Dr Kishore P. Madhwani writes on how not to worry and combat the possibility of the spread of the new COVID variant BF.7.

As a public health expert and occupational health consultant, I would state that the most vital thing for us is not to become either complacent or alarmist. Just be careful and strictly follow precautions, because today we are one of the nations… with least number of reported cases in the world.

Since its emergence in late 2019, the SARS COV 2 virus (causing COVID-19) has had time to evolve and mutate, causing waves upon waves of infections with constantly emerging new variants. With every mutation, viruses create lineages and sub-lineages.

Omicron's subvariant BF.7 has been in transmission for a year and has hit several countries, especially China since October 4, 2022. Cases of the BF.7 subvariant hit the USA too in October 2022, where currently 5.7% cases have been reported (as on December 20 2022; 15K to 20K daily cases).

In the UK, 7.6 % cases have been reported so far. It has been de-escalated due to reduced incidence and low growth rates in UK. It has now reached Japan (60K to 70K daily cases), South Korea and Brazil (20K to 30K daily cases) and Australia. A sub-lineage of the Omicron variant BA.5.2.1 has spread in Belgium, Germany, France, and Denmark.

WHY IS CHINA STRUGGLING?

According to experts, this is just a surge as a result of the restrictions being lifted in China. The country is now experiencing the typical Omicron surge, which the other countries have already witnessed. The situation is similar to the one in Hong Kong, when it relaxed restrictions, according to Dr Anurag Agarwal, former head of India’s genome sequencing consortium.

The world is concerned because in China, the BF.7 variant spread like wildfire, sweeping through more provinces in less than a week, as it is highly infectious with a shorter incubation period (one to two days), higher transmissibility rate (10 to 18 times more). This variant quickly bypasses the body’s immunity to the virus, whether it is due through previous infection or vaccination. Hence there is a higher likelihood of this variant spreading and replacing other variants to become the dominant strain. This has been predicted by WHO because it spreads to a larger number of people within a short period.

The rise of mutant variants in above mentioned countries, may cause a fresh surge of infections in India, which is a cause of concern for the Government. Rightfully, public health experts in India have advised caution considering this recent surge of cases. The BF.7 variant has been detected in India too, as early as October 2022. However, it is the BA.5 lineages, which have accounted for 2.5% cases in November 2022.

Currently the most common variant in India is XBB, accounting for 65% cases last month, according to the National SARS-COV2 genome sequencing data. Also, till date, the Omicron variant has not had any devastating impact in India, unlike in other countries. Until today, four cases of F.7 have been detected, quoted Dr Madhavi Joshi, senior scientist at Gujarat Biotechnology Research Centre.

Is BF.7 dangerous?

BF.7 reportedly has enhanced immunity evasion in comparison to its parental Wuhan strain. This means that people who have been infected before or have taken the COVID-19 vaccines can get infected with BF.7. An index case of Alpha variant had the potential to infect four to five individuals, Delta had the potential to infect six to eight individuals, and BF.7 can infect 10 to 18.6 individuals.

The elderly, comorbid, immune compromised, unvaccinated and those without a precautionary dose are more vulnerable to get infected, with the risk of prolonged COVID or complications. Fortunately, the Omicron variant is not causing pulmonary fibrosis (at a later stage), as it did with the Delta variant.

What are symptoms of BF.7?   

The symptoms associated with the BF.7 sub-variant are similar to other sub-variants of Omicron like headache, persistent cough, changes in sense of smell, chest pain, hearing loss and shivering. One should also be cautious of other COVID symptoms such as abdominal pain, vomiting, diarrhoea, runny nose, sore throat and fatigue.

How can we address this current challenge?

A collective responsible approach is feasible only when each of the stakeholders: mentioned below will perform their respective roles.

YOUR CRUCIAL ROLE

TEST, TREAT, ISOLATE, TRACK, VACCINATE and follow Universal CAB Test early (do not wait as incubation period is very short) by RTPCR  on day one or two of symptoms; so that genome sequencing can be done of the positive cases.

If positive, isolate and consult your personal physician for treatment. If you have met other colleagues/individuals, track them immediately and keep them informed to be on alert for symptoms.

Those not vaccinated can take the precautionary dose of Bharat Biotech’s nasal vaccine (will be available as four drops in each nostril once only), irrespective of receiving Covisheild or Covaxin as primary immunisation. An excellent news: Drug Controller General of India has granted emergency use authorisation to Bharat Biotech’s nasal COVID-19 vaccine for primary vaccination (for those not received any vaccine earlier) and for heterologous booster (if earlier received 2 doses of either Covisheild or Covaxin). The advantage of this vaccine is that it can prevent transmission of COVID-19 disease (not just disease severity, as observed with previous vaccines) because it also acts on the nasal mucosa. One can book their doses from 23rd Dec 2022 onwards on the Cowin App. Currently, it will be available at private hospitals and the pricing is yet to be decided. It could prove to be a game changer soon if it successfully prevents transmission of disease.   

UNIVERSAL CAB (Covid Appropriate Behaviour): PREVENTION PRECAUTIONS FOR ALL: 

We sincerely appeal for people to wear masks and behave responsibly (to protect oneself and those who are close to you from all circulating viruses), whether mandatory or not.  

Avoid large gatherings in enclosed small spaces (indirectly implies ensuring premise ventilation by keeping carbon dioxide levels at 800 parts per million) and switch over to virtual platforms for national and international meetings; by restricting travel where feasible.

Practise sanitisation etiquette (personal and hand hygiene) and wherever possible maintain a one-metre social distancing.

If symptomatic, stay at home, consult your personal physician, hydrate well, along with adequate vitamin intake.

Commercially available nitric oxide nasal spray; three to four inhalations in each nostril, sprayed hourly, can inhibit the virus replication if one gets COVID-19. This should be started immediately after testing positive to reduce disease severity.

ROLE OF THE CENTRAL GOVERNMENT

Directives have been sent to all airports to randomly test 2% of all international travellers coming to India - to undertake RTPCR testing for Rs 3000 at the airport itself. Also, all international travellers arriving into India MUST BE FULLY VACCINATED.

Ramp up vaccination boosters as a sizable population has not been vaccinated with the precautionary booster dose. Assist in deploying Bharat Biotech’s nasal vaccine to all states for precautionary booster dose. Currently, it will be available at private hospitals. It could be made available at public hospitals at the earliest.

ROLE OF THE STATE GOVERNMENTS AND LOCAL HEALTH DEPARTMENTS

Ramp up COVID-19 testing and speedily send positive samples for genome sequencing at the earliest to keep a vigil on BF.7

Focus on ramping up test, treat, track, isolate and vaccinate protocol of the Ministry of Health with continuous monitoring and surveillance.

ROLE OF YOUR WORKPLACE ORGANISATION

Judiciously advocate administrative directives including:

1. a) wearing mask on premises and its proper disposal
2. b) Practise surface sanitisation (with hypochlorite) of the premises and hand hygiene.
3. c) For a minimum period of 60 days, consider encouraging virtual meetings and avoid international travel especially to Japan, South Korea, Brazil, areas of Europe and USA where BF.7 cases are currently on the rise). For national travel: decisions could be based on results of genome sequencing. Avoid large gatherings (conferences, symposia) and enclosed small spaces with poor ventilation. With portable CO2 meters monitoring, ensure that the levels are below 800 parts per million by real time spot (available on Amazon) or continuous surveillance.
4. d) Ensure social distancing of 1 metre as far as convenient.
5. e) Encourage work from home. If an employee or family member is having symptoms or is positive, they can resume work after 7 days, without retesting (but with a declaration).
6. f) Organisation can decide for themselves with proactive business policy on their radar for their employee & workplace safety

WHAT SHOULD WE EXPECT AS WE GO AHEAD?

Prohibiting entry (mandatory quarantine) of all visitors if they have visited China in the last 14 days should be advocated by the Central Government.

As China will be witnessing lots and lots of infections; it will be very important to keep a watch on the new variants that will be developing there from now on, as it will help us to become more vigilant in mitigating the spread in India.

In 2023, we all should undertake a complete health check-up (wellness risk assessment) with sugar, cholesterol, kidney, liver, blood pressure, body mass index, mobility status and a mental health evaluation - for your baseline health parameter values. Subsequently we all must control as well as improvise these parameter values for achieving holistic wellness excellence for ourselves and our near and dear. Hydrate well (as COVID dehydrates) with liquids, nourish well with a balanced diet, Vit C and Vit D supplements.

Vis-a-vis exercising and going to the gym, please do a complete cardiac evaluation before undertaking strenuous workouts. Hydrate well during exercise, and after your workout please do incorporate protein supplements for your muscles and warm clear soups to up your hydration, calorie control and cardiovascular protection.