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No need to change Treatment Protocol in view of mutations in strain, says National Task Force on COVID-19
New Delhi, December 28, 2020
A meeting of the National Task Force (NTF) on COVID-19, called to discuss the testing, treatment and surveillance strategies for COVID-19 in view of the new virus strain from the United Kingdom, has concluded that there was no need to change the existing Treatment Protocol in view of mutations emerging in the strain.
The meeting convened on Saturday, felt that since the ICMR had always advocated the use of two or more gene assays for testing SARS-CoV-2, it was unlikely to miss infected cases using the current testing strategy.
The NTF recommended that in addition to the existing surveillance strategies, it was critical to conduct enhanced genomic surveillance for SARS-CoV-2 especially in incoming passengers from the UK.
Besides, it will also be critical to conduct genome sequencing in samples where there is a dropout of the S gene in lab diagnosis, proven cases of re-infections etc. Routine genomic surveillance of SARS-CoV-2 from representative samples needs to be a continuous and well-planned activity, it said.
The meeting took place under the co-chairpersonship of Prof Vinod Paul, Member Niti Aayog and Prof Balram Bhargava, Secretary, Department of Health Research & Director General, Indian Council of Medical Research (ICMR).
The meeting was attended by Prof Randeep Guleria, Director, All India Institute of Medical Sciences (AIIMS), Director General Health Services (DGHS), Drug Controller General of India (DCGI), Director, National Centre for Disease Control (NCDC), other representatives from the Ministry of Health and ICMR as well as independent subject experts.
The main objective of the NTF was to discuss evidence-based modifications in testing, treatment and surveillance strategies for SARS-CoV-2 in view of the recent reports of the emergence of a new variant strain of the virus from the UK. The variant strain has 14 non-synonymous (amino acid altering) mutations, 6 synonymous (non-amino acid altering), and 3 deletions. Eight mutations are present in the Spike (S) gene which carries the binding site (Receptor Binding Domain) of the ACE2 receptors, which are the point of entry of the virus into the human respiratory cells.
The meeting deliberated in detail on aspects related to current National Treatment Protocol, testing strategy and surveillance of SARS-CoV-2 vis-à-vis the UK variant strain. It was emphasized that since the UK variant strain was implicated to cause increased transmissibility of the virus, it was critical to identify individuals infected with this strain and adequately contain them to prevent its transmission in India.
NCDC stated that the Union Government had taken cognizance of the reports of a mutant variant of SARS-CoV-2 reported from the UK and the response of the other countries to these reports. The situation was being monitored proactively. A strategy has been put under place to detect and contain the mutant variant, an official press release said.
The salient features of the strategy include checking at points of entry (All International Airports in India). All passengers who had arrived from the UK between December 21-23 have been tested at the airports. The passengers were allowed to exit the airport only after the RT-PCR test result became available.
All passengers testing positive were put under institutional isolation and their samples sent for Whole Genome Sequencing (WGS). Only after the confirmation of the non-mutant variant upon WGS result, the positive cases were permitted to leave institutional isolation as per the existing management protocol. All the contacts of the positive cases were put under facility quarantine and tested as per the ICMR guidelines.
For community surveillance, the list of all UK arrivals during the past 28 days have been shared by the Bureau of Immigration with the concerned States. All the passengers who had arrived from the UK between November 25 to December 20 were being tracked by the IDSP State Surveillance Units (SSUs) and District Surveillance Units (DSUs).
Testing of these passengers as per the ICMR guidelines was being pursued and all positive cases were put under mandatory facility isolation. The samples of all positive cases were being sent for WGS. Enhanced contact tracing of these positive cases was being undertaken and these contacts were also put under facility quarantine. Discharge of positive cases was being done only after ensuring two samples testing negative after 14 days.
In prospective surveillance, 5% of the positive cases from all States/UTs will be tested for WGS. A genomic surveillance consortium, INSACOG, has been formed under the leadership of NCDC, New Delhi for laboratory and epidemiological surveillance of circulating strains of SARS-CoV-2 in the country.
More than 50 samples of the UK returnees were currently under sequencing at the designated laboratories. Other laboratories in the consortium are National Centre for Disease Control, Delhi; CSIR-Institute of Genomics and Integrative Biology, Delhi; CSIR- Centre for Cellular and Molecular Biology, Hyderabad; DBT- Institute of Life Sciences, Bhubaneshwar; DBT-National Institute of Biomedical Genomics, Kalyani; DBT-InStem-National Centre for Biological Sciences, Bengaluru; National Institute of Mental Health & Neurosciences (NIMHANS), Bengaluru; ICMR- National Institute of Virology, Pune.
It was proposed to continue enhanced genomic surveillance for early detection and containment of the UK variant SARS-CoV-2 strains. However, it was important to understand that like all other RNA viruses, SARS-CoV-2 will continue to mutate. The mutated virus can also be contained by measures like social distancing, hand hygiene, wearing masks and by an effective vaccine, as and when available.