We are on learning curve how to fight the fast mutating SARS-CoV-2. Fast vaccinations, recoveries, social distancing, face masks and lockdowns can turn the tide. Second virus wave has lead to acute shortage of oxygen in India. Coronavirus deaths overwhelmed crematorium pyres as well as graveyards.
United States, United Kingdom and Germany started sending oxygen, tests, treatment, PPE, concentrators, ventilators, oxygen supplies and medical aids to India when daily covid-19 cases surpassed 350,000 in second wave. Imran Khan prayed for earlier recoveries, Edhi Foundation and Government offered ambulances, digital x-ray machines, oxygen supplies and medical aids to deal with rampant rise in Covid-19 cases. Russia and China also declared to send medical aid to India [Ciara 2021, Geeta 2021; Reuters 2021; Ayaz 2021, AFP 2021, CNN 2021].
World has long been fearing from nuclear wars and preparing for visible enemies but they were forced to confront a biological war with an invisible enemy. Coronavirus attacks after entering into our bodies so the major defense shield is to let it not come near us and vaccinate to alert our internal immune system. You need face masks and sanitizers to cope with this tiny metamorphosing enemy.
Single stranded RNA and double stranded DNA refer to virus and bacteria. A virus is an inanimate infectious agent that can replicate in living cells of other organisms. A virus may be single or double stranded yet coronaviruses are single stranded genetic materials. Various viruses can affect all forms of life i.e. plants, animals, humans and avian species. Bats are host of many types of viruses.
Genetic sequencing technologies determine changing molecular structures by comparing it with original composition to characterize the variants. There can be hundreds of thousands of new strains yet a few of them possess traits which dodge the antibodies inoculated against the original virus. SARS-CoV-2 genome sequencing reveals nine nucleotide variations compared with the reference Wuhan strain (NC-045512). Genetic study shows G614 variant with D614G mutation were common in middle of July 2020 in Pakistan [Umair 2021]. G614 variant with D614G mutation cannot escape host immune system. However, a study in Karachi University finds 50% to 54% Covid-19 cases, at end of 2020 and start of 2021, were due to UK, SA and Brazil variants in Karachi [Faiza 2021].
Severe acute respiratory syndrome coronavirus (SARS) is a viral respiratory disease which was first detected in China in February 2003. Middle East respiratory syndrome (MERS) is a viral respiratory disease which was first detected in Saudi Arab in 2012. SARS-CoV and MERS-CoV were airborne viruses which used to spread through small droplets of saliva in a similar way to the cold and influenza [Zhu 2020]. Flu mutations require pharmacists to update antibodies every year.
Coronavirus disease 2019 (Covid-19) was caused by single stranded RNA virus. Coronaviruses are divided into four genera namely alpha, beta, gamma and delta coronaviruses. First two type affect animals and last two affect birds. However, six types coronaviruses, HCoV-NL63 and HCoV-229E (alpha), HCoV-OC43, HCoVHKU1, SARS-CoV and MERS-CoV (beta) and now seventh SARS-CoV-2 (beta) can jump from horseshoe bats, camels and pangolins to humans. SARS-CoV-2 has zoonotic origin [Hu 2021].
SARS-CoV-2 is also a viral respiratory disease which was detected in Wuhan China at end of 2019. All these viral diseases transfer to humans from certain species of wild animals like bats and camels [Ben 2015]. SARS-CoV and MERS-CoV epidemics evaporated in a couple of years yet SARS-CoV-2 is on steady rise. Dirty secret of rampant rise of SARS-CoV-2 is its fast mutation speed compared to vaccines rates.
“ A genetic mutation is characterized by a permanent change in a DNA sequence that may occur due to environmental factors (UV radiation), or due to an error during the DNA replication process. Genetic mutations can be of many types, including missense, nonsense, insertion, deletion, duplication, frameshift, and repeat expansion mutations. In general, viruses can undergo frequent genetic mutations because of several factors, such as natural selection and random genetic drifts. D614G mutation was dominant form of coronavirus in early 2020.”
Screening and sequencing helps identify victims as well as variants which are causing the diseases. CDC and PHL have detected 240,000 variants out of which 120 were detected in KU. Every month 13,000 to 14,000 new sequences are being reported worldwide. Total number of sequences were 260,860 on 11 April 2021 (GISAID). There are many variants out of which UK variant, Brazilian variant, South African variant, Californian variant, Indian double (B.1.617) and triple (B.1.618) mutant variants are deemed deadlier than others. A few researchers also claim quadruple and quintuple variants as virus can have multiple mutations [Michelle 2021, Cheryl 2021].
Several new SARS-CoV-2 mutations on spike protein have been reported around the world, including one that originated from UK (B.1.1.7), South Africa (B.1.351), Brazil (P.1 and P.2), West Coast United States (B.1.427 and B.1.429), Indian double mutant B.1.617 (E484Q and L452R) and triple mutant B.618 (E484K, H146del and Y145del). A variant escaping detection by immune system can neutralize antibodies, spread faster (L452R) or infect more. B.1.617 had another mutation P681R and triple variant has V383I mutation. South African variant (B.1.351) has three mutations (E484K, N501Y, and K417N). Brazilian variant P.1 also has three mutations (N501Y, E484K, and K417T) where last K417T increases its capability to attach to human cells. P.2 has only (E484K) mutation. [Sandhya 2021]. Pakistani faced G614 variant in earlier waves and experiencing UK variant in 50% cases in third wave. Indian double mutant variant is claimed to be mix of UK, South African and Californian variants. However, virologist claim it is UK variant (B.1.1.7) which should not be called double mutant [Michaileen 2021].
Covid-19 first reached in Europe in West, then in Americas in North, and then Australia in East and finally Antarctica in South. Hong Kong is facing 5th wave [Michael 2021]. We are safe when everybody is safe. Bear in mind evils and diseases are similar things, and we should nip both vices in their buds. However, it is noted the number of daily new cases rise rapidly during political instabilities. Indian negligence in Kumbh festival, election campaigns and land reforms protests have worsened situation. Best solution is vaccines which cover all types of variants.
British Covid-19 variant (B.1.1.7) reached in 18-19 Indian states and Indian double mutant (B.1.617) variant has reached UK and USA [Leah 2021, Alexa 2021]. Brazilian, British, South African and Indian double mutant viruses have reached United States as well as back to China [Erin 2021, Shanghai 2020]. Ground zero may become safe like China as zero patients recover and infected victims die. Chinese response to Covid-19 in terms of strict lockdown, vaccinations, research and economic recoveries is appreciated worldwide. Sino VAC vaccines have high efficacy without any blood clot incidences.
Daily new Covid-19 cases have surpassed 300,000 in India. This number might be under estimate as 1 in 3 to 1 in 3 (25% to 33%) test results are covid-19 positive. Covid-19 cases are rising almost vertically. Funeral pyres of Covid-19 deaths have been converted into crematorium for mass cremation. In second wave, India neither postponed elections and Hindu festivals, nor negotiated Sikh farmers. These crowds have contributed to rise of coronavirus cases. Indian fragile health system is on verge of failure as system is unable to supply surplus medical grade oxygen. Haphazard decisions killed two dozen people by leakage of oxygen. On 22 April 2021, doctors in gave an emergency call of 45-minute oxygen left in Indian hospitals after which it would hard to save patients. Indian police escorts oxygen cylinders to hospitals from risk of being stolen on roads. There have been seen several fight incidents of oxygen. India can control the spread by vaccinating faster than SARS-CoV-2 transmission rate [Aniruddha 2021, Andrew 2021].
Indian Covid-19 Tsunami has surpassed world record in daily new Covid-19 cases. Many people are dying with strokes without showing any covid-19 symptom in India. PCR and LFT tests hardly miss any Covid-19 positive victim, yet, Dr. Shahid claimed in TV a new variant in Pakistan is affecting children with all covid-19 symptoms without shout positive. USA had also reported some cases in 2020 which were doubted to be Kawasaki disease that causes inflammation of coronary arteries [Andrew 2020]. It was believed earlier that Children show positive without any covid-19 symptoms. It means it can happen other way around too, the toddlers show negative and have Covid-19 symptoms. However, children with prolonged abdomen pain or fever should keep on consulting doctors.
Global covid-19 cases are increasing at an average rate of 500,000 per day. New cases peaked at 845,223 in 4th wave compared to 844,553 cases in 3rd wave, 295,387 in 2nd wave and 98,376 in 1st wave. The ratio between peaks of 1st, 2nd, 3rd and 4th waves are 1, 3, 8.58 and 8.59 respectively. Global trend of 4th wave may peak at about one million daily new cases in June or July 2021 [Data, 2021]. Probability of contracting virus to vaccinated persons exists yet aftereffects are less severe compared to unvaccinated people. Rise personal care, facemasks, recoveries, vaccinations and awareness will not let fourth global wave peak exceed many times compared to 3rd wave’s peak yet may exceed few orders.
First wave peaked in April, second in June, and third in Jan so next is likely to peak in June or July 2021. As 548 million people had been vaccinated by end of March 2021 so the daily cases frequency may not exceed 1 million per day. Bear in mind the vaccinated people may contract any new type of strain and may act as asymptomatic spreaders. A large majority of 24% covid-19 affected people spread virus without revealing any signs of being covid-19 victim. Healthy looking, asymptomatic Covid-19 patients, and even vaccinated people may spread disease, however, preliminary research results claim that two vaccines, one from Moderna Inc. and another from Pfizer Inc. & BioNTech SE, are highly protective against the spread of the coronavirus in addition to symptoms [John 2021].
Pfizer and BioNTech vaccines are 95.3% effective in preventing against Covid-19 disease, however, Americans despite being 1 of three vaccinated are worried about how long this prevention will last that has no warranty at this moment [Karen 2021]. Coronavirus is mutating fast to recreate infection waves. Any person recovering from Covid-19 disease may contract again new variant. There is possibility of being attacked several times by various variants. There are five variants and there are five waves worldwide. Simulation models show possibility of six tides by superposition of covid-19 waves [Koltsova 2020].
Worldometers data shows 1st Wave in South, 2nd Wave in East, 3rd Wave in West, 4th Wave in North and 5th Wave in Hong Kong. Virologists on learning curve and global herd immunity seems to be final answer. Vaccines are there but people fear from blood clots, although, probability of cerebral venous thrombosis due to antibodies is 4 (Pfizer or Moderna) to 5 (AstraZeneca) per million by vaccines and 39 per million by the coronavirus [Steve 2021]. Both the Pfizer and Moderna vaccines are so-called messenger RNA-based vaccines. However, Covid-19 causes more blood clots than vaccines [Steve 2021]. Australia records first death due to AstraZeneca vaccines [Michael 2021]. Medical experts are upset on vaccine shot induced blood clot (VITT) with lower platelets. CDC warned against using anti-clotting drug Herapin for it. Doctors recorded a rare of their own student have blood clot after vaccination. US Health Authorities stopped have halted use of Johnson & Johnson vaccines [Marianne 2021].
By third week of April 2021 the global covid-19 cases, recoveries and deaths had surpassed 142, 121 and 3 million. Despite vaccine rollout worldwide, especially United States, Brazil and India, new Covid-19 cases are rising again due to virus mutating, rolling back of safety measures and recent increase in travel. Mutant strains cause reinfections due to halfhearted response in vaccinations and face masks [Adriana 2021]. Media reports that vaccines do not help immunocompromised patients as they can contract virus despite vaccination. It is said that 3% US population is immunocompromised [Maria 2021; Virginia 2021]. Human bodies are equipped with an immune system that fights infection. “It produces chemicals and releases cells called macrophages that swallow these foreign organisms, thereby protecting us,” says Dr Rajeeva Moger. However, several factors like diseases, treatments and age can make us immunocompromised. These people are at a higher risk during the COVID-19 pandemic. People having diabetes, kidney failure, HIV and cancer are immunocompromised. People with lung issues like asthma or bronchitis have a higher chance of complication if they contract the disease. Minimum six-hours sleep, exercise and balanced diet can improve immune system naturally [Susan 2021].
First wave of Covid-19 pandemic has reached Micronesia, Polynesia and Antarctica in South, in 2021 [Michelle 2021]. Eastern, Western and Northern (Arctic) countries are facing second, third and fourth waves by emerging covid-19 variants. The highest number of Covid-19 cases (43%) have been reported by Wordometers to be in United States (31.92 million), India (13.53 million) and Brazil (13.48 million), and the lowest in Micronesia (1).
In Asia China faces 1st wave, India 2nd wave and Pakistan 3rd wave. Asians, Europeans and Americans are facing 2nd, 3rd and 4th Covid-19 waves. Hong Kong facing 5th wave and Spain is heading toward fifth wave [Michael 2021]. Covid-19 history shows new variants and waves may continue until getting herd immunity by vaccinations and recoveries. We are on learning curve how the coronavirus will play out in future.
Micronesia has recorded only one case of Covid-19 disease whilst USA, India and Brazil reported 32, 15 and 13 million cases on 19 April 2021. China faced one wave only whereas India and Russia are facing second wave, Brazil and Turkey third wave, USA and Israel fourth wave and Iran, Spain and Hong Kong fifth waves. Experts expect maximum six waves in future.
Covid-19 and variants are viewed as lungs diseases yet they affect heart, blood pressure and sugar patients more than normal victims. A Chinese study shows 49% covid-19 victims in 65-72 age group were blood pressure patients. Covid-19 affected elders and new-fangled variants affect children too. TV channels are showing sanitizer, hands wash and face mask ads yet people do not comply in letter and spirit. Heart, blood pressure and diabetes patients need more care. Researcher hold the old age people, having acute hypertension are likely to be more vulnerable to Covid-19 disease. Fat and overweight people should also take care [Nishiga 2020, Ran 2020, Guozhen 2020, Clark 2021].
Covid-19 and its variants are viewed as indefinite peril looming on human race. Virologists said that 75% recoveries or vaccinations will create herd immunity. We have 125 million recoveries and 450 million vaccinations which mean so far 7.7% people are save and 5.05 billion people must be vaccinated or get recovery after contracting coronavirus. Unfortunately, virus is mutating faster than inventing vaccinations and booster shots for new variants. A covid-19 victim may be affected again by other type of variant. Experts worry the things don’t seem to be going in right direction [Alex 2020].
India had controlled first wave but new variants and reinfections have led her to second more wave deadlier. Daily new cases were 275,000 on 18 April 2021. India was supposed to supply vaccines to other countries but second wave forced her to halt all exports. Indian scientists, frankly, don’t know what is driving the second wave. Rising cases disapprove her claim to have achieved herd immunity or the so called herd immunity does not guard against new variants. [Benjamin, 2021].
Global average infection rate of top five Covid-19 affected countries is 7.72%, however, individual, average Covid-19 infection rates of Brazil, USA, France and UK are 48.60%, 7.66%, 7.32% and 3.4% respectively. Similarly, average infection rates in India and Pakistan are 5.55% and 6.78%, however, daily infection rates on 17 April 2021, in India and Pakistan, during 2nd and 3rd waves were 17.44% and 5% respectively. Wordometers data does not show total number of covid-19 tests on daily basis.
Government of Pakistan warns of seven hot spots having 10 to 17% positive covid-19 test rates. Covid-19 cases fell sharply with lockdown and started surging again when relaxed. Now lockdown also seems failing against covid-19 in third wave. There are 134 testing laboratories with total capacity of 100,000 cases per day. Government imposed lockdown at end of March 2021, when new cases in third wave started approaching 90% of first wave peak.
New Covid-19 cases are sharply rising in India, Bangladesh and Pakistan. New cases frequency reaching 275,000 per day in India and 6,000 per day in Pakistan in middle of April 2021. It is second wave in India, third wave in Pakistan. School, colleges and universities are closed yet some business were allowed to continue to support the paralyzed economy.
Either medicine companies reach the level of developing vaccines before mutation of virus into next variant or community gets herd immunity against UK variant (B.1.1.7), South African variant (B.1.351), Brazilian variant (P.1 & P.2), California variants (B.1.427 and B.1.429) and Indian double mutant (B.1.617) [Korin 2021, BBC 2021]. UK variant is more deadly as it lives for long time human body so spreads 30-50% more than other variants.
Health experts advise inoculated people to use masks at crowded places despite vaccinations as a few variants still can cause reinfection. Coronavirus’s spike protein, called the E484K mutation, was identified in South Africa, Brazil and New York. Antibodies from vaccinated people are less effective against B.1.351 virus. The variant that popped up in different regions of California – called B.1.427 or B.1.429 – does not contain the E484K mutation yet it poses serious risk of disease and death. California variant contains three spike protein mutations: S13l, W152C and L452R. Indian double mutant variant has two mutations.
First is E484Q mutation, similar to E484K mutation, and second is L452R mutation that caused outbreak in California. This mutation helps virus neutralize the antibodies developed by vaccination or earlier recovery from previous Covid-19 infections. Double mutant may be dominant variant in second wave. All eyes are on UK variant (B.1.1.7) having N501Y mutation that makes it 60% more deadly. “A little bit less effective is not not-effective,” Michels said. “Once the virus changes so much that the vaccines are useless… that’s going to be the (real) problem.” [Adrianna 2021].
Genome sequencing of 401 samples, shows 81% victims in India are infected with UK B117 variant a few with double mutant that may become dominant in future. Vaccine manufacturers may tweak their vaccines to adjust for variants too in short time, some already calling is booster shots. They do it for flu vaccines already. Second dose increases specific antibodies, immunoglobulin G (IgG) in umbilical cord blood and breast milk. IgG imparts long term protection against virus and reproduce rapidly when exposed to the real virus [Amir 2021].
Dozens of epidemiologists, virologists and infectious disease specialists shows that that world has less than a year to vaccinate everybody to curb covid-19 virus else new variants will evade the vaccines. It is hard to develop new vaccines for mutated strains. It is a race against the clock as time and spreading rate allow new strains to develop [Marisa 2021]. Current Covid-19 vaccines will become ineffective against new variants by next year.
The California variant has three mutations in the spike protein of SARS-CoV-2, so it is more infectious than the initial, dominant novel coronavirus strain. “changes in the spike protein are likely to change the ability of the virus to bind to human cells”, increasing virus efficiency.
Variants of concern, two California variants, have evidence of an increased risk of transmission, more hospitalizations or deaths, a “significant reduction” in the ability of antibodies developed against the virus to fight the virus, and reduced effectiveness of treatments. These variants cause a “moderate reduction” in vaccine performance. However, Dr. Adalja anticipates that the California variant will not be a problem, as long as people receive both doses [Korin 2021].
California variant made up 35% of all COVID-19 cases in the state, and 44% of all coronavirus cases in Southern California. Patients infected with the California variant were nearly five times more likely to be admitted to the ICU and 11 times more likely to die compared to patients who carried other viral strains. This clade was the one that took hold in New York in early 2020, when the pandemic first started to ramp up in the United States [Meredith 2021].
Moderna, Pfizer, and AstraZeneca Covid-19 vaccines are mostly being distributed in the U.S, UK, or Europe. China (Sinovac, Sinopharm, Convidecia) and Russia (Sputnik V) have created their own Covid-19 vaccines which have 50% to >70% efficiacies. Vaccine developer companies say they developing booster shots for new variants. Virologists warn the sparse vaccinations will make new strains more resistant. Efficacies of various vaccines vary from 50% to 95%.
Chinese vaccine was reported to be 50.7% effective against P1 (more) and P2 (less) variants in Brazil. Efficacy rises to 62.3% if second doze relayed by more than two weeks. Rampant rise in digital technologies and fast foods have reduced human activities. The processed foods have chemical preservatives tert-butylhydroquinone (TBHQ), which reduce immunity against viral and bacterial attacks [Naidenko, 2021]. However, Chinese Sinovac and Sinopharm's jabs have shown no blood clot issues in Pakistan. China has given millions of doses to Pakistan.
Covid-19 cases are once again surging in USA, Brazil, India and Europe. United States is hard hit by Covid-19 Pandemic at individual level and Europe is even harder hit at collective level. Average global covid-19 death rate is 2.64% that is higher than 2.36% in America. Death rate is 1.41% in India and 2.78% in Brazil. However, death rate is 28.86% in Belgium and 3.65% in Italy. UK, Spain and several European countries hide their death rates from fear of public panic.
Biologists, virologists and pharmacists are on learning curve, nobody knows the end. Covid-19 infection and recovery rates show possibility of herd immunity with loss of 2 million lives in the best case and 4 million in the worst case [Norith 2020]. We live in an interconnected world. Nobody is safe until everybody is not safe. We must vaccinate, wear face masks and reduce travel. As long as people continue flouting safety rules during spring break in west and social events in east the regenerative waves will continue coming. Earlier we start taking care the better it would be.
Coughing and sneezing victims fill the air with fomites bearing coronaviruses which last from minutes to hours affecting people around. When these victims go inside crowded indoors they start infecting others who further spread the viruses during their indoor outdoor activities through surfaces. Abstinence is the best practice and do not wear facemask under your nose. Way the social, religious and political events are being held worldwide, it is very difficult to contain the spread of coronavirus. When eight to ten people sitting around a table without masks - talk, laugh, cough, sneeze, yawn and yell – there is now way to stop the spread of Covid-19.
When civil administration asks traders to shut down their shops tens of spectators stand to watch them enforcing the law. They make so dense crowds and flying dust particles in wind gust whirl their breaths among them. There is now way to prevent viral spread among such clusters. Smart micro lockdowns are a pie in sky the incumbents should take strict measures. Let us learn how to adapt to live with coronavirus virus. Leaders should avoid taking first donated vaccines. Wish better for others nature will protect you. Feel happy prioritizing others over yourself.
Polluted airs, contaminated waters and fast food deliveries mediate covod-19 transmissions. Schools, mosques, marriage halls, churches, temples, shrines, shopping malls, gas stations, bars, gatherings, hugging, restaurants, parks, buses, trains and airlines play key role in local and global spread of Covid-19 Pandemic. Political and burial gatherings also spread coronavirus. Bangladesh and Pakistan are said to be world’s most polluted countries and India is considered relatively cleaner as western winds sweep her stubble burning smog to Pakistan and eastern winds to Bangladesh. India and China are the biggest regional polluters. Outside air affects us inside [Alexandra 2021].
Lockdown and adherence to SOPs worked in first wave but people are seen not caring much in subsequent covid-19 waves. Air, water and surfaces play coordinated role in covid-19 transmission. Social setups, hugging, embracing and joint dinner cultures multiply infectious diseases. During pandemic do not go near your dear ones, especially babies and elders, without face mask.
Covid-19 injection prices are too high in Pakistan. A covid-19 patient has to pay Rs100,000 daily in private hospitals. Poverty, health and ignorance based business are flourishing in Pakistan. Trade, health and education business loot in name of inflation, covid-19 and foundations. Governments should set right the state institutions instead of letting rich elites plunder the people. World Bank is sponsoring RISE, SHIFT and PACE projects to several countries to increase their resilience against Covid-19 pandemic. Research on Covid-19 has also paved the way for discovery of vaccines against cancer and HIV diseases.
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