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Delta is a SARS-CoV-2 variant of concern globally. Delta Plus, with an additional mutation, is a VoC (Variant of Concern) in India. On Monday, the central government gave an update on the Delta Plus variant of the coronavirus, saying it is present in 12 states.
According to the report by the ICMR, 51 cases of the variant have been identified from more than 45,000 samples collected during April, May and June, and that the Delta Plus variant is very localised in the country.
The first case of the Delta Plus variant of COVID-19 was detected in Jammu and Kashmir. The Union Health Ministry has advised Maharashtra, Kerala and Tamil Nadu that the Public Health Response measures should be more focused and effective and to take up immediate containment measures in the districts. Apart from India, the Delta Plus Variant has also been detected in nine countries, including UK, Portugal, Switzerland, Poland, Japan, Nepal, China, and Russia. The Delta Plus variant was first found in Europe .
Experts also warned that Delta Plus might show resistance against monoclonal antibodies cocktail treatments such as the Roche and Cipla ones marketed in India. However, there is no proof to suggest that this variant could be more transmissible than others. Whether Delta Plus can beat pre-existing immunity better than earlier variants is yet to be understood .
Reports suggest that the new variant may bypass immunity provided by both vaccine and earlier infection. The two Indian vaccines, Covaxin and Covishield, have shown 3 to 8 times less efficacy against Delta and Beta, reports said. Just over 4 per cent of Indians are fully vaccinated, and about 18 per cent have received one dose so far. And if the speed doesn't pick up, millions will still be vulnerable. However, immunity from past COVID infections can protect people, pointed out experts .
In a COVID Media Briefing held by the Health Ministry on 25 June 2021, Secretary, Department of Biotechnology; Director-General, Indian Council of Medical Research; and Director, National Centre for Disease Control have answered many questions about the Delta and Delta Plus variants of the SARS-Cov-2 virus.
Let's take a look.
Delta And Delta Plus Variants: Frequently Asked Questions
1. What are Delta and Delta Plus variants?
These are the names given to variants of the SARS-CoV-2 virus, based on their mutations. WHO has recommended using letters of the Greek Alphabet, i.e., Alpha (B.1.1.7), Beta (B.1.351), Gamma (P.1), Delta (B.1.617), etc., to denote variants.
Delta variant, also known as SARS-CoV-2 B.1.617, has about 15-17 mutations. It was first reported in October 2020. More than 60 per cent of cases in Maharashtra in February 2021 pertained to delta variants.
It is the Indian scientists who identified the Delta Variant and submitted it to the global database. Delta variant is classified as a Variant of Concern and has now spread to 80 countries, as per WHO.
Delta variant (B.1.617) has three subtypes, B1.617.1, B.1.617.2 and B.1.617.3, among which B.1.617.1 and B.1.617.3 have been classified as Variant of Interest, while B.1.617.2 (Delta Plus) has been classified as a Variant of Concern.
The Delta Plus variant has an additional mutation compared to the Delta variant; this mutation has been named the K417N mutation. 'Plus' means an additional mutation has happened to the Delta variant. It does not mean that the Delta Plus variant is more severe or highly transmissible than the Delta variant.
2. Why has the Delta Plus Variant (B.1.617.2) been classified as a Variant of Concern?
The Delta Plus variant has been classified as a Variant of Concern because of the characteristics such as increased transmissibility, stronger binding to receptors of lung cells, potential reduction in monoclonal antibody response and potential post-vaccination immune escape.
3. What are Variants of Interest (VoI) and Variants of Concern (VoC)?
When the mutations happen - if there is any previous association with any other similar variant that is felt to impact public health - then it becomes a Variant under Investigation.
Once genetic markers are identified with an association with receptor binding domain or which have an implication on antibodies or neutralising assays, we start calling them Variants of Interest.
The moment we get evidence for increased transmission through field-site and clinical correlations, it becomes a Variant of Concern. Variants of concern are those that have one or more of the characteristics such as:
- Increased transmissibility.
- Change in virulence/ disease presentation.
- Evading the diagnostics, drugs and vaccines.
- Random error during replication of the virus
- Immune pressure faced by viruses after treatments such as convalescent plasma, vaccination or monoclonal antibodies (antibodies produced by a single clone of cells with identical antibody molecules)
- Uninterrupted transmission due to lack of COVID-appropriate behaviour. Here the virus finds an excellent host to grow and becomes fitter and more transmissible.
The 1st Variant of Concern was announced by the UK, where it was found. Currently, the scientists identified four variants of concern - Alpha, Beta, Gamma and Delta.
4. Why are frequent mutations seen in the SARS-CoV-2 virus? When will the mutations stop?
SARS-CoV-2 can mutate due to the following reasons:
The virus will continue to mutate as long as the pandemic remains. This makes it all the more crucial to follow COVID appropriate behaviour.
5. Do COVISHIELD and COVAXIN work against the variants of SARS-CoV-2?
Yes, COVISHIELD and COVAXIN are both effective against the Alpha, Beta, Gamma and Delta variants. Lab tests to check vaccine effectiveness on Delta Plus Variant are ongoing.
Delta Plus Variants: The virus has been isolated and is being cultured now at ICMR's National Institute of Virology, Pune. Laboratory tests to check vaccine effectiveness are ongoing, and the results will be available in 7 to 10 days. This will be the first result in the world.
6. What is the impact of mutations?
The normal process of mutations begins to impact us when it leads to changes in transmission levels or treatment. Mutations can have positive, negative or neutral effects on human health. Negative impacts include clustering of infections, increased transmissibility, ability to escape immunity and infect someone who has prior immunity, neutralisation escape from monoclonal antibodies, improved binding to lung cells and increased severity of infection.
Positive impacts can be that the virus becomes non-viable.
7. Why does a virus mutate?
Virus by its very nature mutates. It is part of its evolution. The SARS-Cov-2 virus is a single-stranded RNA virus. So, changes in the genetic sequence of the RNA are mutations. The moment a virus enters its host cell or a susceptible body, it starts replicating. When the spread of infection increases, the rate of replication also increases. A virus that has got a mutation in it is known as a variant.
8. What is the trend of Variants of Concern circulating in India?
As per the latest data, 90 per cent of samples tested have been found to have Delta Variants (B.1.617). However, the B.1.1.7 strain, which was the most prevalent variant in India in the initial days of the pandemic, has decreased.
9. Why public health action is not taken immediately after noticing mutations in the virus?
It is not possible to say whether the mutations noticed will increase transmission. Also, until there is scientific evidence that proves a correlation between the rising number of cases and variant proportion, we cannot confirm a surge in the particular variant. Once mutations are found, analysis is made week on week to find any such correlation between the surge of cases and variant proportion. Public health action can be taken only after scientific proofs for such correlation are available.
Once such correlation is established, this will help prepare in advance when such a variant is seen in another area/region.
10. What does a common man do to protect them from these Variants of Concern?
One must follow COVID Appropriate Behaviour, which includes wearing a mask properly, washing hands frequently and maintaining social distancing.
The second wave is not over yet. It is possible to prevent a third big wave provided individuals and society practise protective behaviour.
Further, Test Positivity Rate must be closely monitored by each district. If the test positivity goes above 5 per cent, strict restrictions must be imposed.
11. What are the public health interventions being carried out to tackle these variants?
The public health interventions needed are the same, irrespective of the variants. The following measures are being taken:
- Cluster containment
- Isolation and treatment of cases
- Quarantining of contacts
- Ramping up vaccination
- International passengers (during the beginning of the pandemic)
- Community surveillance (where RT-PCR samples report CT Value less than 25)
- Sentinel surveillance - Samples are obtained from labs (to check transmission) and hospitals (to check severity)
12. Do public health strategies change as the virus mutates and more variants arise?
No, public health prevention strategies do not change with variants.
13. Why is continuous monitoring of mutations important?
Continuous monitoring of mutations is important to track potential vaccine escape, increased transmissibility and disease severity.
14. How often are these mutations studied in India?
Indian SARS-CoV-2 Genomics Consortium (INSACOG), coordinated by the Department of Biotechnology (DBT) and Union Health Ministry, ICMR, and CSIR, monitors the genomic variations of SARS-CoV-2 regularly through a pan India multi-laboratory network.
It was set up with 10 National Labs in December 2020 and has been expanded to 28 labs and 300 sentinel sites from where genomic samples are collected. The INSACOG hospital network looks at samples and informs INSACOG about the severity, clinical correlation, breakthrough infections and re-infections.
More than 65,000 samples have been taken from states and processed, while nearly 50,000 samples have been analysed, of which 50 per cent have been reported to be Variants of Concern.
15. On what basis are the samples subjected to Genome Sequencing?
Sample selection is made under three broad categories:
When there is any public health impact noticed because of genetic mutation, then the same is monitored.
On A Final Note…
Experts continue to stress the importance of taking up necessary COVID-19 measures and speed up testing, tracking and vaccination, as the number slowly but surely continue to rise.