Covid-19: Experts warn Mumbaikars about new A.Y.4.2 sub-variant

AY.4.2 is 60 per cent more transmissible than the Alpha and Delta variants. File pic

With the festive season around the corner, health experts have warned of the new Delta plus sub-variant, AY.4.2, which spreads faster than earlier variants, and urged people to follow social distancing norms and use masks. They say those who are unvaccinated are at higher risk of contracting it. The variant causes neurological problems and Covid encephalitis and has till date, affected 25 people in India.

Dr Wiqar Shaikh, professor of medicine, Grant Medical College and Sir JJ Group of Hospitals, explained that a mutation is the result of the virus making an error during multiplication/reproduction, which causes changes in its genetic code. A mutation could be more infective and cause more deaths compared to the original virus. Dr Shaikh expressed concern that more than 25 cases of AY.4.2 have been confirmed in India and there were reports coming in from Karnataka and few other states.

Dr Shaikh added that the lineage of Covid-19 is overseen by researchers from Cog-UK, which is a collaboration between the University of Edinburgh and the University of Oxford. He said that in April 2021, two samples were tested by Cog-UK from people having a travel history to India. These samples did not match any existing variant of the Covid-19 virus and were found to be a sub-lineage of the Delta variant, which was labelled as the AY.4.2 variant. In the UK, over the past one month, 63 per cent of cases are due to AY.4.2.

Warning bells on third wave

Dr Shaikh said AY.4.2 has spread to more than 33 countries around the world, including Germany, Ireland, Denmark, US, Israel, Russia, China and the UK. He quoted the United Kingdom Health Security Agency (UKHSA) which said that AY.4.2 is 60 per cent more transmissible than the Alpha and Delta variants. The UKHSA has declared AY.4.2 as a ‘variant of interest' and the WHO is expected to do the same.

Dr Shaikh further added, "As per reports from the UK till date, it is possible that AY.4.2 could demonstrate even greater escape immunity and be less recognizable to both natural as well as vaccine induced antibodies, as well as to the more important T-cells. Besides, because of the poorly vaccinated pediatric population, it is possible that AY.4.2 could infect children besides the fully vaccinated population." He said the third wave of Covid-19 in India could be caused by AY.4.2.

‘Unclear method of spread'

"The genome monitoring labs in India have detected few cases of AY.4.2 in some states such as Kerala, Karnataka, Madhya Pradesh, etc. in the past few days," said Dr Subhash Hira, professor of Global Health at the University of Washington-Seattle. "It is yet unclear if this Delta plus sub-variant AY4.2 is spreading to countries through travel transmission or these sub-variant mutations will indigenously emerge in countries as a consequence of the third wave. Whatever be the mode of origin of variants and sub-variants, countries like India, on the verge of the third wave, need to scale up their genome sequence monitoring in all states so that all develop a common strategic plan to contain this new sub-variant," said Dr Hira.

AY.4.2 has spread to more than 33 countries around the world, including Germany, Ireland, Denmark, US, Israel, Russia, China and the UK. Representation pic

Dr Hira added, "The sudden surge of death numbers in Russia and China last week is being suspected to have been caused by ‘Covid encephalitis (inflammation of the brain)'. Every country has to be ready to implement strategic plans to answer several fundamental questions regarding every variant that emerges, namely, its origin, transmissibility rate, clinical features and main target organs, vulnerability groups e.g. children, treatment of choice, efficacy of vaccine protection, etc. We are likely to see more such variants and sub-variants as the Covid pandemic starts to age. The genome sequencing labs are an important component of pandemic control and they need to be kept efficiently functional by our health programme," said Dr Hira. While the clinical symptoms of cough, breathlessness, fever, diarrhea etc are almost the same as those with the traditional Covid-19 infection, an exceptional addition seen in AY4.2 is the encephalitis appearing as ‘clouding of alertness, drowsiness, seizures, etc leading to coma over days', Dr Hira said.

‘Battle not over'

Dr Santosh Bansode, Head of Department, Emergency Medicine, Wockhardt Hospitals said, "A fully vaccinated person will mostly get mild symptoms from AY.4.2, but if he/she transfers this infection to an unvaccinated person, that person may suffer serious symptoms. If such a new variant starts spreading in our country and city, we will face a huge stress on our healthcare system."

"Now we are unlocking everything slowly and we can see people are getting very casual and not wearing masks properly in public places. This behaviour will cause deep trouble if such a variant enters our community. We must keep educating people about new variants and problems they cause all over the world and encouraging them to take adequate precautions.," he said.

He wants people to look out for fever, cough, a runny nose, shortness of breath, unusual tiredness, headache, generalised weakness and body pain. The new variant causes similar effects on all body organs as older variants. Dr Bansode said in severe symptomatic patients the tendency to form clots in vessels increases and this can affect the lungs, heart, brain, etc.

"There is no need to panic. Health authorities are investigating the characteristics of the new variant. Until further details are available, Covid appropriate behaviour accompanied by complete vaccination continues to be the mainstay of protection especially during the festive season," explained Dr Ketan Vagholkar, professor of surgery at DY Patil Medical College.

25
No. of people said to be affected by AY.4.2 in India