Why the Indian COVID mutation should worry Israelis - analysis

The Indian variant is a “double mutation.” One aspect of it appears to make the virus more infectious.

People on Jaffa Street in Jerusalem, during Israel's third nationwide lockdown, Sunday, January 10, 2020. (photo credit: MARC ISRAEL SELLEM)
People on Jaffa Street in Jerusalem, during Israel's third nationwide lockdown, Sunday, January 10, 2020.
(photo credit: MARC ISRAEL SELLEM)
Should the seven cases of the Indian variant identified at Ben-Gurion Airport worry Israel?
On Sunday, citizens removed their masks in outdoor settings, but in other countries, even where vaccination campaigns have reached similar levels, cases are surging – driven in part by new hyper-infectious variants.
Chile is leading the Western Hemisphere in vaccinations per capita with more than seven and a half million people who have had at least one dose, among them five million who are fully vaccinated. Yet, daily cases are hitting as high as 8,000 – beating the country’s own previous peaks.
In India, where more than three million people are getting the jab each day, cases have topped 200,000 a day.
“In the US, as in many parts of the world where there are ongoing vaccination efforts, we are continuing to see increasing cases and hospitalizations caused by the relaxation of prevention protocols, the rise in COVID-19 variants and the increasing burden on health-care systems,” Anne Schuchat, principal deputy director of the Centers for Disease Control and Prevention, told Bloomberg.
“We are not done with the corona yet, because it can come back,” Prime Minister Benjamin Netanyahu said Sunday.
Health officials believe that a core cause of the latest outbreak in India is tied to a new “double mutation,” the same one brought into the country by seven people, the Health Ministry said over the weekend.
Variants, of course, are not uncommon.
“If you deal with viruses and study viruses and mutations, you should not be surprised about mutations,” said Tel Aviv University Prof. Noam Shomron. “Viruses change and mutate all the time.”
But just because something is usual does not mean we shouldn't be concerned about it, he warned.
“It is concerning because this has a direct effect on the global pandemic,” Shomron said – and it could also cause an escalation in Israel.
THERE ARE three reasons why health officials pay attention to variants. First, because they could be more infectious, like the British variant. Second, they could cause a more severe case of the disease. And third, they could break through the existing immunity that has been developed through infection or vaccination.
Israel, where the majority of high-risk people are inoculated, has to focus on whether or not a particular variant could be vaccine-resistant and thereby infect people who believe they are protected – potentially harming the country’s vaccination campaign.
“I don’t want anyone to panic,” Shomron said. “On the other hand, we have to check and make sure our vaccines can stand up to the Indian mutation or any other mutation.”
While it is premature to categorize the Indian variant as a major concern, it is a variant under investigation, explained Prof. Cyrille Cohen, a member of the advisory committee for clinical trials on SARS-CoV-2 vaccines at the Health Ministry and head of the laboratory of tumor immunology and immunotherapy at Bar-Ilan University.
The new variant, classified as B.1.617, is thought to be connected to India’s new and more deadly wave of COVID-19 infections. Today, the variant accounts for more than 50% of infections there, whereas only a few months ago it accounted for almost none. Cohen said that in some provinces that percentage is as high as 70%.
Moreover, the variant has been found in more than 10 countries from Australia and Belgium to the UK and the US, according to the Indian government.
As mentioned, the Indian variant is a “double mutation.” Cohen said that one aspect of the double mutation appears to make the virus more infectious. The other could allow the virus to break through and infect people who were already sick with coronavirus or even those who were vaccinated.
INDIAN OFFICIALS have said the country’s second wave is due to a mix of factors, the variant being only one of them. Wedding gatherings, public complacency and gatherings for election campaigning in four large states have also led to the spike. India’s medical authorities are doing genome sequencing to determine whether there’s a strong correlation between this variant and positive cases.
Shomron said he “hopes and believes” that the Pfizer vaccine will likely prove at least somewhat effective against the variant, which was caught early and has therefore not yet spread throughout Israel.
“The Pfizer vaccine might be less effective against the Indian variant than it is against the common variant – and that means we have to be very careful," he said. "If we pass a certain point in time where the virus spreads out, it could become impossible to contain it.”
He recommended further study of the variant, keeping in mind that while the mutation has been named the “Indian variant,” a person could be infected elsewhere and carry it into the country.
Israel is slated to open its airports to foreign tourists beginning May 23. While most health officials say this is the correct move for Israel, Cohen said that still, “it is concerning to some extent.”
“You increase chances of importing new variants when opening,” he said.
COHEN RECOMMENDED that Israel only allow vaccinated people to enter the country and that it continues to limit daily travel. At its peak, Ben-Gurion Airport could see around 100,000 to 150,000 travelers a day, Cohen said. So far this month, Israel has had an average of 11,000 Israelis and foreigners entering or exiting the country per day, according to data released by the Administration of Border Crossings, Population and Immigration.
He said the Health Ministry should also ensure that not only can they test people who enter Israel but also track them, since people could test negative at the airport but later be found to be positive for coronavirus. One idea would be to use a rapid antigen in addition to the standard PCR test at the airport to get a faster indication of possible contamination.
And, of course, quarantine – when required – would need to be enforced.
“There are a lot of questions we need to answer – and if we don’t get all the answers, we could jeopardize the success of our vaccination campaign,” he said.
Just look at what is happening in Chile, where the Brazilian variant, which is known to have a 20% to 30% reinfection rate, is spreading. Analysts believe Chile’s surge in coronavirus cases is due to a combination of public complacency, vacation travel, international travel and its use of less effective Chinese vaccines. Most of its population was vaccinated with China’s Sinovac, which Chile reported is just slightly over 50% effective against COVID-19.
Until this month, the country’s main airports remained open to foreigners, letting in variants from Brazil, Britain, Nigeria and California, Chile’s Health Ministry said.
As such, while Israelis takes off their masks, Cohen said it is too early to assume the virus is over for the Jewish state.
“No one can predict the future,” said Dr. Nadav Sorek, the clinical microbiology lab manager at Samson Assuta Ashdod Hospital. “We all want to know what is going to happen in the fall – or even in the next few weeks and months – but we really don’t know.”
He said the Indian variant should remind Israel that “we have to be alert, keep track, be very aware and not think we beat the virus and that it is not going to come back.
“The main lesson we need to learn from this past year,” he continued, is “to be very careful in our predictions, analyze the data and make decisions – not based on wishful thinking and what we want to happen, but on scientific evidence.”