All pandemics settle with less frequent oscillations, says Dr Gagandeep Kang on how long will COVID-19 continue

Dr Gagandeep Kang is one of India’s foremost virologists and member of the COVID-19 Working Group under the National Technical Advisory Group on Immunisation. She holds the distinction of being the first Indian woman to become a Fellow of the Royal Society. In a conversation about the course of the COVID-19 pandemic in India, she said that while the worst of the Omicron-fuelled surge may be behind, existing vaccines against the coronavirus need to be refined to offer better protection. Dr Kang believes that despite the surge in infections during the third wave, India has done relatively well thanks to the high vaccination coverage and previous history of infections. Here are some excerpts from her interaction with Moneycontrol: Given that the third COVID-19 wave in India, fuelled by the Omicron variant, seems to be plateauing, can we say that the worst is behind us? For this wave, the descent has started and we hope that the tapering will be rapid. There is a lag of severe disease behind acute cases, but it is unlikely to be beyond the capacity of the health system. The number of hospitalisations as well as deaths due to COVID-19 infections this time round have been far lower than in the Delta wave. Is this because of the nature of the variant or vaccination/hybrid immunity? What can we say conclusively? Conclusively, we can say that prior exposure and vaccination helped in reducing severe disease. We have done better than many other countries with different age structures, infection histories and vaccination coverage. Is the omicron variant less severe than Delta? Based on the limited data on disease severity in unvaccinated, uninfected individuals, it appears a little less severe; but it is likely that the bulk of the reduction in severity is because of infection or vaccination. The way this ongoing wave has played out in India, do you think there was an element of surprise as compared to the recent waves in several European countries and the US? Not really, we expected a situation more similar to South Africa than Europe or the US and it has played out that way, thankfully. Some countries are reporting that the BA 2 sub-lineage of Omicron, which is even more transmissible than BA 1, is causing a fresh rise in COVID-19 cases. What do we know about this strain and what implications could it have on the pandemic trajectory locally? We know that it grew rapidly as a proportion of cases in Denmark, India and the UK, and is still growing. At the moment we do not have any evidence of either increased transmissibility or increased severity, but the question of whether it is increasing because of better immune escape needs to be investigated urgently. The consequences of a more rapid spread are that greater numbers of people will be infected or reinfected, which is always a concern for the clinically vulnerable. Also, we need to remember that a variant with increased immune escape could give rise to future, more concerning variants as well, so tracking is essential. It is now obvious that new variants of the COVID-19 virus are emerging every few months and triggering fresh waves of infections. Do viruses have an indefinite capacity to keep mutating? How long do you think this pandemic will continue? RNA viruses can mutate forever. We have the common cold coronavirus, which still mutates, but the question is how often will the mutations have clinical consequences? That is unpredictable. There is still room for greater transmissibility and greater immune escape, and greater severity, but whether we will see a virus with all three attributes is unknown. All pandemics settle with less frequent oscillations. We are in the middle of a cholera pandemic — does the world know? What are your views on COVID-19 vaccine booster doses in a country like India? What data and parameters should be taken into consideration before booster doses are offered to people? This needs a really long answer, but briefly, the vaccines we have now are great but are the first phase of vaccines. We need to either make new vaccines or have vaccination strategies that give more durable protection to the most vulnerable populations. I don’t think we have reached the limit of the protection that vaccines can give us yet.