GS Paper: GS3-17.Awareness in the fields of IT, Space, Computers, Robotics, Nano-technology, Bio-technology and issues relating to Intellectual Property Rights.

In early March, members of the Indian SARS-CoV-2 Genomic Consortia (INSACOG), an advisory group to the Central government, warned of a new and contagious form of the novel coronavirus.

What is INSACOG?

• INSACOG is a consortium of 10 labs across the country tasked with scanning COVID-19 samples from swathes of patients and flagging the presence of variants that were known to have spiked transmission internationally.
• It has also been tasked with checking whether certain combinations of mutations were becoming more widespread in India.
• Some of these labs had begun scanning for mutations in April 2020 itself, but it was not a pan-India effort.
• The institutes involved were laboratories of the Department of Biotechnology, the CSIR, the ICMR, and the Ministry of Health & Family Welfare (MoHFW).
• The National Centre for Disease Control (NCDC) under the MoHFW was tasked with coordinating the collection of samples from the States as well correlating disease with the mutations.
• The work began in January by sequencing samples of people who had a history of travel from the United Kingdom and a proportion of positive samples in the community.

What are the findings?

• The “foreign” variants identified were primarily the B.1.1.7 (first identified in the United Kingdom) and the B.1.351 (first found in South Africa) and a small number of P2 variants (from Brazil).
• However, some labs flagged the growing presence of variants identified in India that were clubbed into a family of inter-related variants called B.1.617, also known as the ‘double mutant’ variant.
• It was primarily due to two mutations — E484Q and L452R — on the spike protein.
• The B.1.617 family was marked as an international ‘variant of concern’ after it was linked to a recent spike in cases in the UK.
• INSACOG labs also found that the B.1.1.7 variant, which is marked by increased infectivity, is distinctly more prevalent in several northern and central Indian States in comparison to southern States.

Beyond identifying patterns, why is genome sequencing useful?

• The purpose of genome sequencing is to understand the role of certain mutations in increasing the virus’s infectivity.
• Some mutations have also been linked to immune escape, or the virus’s ability to evade antibodies, and this has consequences for vaccines.
• Labs across the world, including many in India, have been studying if the vaccines developed so far are effective against such mutant strains of the virus.
• They do this by extracting the virus from COVID-19-positive samples and growing enough of it. Then, blood serum from people who are vaccinated, and thereby have antibodies, is drawn.
• Using different probes, scientists determine how much of the antibodies thus extracted are required to kill a portion of the cultured virus.
• In general, the antibodies generated after vaccination — and this was true of Covaxin, Covishield, Pfizer and Moderna jabs — were able to neutralize variants.
• Antibody levels are not the only markers of protection and there is a parallel network of cellular immunity that plays a critical role in how vaccines activate immunity.
• The current evidence for most COVID-19 vaccines is that they have almost 75% to 90% efficacy in protecting against disease but less so in preventing re-infection and transmission.

Challenges faced by INSACOG

• Given that the novel coronavirus is spreading, mutating, and showing geographical variations, the aim of the group was to sequence at least 5% of the samples.
• For many reasons, this has so far been only around 1%, primarily due to a shortage of funds and insufficient reagents and tools necessary to scale up the process.
• While some of these issues, the INSACOG, in spite of being peopled by expert scientists, is ultimately an advisory group to the Central government and part of its communication structure.
• Warnings about emerging variants were not made public with sufficient urgency and the sharing of datasets, even within constituent groups of the INSACOG, was less than ideal.

About mucormycosis

• Mucormycosis is a fungal infection that has a high mortality rate of 50 per cent.
• An increasing number of Covid-19 patients have been developing this infection while still at the hospital or after discharge.
• The disease often manifests in the skin and also affects the lungs and the brain.
• Some of the common symptoms include sinusitis, blackish nasal discharge, facial pain, headaches, and pain around the eyes.

Who is at risk

• Patients who have been hospitalised for Covid-19 and particularly those who require oxygen therapy during Covid-19 illness are at a much higher risk of mucormycosis.
• However, there are some cases of mucormycosis in patients with asymptomatic Covid-19 infection.
• Before the pandemic, patients with uncontrolled diabetes were at a higher risk of mucormycosis.
• The risk of mucormycosis rises for these patients for two reasons.
• First is that Covid-19 further impairs their immune system.
• Second, they are given corticosteroids for their treatment it leads to a rise in their blood sugar level thus increasing their risk of mucormycosis.

Treatment

• Today, we have a number of drugs and anti-fungal medicines that can treat mucormycosis.
• These are given by IV or taken orally.
• Surgery is needed to remove the affected dead tissues along with antifungal therapy.