More JN.1 infections in India: Is India on the cusp of another COVID wave?

In the winter of 2021, India detected its first case of the Omicron coronavirus variant, which then spread rapidly, fuelling a third wave in the country. Now, a year-and-a-half-later, the nation is once again witnessing a rise in JN.1 cases, causing people to worry about yet another COVID wave.

On Wednesday (20 December), India confirmed that there were 21 cases of the new sub-variant, JN.1 – which is a descendant of Pirola. Of the 21, 19 were from Goa, and one each from Maharashtra and Kerala. This comes after the first such case was detected in the southern state of Kerala back on 8 December in a 79-year-old woman from Karakulam in Thiruvananthapuram district.

The detection of the COVID sub-variant, which has been classified as a ‘variant of interest’ by the World Health Organization, has prompted the Centre to take note of the situation and issue an advisory to states and Union Territories. Medical experts are also urging people to remain vigilant and resort to masking in crowded places, especially for the elderly and those with co-morbidities.

So, the question is – will the new variant drive a winter wave for India? Here’s what we found out.

COVID cases on the rise again

On Wednesday, the country saw a bump in COVID cases – the highest since 21 May. According to data, India recorded 614 new coronavirus infections in the past 24 hours, with three deaths from Kerala. India’s active caseload now stands at 2,311 and the overall death toll for the country stands at 5.33 lakh.

As per the Union health ministry data, Kerala recorded the highest spike with 292 cases. This was followed by Tamil Nadu, which registered 13 new cases, Maharashtra (11 cases), Karnataka (nine new cases), Telangana and Puducherry (four new cases), Delhi and Gujarat (three new cases), and Goa and Punjab (one new case).

Also read: JN.1 is causing jitters in India. But should you worry?

In addition to the new infections, three new deaths were also recorded from the state of Kerala.

Union Health Minister Mansukh Mandaviya on Wednesday reviewed the preparedness of health facilities across the country and stressed on being alert against emerging strains of coronavirus. In a high-level meet, he asked the states and Union Territories to be prepared with mock drills of hospital preparedness, increased surveillance, and effective communication with people.

आज देश के सभी राज्यों एवं UTs के स्वास्थ्य मंत्रियों व वरिष्ठ अधिकारियों के साथ respiratory illnesses (कोविड-19 समेत) और public health संबंधित तैयारियों को लेकर समीक्षा बैठक की।

बैठक में सभी राज्यों ने स्वास्थ्य सुविधाओं के बेहतर क्रियान्वयन हेतु सकारात्मक दृष्टिकोण रखा। pic.twitter.com/rYkDCIkg2F

— Dr Mansukh Mandaviya (@mansukhmandviya) December 20, 2023

Union Health Secretary Sudhansh Pant, reacting to the situation, said that even though cases are on the rise, 92.8 per cent of the cases are in home isolation, indicating mild illness. “No increase in hospitalisation rates has been witnessed due to COVID-19. The cases that have been hospitalised were due to other medical conditions and COVID was an incidental finding,” he said.

About the new JN.1 variant, Pant said the variant was currently under intense scientific scrutiny but not a cause of immediate concern. Officials said that no clustering of cases due to the JN.1 variant has been observed in India. All the cases were found to be mild and the patients recovered without any complications, they said.

Masking makes a return

As news emerged that Kerala had recorded the country’s first JN.1 infection, neighbouring state Karnataka imposed a mask mandate, making it mandatory for people above the age of 60, and those with comorbidities, to wear masks.

“Those above 60 years of age and those with comorbidities like issues related to heart, and kidney among others, and those with cough, phlegm and fever should mandatorily wear masks,” said state Health Minister Dinesh Gundu Rao.

While other states haven’t mandated for masks, officials have urged people to mask up in big, crowded places.

Chandrakant Lahariya, a senior consultant physician and public health expert told news agency PTI that one must continue vigilance and adherence to existing precautionary measures against JN.1, including the use of masks, maintaining hand hygiene, social distancing, avoiding crowded or poorly ventilated areas, and following proper cough etiquette.

Worries over a winter wave

With the detection of the new sub-variant, which is also rapidly spreading across the US and other countries, and the rise in cases, the public is worried that COVID will play partypooper during this festive season.

However, public health experts are allaying fears of another COVID wave, saying this is neither surprising nor particularly worrying. As Chandrakant Lahariya told PTI, “As it happens with most respiratory viruses, including the influenza viruses, the circulating viruses keep changing. Therefore, a sub-variant of SARS CoV-2 is not a surprise at all.”

Vinod Scaria, senior consultant at Mumbai’s Vishwanath Cancer Foundation, agreed with this view and added that the JN.1 variant has possibly been in circulation in India as early as November 2023.

“While this would mean reinfections would pick up significantly, there is no evidence to suggest JN.1 could pose a significant threat to public health compared to other variants in circulation,” he said.

Virologist Dr Jacob John also called for calm and asked people not to panic. Speaking to the Times of India, he said that another wave of COVID is highly unlikely, as the current disease pattern is “endemic” with low and steady numbers. JN.1 has spread to many countries, and while it may cause fluctuations, a massive wave is improbable.

Co-chair at INSACOG’s advisory board, Dr Saumitra Das, was also confident that there would be no new wave. He told News18 that he believed India is in a safe space, considering the high coverage of vaccination. “The situation two years ago was different from the situation now. Today, more than 90 per cent of our population is vaccinated. We have not seen an increase in hospitalisation and oxygen or ventilator requirements.”

About the JN.1 sub-variant

The JN.1 sub-variant, first detected in Luxembourg in late August, is a descendant from the strain known as BA.2.86, nicknamed “Pirola”. Since then, it has spread to various parts of the world. In fact, Dr Rajendram Rajnarayanan, of the New York Institute of Technology campus in Jonesboro, Arkansas, had told Salon.com earlier, “With travel and the holidays coming up, we know that it’s gonna spread everywhere. This has all the features of becoming a dominant lineage like EG.5 or XBB.1.16.6.”

The United States’ Centers for Disease Control and Prevention has said that the continued growth of JN.1 suggests that it is either more transmissible or better at evading our immune systems, or both. However, it added that there is no evidence that JN.1 poses an increased risk to public health or causes more severe disease than other variants as of now.

Experts have found that JN.1 has an additional mutation in its spike protein that enables it to infect cells better than its parent virus. As a result, it has spread faster in recent weeks.

And most agree that the new sub-variant would not cause severe disease, but could cause new infections.

With inputs from agencies