India's COVID-19 crisis: a call for international action

Kuppalli, Krutika; Gala, Pooja; Cherabuddi, Kartikeya; Kalantri, Shriprakash; Mohanan, Manoj; Mukherjee, Bhramar; Pinto, Lancelot; Prakash, Manu; Pramesh, C.S.; Rathi, Sahaj; Pai, Nitika Pant; Yamey, Gavin; Pai, Madhukar

doi:10.1016/s0140-6736(21)01121-1

Cited by 45 publications

(31 citation statements)

References 3 publications

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“…North America and Europe are already considering a return to normalcy, re-opening public spaces, lifting restrictions on public gatherings, and extending vaccination to adolescents using highly effective mRNA vaccines. In contrast, LMICs are facing devastating waves of the coronavirus, possibly driven by the rise of more transmissible variants of concern (VOC) such as the P.1 VOC first detected in Brazil or, more recently, the B.1.617 VOC in India, leading to overwhelmed healthcare services and unprecedented death tolls ( Kuppalli et al., 2021 ). Africa is bracing itself to confront the same fate, as the B.1.351 SARS-CoV-2 VOC first detected in South Africa has been steadily spreading across the continent, and reports of the B1.1.7 and the B.1.617 VOC are on the rise, notably in incoming travelers ( Figure 3 ).…”

Section: Main Textmentioning

confidence: 99%

“…Increased demand for vaccines in India, faced with a devastating up surge in COVID-19 cases, and government decision to redirect locally produced doses toward the domestic market has had repercussions around the globe ( Kuppalli et al., 2021 ). As a consequence, SSI, the chief supplier for COVAX, has postponed delivery of the 90 million vaccine doses expected in March and April.…”

Section: Main Textmentioning

confidence: 99%

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COVID-19 vaccine access in Africa: Global distribution, vaccine platforms, and challenges ahead

Loembé

Nkengasong

2021

Immunity

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Development COVID-19 vaccines in a record time has been an unprecedented global scientific achievement. However, the world has failed to ensure equitable access to what should have been a global public good. What options remain available to African countries to ensure immunization of their populations and ultimately overcome the pandemic?Introduction: vaccine access globally, a tale of two worlds? By the end of April, as the world just passed the one-year mark since the COVID-19 pandemic was declared, more than 150 million cases and 3 million deaths have been reported worldwide (https://covid19.who.int/), including 4,5 million cases (3%) and 120, 000 deaths (4%) in Africa (https://africacdc.org/ covid-19/). Though the continent, home to 17% of the world population, shares a relatively smaller fraction of this global toll, the impact of COVID-19 has been devastating. Africa bears a disproportionate burden of infectious diseases in the face of chronic shortages in its healthcare workforce: any disruption to essential health services, any health care worker (HCW) infected, magnifies the impact of the pandemic. Health services for HIV, tuberculosis, and malaria on the continent have been severely hit by COVID-19 as access has been curtailed due to COVID-19 related movement restrictions. According to a survey by the Global Fund (The Global Fund, 2021), HIV testing has fallen by 41% on average, TB referral and screening by 28%-29%, and half of health facilities have recorded COVID-19 infections among HCWs. According to the United Nations Children's Emergency Fund (UNICEF), interruptions in immunization campaigns will leave 80 million children under the age of 1 unvaccinated or under-vaccinated. Stringent measures promptly implemented to curb the pandemic have wreaked havoc on economies across the continent.

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Section: Main Textmentioning

confidence: 99%

Section: Main Textmentioning

confidence: 99%

COVID-19 vaccine access in Africa: Global distribution, vaccine platforms, and challenges ahead

Loembé

Nkengasong

2021

Immunity

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“…Recently there have been massive surges of COVID-19 community transmission in a few countries around the world, but most prominently in India 18 and Chile 19,20 . In order to identify the mutations that are associated with these surges, we systematically analysed the mutations that increased monotonically in prevalence correlated with the monotonic increase in test positivity between February and April 2021 (Figure 2a and Figure 3a).…”

Section: Surging Sars-cov-2 Variants In India and Chile Have Acquired New Deletions In An Antigenic Supersite Enabling Evasion Of Neutralmentioning

confidence: 99%

Antigenic minimalism of SARS-CoV-2 is linked to surges in COVID-19 community transmission and vaccine breakthrough infections

Venkatakrishnan

Lenehan

Ghosh

et al. 2021

Preprint

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The raging COVID-19 pandemic in India and reports of “vaccine breakthrough infections” globally have raised alarm mandating the characterization of the immuno-evasive features of SARS-CoV-2. Here, we systematically analyzed over 1.3 million SARS-CoV-2 genomes from 178 countries and performed whole-genome viral sequencing from 53 COVID-19 patients, including 20 vaccine breakthrough infections. We identified 116 Spike protein mutations that increased in prevalence during at least one surge in SARS-CoV-2 test positivity in any country over a three-month window. Deletions in the Spike protein N-terminal domain (NTD) are highly enriched for these ‘surge-associated mutations’ (Odds Ratio = 18.2, 95% CI: 7.53-48.7; p=1.465x10-18). In the recent COVID-19 surge in India, an NTD deletion (ΔF157/R158) increased over 10-fold in prevalence from February 2021 (1.1%) to April 2021 (15%). During the recent surge in Chile, an NTD deletion (Δ246-253) increased rapidly over 30-fold in prevalence from January 2021 (0.86%) to April 2021 (33%). Strikingly, these simultaneously emerging deletions associated with surges in different parts of the world both occur at an antigenic supersite that is targeted by neutralizing antibodies. Finally, we generated clinically annotated SARS-CoV-2 whole genome sequences and identified deletions within this NTD antigenic supersite in a patient with vaccine breakthrough infection (Δ156-164) and other deletions from unvaccinated severe COVID-19 patients that could represent emerging deletion-prone regions. Overall, the expanding repertoire of Spike protein deletions throughout the pandemic and their association with case surges and vaccine breakthrough infections point to antigenic minimalism as an emerging evolutionary strategy for SARS-CoV-2 to evade immune responses. This study highlights the urgent need to sequence SARS-CoV-2 genomes at a larger scale globally and to mandate a public health policy for transparent reporting of relevant clinical annotations (e.g. vaccination status) in order to aid the development of comprehensive therapeutic strategies.

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“…1 On May 1 2021, India reported more than 400 000 new daily COVID‐19 cases. 2 Several recent reports detail India's COVID‐19 emergency during the second wave 3 , 4 , 5 with COVID‐19 management depending on location, resources and disease burden under very limited healthcare resources. 6 , 7 , 8 , 9 …”

Section: Introductionmentioning

confidence: 99%

Consequences of the first and secondCOVID‐19 wave on kidney transplant recipients at a large Indian transplant centre

et al. 2021

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Background There is a scarcity of data comparing the consequences of first and second COVID‐19 waves on kidney transplant recipients (KTRs) in India. Methods We conducted a single‐centre retrospective study of 259 KTRs with COVID‐19 to compare first wave (March 15–December 31 2020, n = 157) and second wave (April 1–May 31 2021, n = 102). Results KTRs during second wave were younger (43 vs. 40 years; p ‐value .04) and also included paediatric patients (0 vs. 5.9%; p ‐value .003). Symptoms were milder during the second wave (45 vs. 62.7%; p ‐value .007); COVID‐19 positive patients had less frequent cough (32 vs. 13.8%; p ‐value .001), fever was less frequent (58 vs. 37%; p ‐value .001), and we observed fewer co‐morbidities (11 vs. 20.6%; p ‐value .04). The percentages of neutrophils (77 vs. 83%; p ‐value .001) and serum ferritin (439 vs. 688; p ‐value .0006) were higher during second wave, while lymphocyte counts were reduced (20 vs. 14%; p ‐value .0001). Hydroxychloroquine (11 vs. 0%; p ‐value .0001) and tocilizumab (7 vs. 0%; p ‐value .004) were more frequently prescribed during first wave, while utilization of dexamethasone (6 vs. 27%; p ‐value .0001) and remdesivir (47 vs. 65%; p ‐value .03) increased during the second wave. Mucormycosis (1.3 vs. 10%; p ‐value .01) and ICU admissions (20 vs. 37.2%; p ‐value .002) were more frequent during second wave. The 28‐day mortality rate (9.6 vs. 10%; p ‐value 1) was not different. Conclusions There has been a different clinical spectrum of COVID‐19 amongst KTR with similar mortality between the two waves at a large Indian transplant centre.

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India's COVID-19 crisis: a call for international action

Cited by 45 publications

References 3 publications

COVID-19 vaccine access in Africa: Global distribution, vaccine platforms, and challenges ahead

COVID-19 vaccine access in Africa: Global distribution, vaccine platforms, and challenges ahead

Antigenic minimalism of SARS-CoV-2 is linked to surges in COVID-19 community transmission and vaccine breakthrough infections

Consequences of the first and secondCOVID‐19 wave on kidney transplant recipients at a large Indian transplant centre

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