of a deadlier third wave looms over the country. Multiple waves in different countries had prompted genome sequencing and this process revealed that a large number of mutated variants of the SARS-CoV-2 are now in circulation. Of these variants, the delta variant, designated as B.1.617.2 is said to have been the main culprit behind India’s COVID-19 2.0. This variant was first identified in India and was called a Variant of Concern (or VOC) by WHO.

The delta variant was concerning due to its high potential for transmission, which led to a sudden rise of infections. However, a few days back, a mutated delta variant, called the delta plus, was identified via genome sequencing. This variant has been designated as B.1.617.2.1 or AY.1. This variant has arisen due to a specific K417N mutation of the delta variant. Though called a Variant of Interest (VOI) initially, it has now been called a Variant of Concern.

The Government of India and its health ministry are on high alert after the detection of the new delta plus variant. The first case of the delta plus variant was found in a sample collected in April in Maharashtra. As of today, the western state has around 20 cases of the delta plus variant and the initial cases have been traced to Jalgaon and Ratnagiri. Other states where this variant has been found include Madhya Pradesh, Karnataka, Kerala, Tamil Nadu, and Jammu & Kashmir.

As of June 16th, around 200 delta plus variant cases have been detected in as many as 11 countries. As of 25th June, India has around 48 cases of the delta plus variant. So far, only one 59-year-old, non-vaccinated woman from Madhya Pradesh has died after being infected by this variant. The actual mortality rate due to the delta plus variant is still unknown.

It is normal to wonder “What makes the delta plus variant one of concern?”. The mutations in delta plus variant make the virus more transmissible than the delta variant and enable it to surpass the human immunity system. The antibody cocktail that shot into limelight after it was used to treat ex-US President Donald Trump is not effective in treating cases with this variant in case of an emergency. For these reasons, the delta plus variant is a serious concern.

The existing vaccine options available in the world, including India’s Covishield and Covaxin, are found to be effective against all the existing coronavirus strains, including the delta and delta plus. Though multiple studies are still underway to study the efficacy of the existing vaccines against the delta plus variant, preliminary studies have suggested that the earliest vaccines made against the earlier variants are still effective against the emerging variants.‍

Third wave in India ‍

Even before the second wave ended, healthcare experts, global health researchers and others speculated the arrival of a third COVID-19 wave. While that seemed too far-fetched and pessimistic at the peak of the second wave when India’s healthcare infrastructure was crumbling, with the emergence of the delta plus variant, this speculation seems even more real. “Will India have the third wave?” is still a question nobody can answer with certainty. However, what is known is that there have been third waves in many western countries, primarily due to the highly transmissible delta variant.

Many predictive models are being released by various institutes about when the likely third wave is set to impact India. The expected timeline of the third wave starts from as soon as 6 weeks to as delayed as 8 months. While the arrival of the third wave is not certain, the central and state governments are working on a war-footing to ensure COVID-19 appropriate behaviour, strict norms, and vaccination for as many people as possible to avoid an impending third wave.

While vaccination reduces your chances of getting infected with COVID-19, the number of breakthrough infections have increased significantly due to the delta and delta plus variants. This makes it abundantly clear that vaccination alone isn’t enough to protect us against these variants. One must continue to follow social distancing norms, wear a mask outside and ensure proper hygiene and sanitation practices to reduce the chances of getting infected with COVID-19 to a minimum.

This article is prepared in consultation with Dr. Amrit Jha (MBBS, MS Ortho) & Dr. Darshan Sheth (MBBS, MHA).

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