The health system should be resilient: Soumya Swaminathan 

Inputs of Chief Scientist of World Health Organisation (WHO) and chairperson of MSSRF, Chennai, Soumya Swaminathan on COVID-19 cases’ surge and the State’s role

Former Chief Scientist of World Health Organisation (WHO) and chairperson of MSSRF, Chennai, Soumya Swaminathan says

On the present surge:

The current surge is caused by the XBB series of Omicron lineages with new mutations that have advantages in transmission ability. The concern is that every time infections go up, there is a chance of more people falling sick and some of them needing hospitalisation or dying of severe infection. There may also be some waning of antibody responses a year after the last vaccine dose which could be fuelling this rise; however, we believe that T cell-mediated immunity that protects against severe disease is longer lasting.

The new XBB lineages have some new mutations that allow antibody evasion and better binding to receptors, especially in the upper respiratory tract. There does not seem to be any data indicating increased clinical severity.

What the State should focus on:

All States should ensure that the health system has enough resilience to be able to cope with an increase in hospitalisations due to severe lower respiratory infection or pneumonia (due to a number of different viruses circulating now), without affecting routine care and essential services. Diagnostic services should be made widely available through government clinics and data on hospitalisations due to influenza-like illness and severe acute respiratory infection regularly analysed and reported.

Daily numbers being reported are currently under-estimates as a lot of testing is happening in homes with no reporting. A subset of samples should be sequenced to keep track of virus evolution — this genomic data needs to be correlated with clinical and epidemiological trends. Communication to the public is key — when people should test, where they can go, what precautions to use, what drugs to take or not to take. There is a lot of misuse and overuse of antibiotics. Hopefully, we will not see the misuse of corticosteroids we saw last time, especially in the private sector and by self-prescribing.