Be calm, but alert and concern over a new strain of delta variant

India has classified the delta plus a variant of concern and there are fears that it could potentially be more contagious. Variant is classified as either a variant of interest (VOI) or a variant of concern (VOC).

A VOI is one that is "suspected" to either be more contagious than the initial strain, cause more severe disease, or escape the protection offered by vaccines. It can become a VOC if more evidence emerges that it does one or more of the things mentioned above.

As far as the delta plus variant is concerned, although classified as a VOC, yet the jury is still out on whether it is more virulent and contagious compared to the original delta variant, which itself is a mutation of the original SARS-CoV-2 virus which first reared its ugly head in Wuhan last year.

Delta plus also known as B.1.617.2.1 or AY.1 has generated a significant amount of global media attention recently, and is a strain mutated from the delta variant. The latter was first detected in India in February, and has ravaged the country with its second wave, and had spread to many other countries including Malaysia. As for the delta plus variant, already about 40 cases have been detected sporadically in Maharashtra, Kerala and Madhya Pradesh, according to the Indian Health Ministry on June 23.

Meanwhile in a statement to Reuters on June 24, the World Health Organisation (WHO) said it is tracking this variant as part of the Delta variant. "For the moment, this variant does not seem to be common, currently accounting for only a small fraction of the Delta sequences ... Delta and other circulating VOC remain a higher public health risk as they have demonstrated increases in transmission," it added.

But India's health ministry warned that regions where the delta plus strain have been found "may need to enhance their public health response by focusing on surveillance, enhanced testing, quick contact-tracing, and priority vaccination."

There are worries delta plus would inflict another wave of infections on India after it emerged from the world's worst surge in cases only recently, although so far there is no significant increase in the prevalence of the strain.

Although India seems to be the focus of this strain, it was actually first detected in the UK on June 11, where the Public Health England in its routine scanning of COVID cases in the country (where the delta variant is now responsible for the bulk of new infections) has found almost 40 cases of the newer variant, which has acquired the spike protein mutation of delta plus.

It added, as of June 16, cases of the delta plus variant had also been identified in the US as well as Canada, India, Japan, Nepal, Poland, Portugal, Russia, Switzerland and Turkey.

According to scientists, all variants of the Covid-19 virus carry clusters of mutations. In the case of delta plus, a mutation known as K417N, which distinguishes it from the regular delta variant, has an impact on the spike protein, which is the part of the virus that attaches to the cells it infects.

Francois Balloux, director of the University College London (UCL) Genetics Institute said the K417N mutation isn't entirely new because it has "arisen independently in several viral lineages".

The mutation was seen in a strain found in Qatar in March 2020, and is also found in the Beta variant first detected in South Africa last fall, he told the Science Media Centre on June 23.

"The mutation may contribute to immune escape, though its impact on transmissibility is not clear-cut," he added.

Mutations are common to all viruses. Some of those changes make viruses better at infecting cells, or better at replicating, while others have little effect or are even harmful to the virus.

Although it’s not certain yet on whether the mutation may have an impact on vaccine efficacy, Julian Tang, professor of respiratory sciences at the University of Leicester, however cautioned it could potentially give the variant "significant vaccine escape properties."

Most of the vaccines are designed to train the body to recognise the spike protein, or parts of it – the area where delta plus' mutation took place.

For now, experts are largely cautioning the public and governments to remain watchful but calm. What does this mean for Malaysia?

It means what the heading of the article is saying. While experts are still trying to determine the “nastiness” of the delta plus variant, let’s be calm and not panic but at the same time, let’s not throw caution to the wind. It is good that the government has extended the first phase of the National Recovery Plan today. And it is also good that the infection curve has flattened as seen from the peak of infection of this fourth wave at 9,020 cases recorded on May 29 is not breached.

But these are not sufficient indicators as it will lead us to complacency. With a new variant, testing is the key. Even for the current Delta variant that is causing the spread of the disease, it is when the data shows that the curve is flattening, that relatively more testing needs to be ramped up so that the flattening of the curve is not followed by a rising of the curve as seen in the ending of the second and third waves.

EMIR Research has written two articles “Malaysia needs to accelerate COVID-19 testing” and “Increase testing intensity alongside vaccination drive” on the dire need for testing to be ramped up.

Of course, this increased testing must also move in tandem with the upgrading of the capacity of the health care system to cope with the expected high number of infections that immediately followed increased testing.

In fact, increased testing can be considered as part and parcel of the upgrading of the healthcare system in much the same way as increasing hospital beds, increasing ICU wards and increasing quarantine spaces, etc but all this must be done concurrently and urgently.

Together with increased surveillance, quick contact-tracing, and priority vaccination, all these would contribute to the flattening of the curve to its floor i.e. zero infection, and any new virulent variants can then be dealt swiftly.

With Indonesia experiencing a daily infection of more than 21,000 cases in recent days, and with more countries imposing fresh curbs like Australia, Bangladesh, Russia, Taiwan, Israel, Portugal and Indonesia, it’s time we put back the conversation on managing the COVID-19 pandemic back to the front burner.

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Jamari Mohtar is Director, Media & Communications at EMIR Research, a think tank focused on strategic policy recommendations based on rigorous research.