Magnitude of genomic sequencing is undervalued in India to fight pandemic
Genome sequencing is the process of determining the completeness of the DNA sequences of an organism’s genome at a single time. It is figuring out the order of deoxyribonucleic acid (DNA) or bases in the genome, the order of A, C, G and T build an organisms DNA. To read a word we catch series of letters that make up that word, sequencing is similar to it, sequencing machines catch sequences of DNA bases. Once genome sequencing is completed healthcare professionals can look at deviations found in an organism’s genes, it helps in avoiding health disorders, genetic disorders or in the case of Coronavirus reducing the virus’ fatality rate. It is like knowing the blueprint and Achilles’ tendon of the enemy fort.
India has faltered at many footings when it comes to combatting Coronavirus, images and news showing desperation for oxygen, hospital beds have substantiated this point. The government staggered in adopting genomic sequencing and vaccinating its citizens to fight and contain the virus. An ideal strategy would have required tremendous research, tracking of variants, conducting further research to assess its fatality rate, transmission rate and immune escape tendency. Once the nature of the variant is known medical standard operating procedures are circulated to treat patients thereby saving lives. Guidelines for daily routines, diet, lockdown and unlock can be tailored to contain the spread of the virus. The United Kingdom and the United States were able to contain the spread of the virus because of increased vaccination coverage and a massive surge in genome sequencing, tracking of variants and timely actions.According to the Indian government total of 5% of confirmed COVID-19 cases were supposed to go under the radar. The government set up Indians SARS CoV2 Genomic Consortia but the level of genomic sequencing remained exclusive only to a few thousand cases. For a country where four lakh cases were recorded daily few thousand sequencing is like peanuts. Indian scientists understand alpha variant which was found in England better than Delta variant which was found in Maharashtra, such a shame. Apart from less sequencing, the pace at which data is disseminated is alarmingly low, this data is crucial to respond to the pandemic. After a search conducted with 3600 genomic sequence samples from November to April 2021 researchers found that the Delta variant was highly circulated in Delhi, it was found in 60% of the samples. The research concluded that the Delta variant is 50% more transmissible than the Alpha variant. It is associated with a low value obtained on RT- PCR, high viral load meaning a higher degree of infection. The researchers concluded that the second wave of the pandemic was induced by the Delta variant, but they could not prove it to be the reason for massive deaths and high case fatality rate.
After two years of the pandemic, this is the first detailed study of Coronavirus by the country providing useful insights. Public Health England reported the Delta variant had spread in the UK replacing the Alpha variant. PHE also confirmed the delta variant to be the reason why severity and hospitalisation levels intensified. Delta variant had breakthrough infections meaning it infected people who were prior vaccinated, PHE concluded that single dose vaccines are ineffective against Delta variant in patients with symptomatic cases. The Lancet journal published a laboratory study that reported people who were injected with a double dose of Pfizer and BioNtech vaccines were 5.8 times more incapable to fight the delta variant as compared to its ancestor; the first Covid 19 variant.
Scientific findings due to genomic sequencing are like a nuclear bomb against the pandemic. If weadequately understand the variant, keep track of it and look for emerging variants, the public health policies will be efficient and effective in containing the spread. Mutation is nature of the virus, the more it spreads the faster it mutates like breakthrough infection, immune escape etc. This continuous mutation demands simultaneous upgrade in protocols and agendassketched to fight the pandemic in every country. All this scientific research is beneficial only if the data is used in making policy to fight the pandemic.
What should be done?
India needs to ramp up genome sequencing across all the states so that if any particular state is reporting a ‘delinquent’ its spread can be contained and SoPs can be formulated. While collecting genomes samples should be proportional to the number of infected patients so that variants can be tracked at the district level. When it comes to urban areas samples for genome sequencing should be exponentially increased. The conclusions from research from all over the country should be collected, a nationwide examination report should be written and shared with the public immediately. This drill should be done periodically to keep up with mutation.
The government needs to fund and support scientificand operational vaccine effectiveness research. This data needs to be analysed regularly and must include demographic features like age, weight, gender, co-morbidities et cetera.
There have been cases where the immune escape tendency of virus has dampened the vaccination drive in India. India has vaccinated 37% of people above 45years of age and 43% of people above 60 years of age. India is right now focused on administering one dose of vaccine to every person above 18 years of age. To tackle immune escape India should rethink its vaccination policy and check whether the policy should aim to administer people both the doses who fall between the age 45 to 60 and above. The policy also needs to check if the gap between two doses of vaccine should be reduced for people aged 45 years and above. Another check needs to be made about people between 18 to 44 years. It must be determined if this age group should be put on hold for vaccination till enough vaccines are available in India.
Epidemiologists should be put on teams that make operational guidelines and strategies to tackle Covid19 so that data generated from the research can be applied. As India is slowly preparing for unlock, states and districts which have a higher level of the Delta variant circulation (which has a high transmission rate) should follow Covid appropriate behaviour strictly in public places to avoid the third wave.
Rampant use of unapproved and controversial therapies in treatment of COVID-19 gives sufficient proof that India is not adapting evidence into practice. The data research is not being applied to real-time use. Even if genome sequencing is increased, unless the resultant data is shared and used in health intervention the money, effort and time spent on the research is wasted. This will help us to stop the immune escape, breakthrough infections and reduce the case fatality rate. The only way to fight this pandemic is through evidence-based policies which must constantly change themselves to adapt to mutations. Medical experts have predicted a third wave and India is preparing for it. It’s time we increase genome sequencing and apply the analysis to real life situations.