Dance of multiple flu viruses in Karnataka

The XBB 1.16 variant is the latest addition and is said to be driving the recent surge in Covid cases. It has been marked a ‘Variant of Concern’ as it is said to be more transmissible.

Published: 27th March 2023 07:39 AM  |   Last Updated: 27th March 2023 07:39 AM   |  A+A-

Coronavirus, Covid-19, Corona test, Corona

For representational purposes (Photo | S Senbagapandiyan, EPS)

Express News Service

BENGALURU: Ever since the Covid pandemic hit the world, we have been hearing of multiple waves of the infection, even as SARS-CoV-2 virus continues to evolve. The XBB 1.16 variant is the latest addition and is said to be driving the recent surge in Covid cases. It has been marked a ‘Variant of Concern’ as it is said to be more transmissible and escapes immunity smartly. The alarming recent surge called for a high-level meeting, chaired by Prime Minister Narendra Modi, to review the situation on March 23.

Influenza-like Infections (ILI) and Severe Acute Respiratory Infections (SARI), especially Covid, H3N2 virus, H1N1 (Swine Flu) and the Adenovirus, have largely affected the population in Karnataka since January this year.

In the early weeks of January, when the weather was transitioning from winter to summer, both government and private-run hospitals saw an upsurge in flu-like cases among people of all age groups. 

Health dept on high alert
The Karnataka Health Department, which has set off alarm bells, is on high alert. This is because after a lull, Covid cases in the state, especially in Bengaluru, have spiked. According to data from the Indian SARS-CoV-2 Genomics Consortium (INSACOG), 349 samples were found with the XBB 1.16 variant from January to March. The central government’s health information portal also showed that Karnataka saw over 70,000 ILI/SARI cases from January till now. 

XBB 1.16 variant in circulation since January
The first case of the XBB 1.16 variant was reported in January. Karnataka is said to have recorded 61 cases of the variant and stands third in the country after Maharashtra and Telangana in the number of cases. The state health department has requested the Centre to augment the vaccine supplies. Doctors from the Bengaluru Medical College and Research Institute (BMCRI) said that over the last few weeks, most positive cases were seen with the older Covid variants. But the recent spike in cases could be attributed to the new variant. 

Namma Bengaluru and its sizeable Covid/ILI/SARI caseload
The Silicon City is contributing a sizable chunk to the state’s Covid caseload. After many weeks, positive cases in the state crossed the 600-mark in March, registering an uptick in hospitalisations. From just 12 hospitalisations on March 1, they went up steadily to cross 600 cases. Bengaluru alone contributed over 400 active Covid cases with the positivity rate per week crossing 8 per cent. Three deaths were reported in March with patients having had a history of ILI and SARI.

The sudden rise in hospitalisations in Bengaluru, especially ICU admissions requiring ventilator support, triggered the health department to direct the Bruhat Bengaluru Mahanagara Palike (BBMP) to take up a clinical audit to understand the reason for the spike. It also wanted the Palike to investigate if there is any co-infection (simultaneous infection) of H3N2 and Covid as both share similar respiratory infection signs and symptoms.

Dr MK Sudarshan, chairman, Technical Advisory Committee (TAC), said Karnataka has seen a high number of H3N2 and H1N1 cases along with Covid in the past two months. The Union Health Ministry data shows a similar spike in Tamil Nadu and Kerala. He said increasing ICU admissions are a concern. ILI/SARI viruses do not have the same qualities as SARS-COV-2 and do not cause any outbreak, he said. Intense testing will help study different viruses in infected people and allow the authorities to take preventative measures. The situation is not expected to spiral down in the coming weeks and the cases will decline after the summer fully sets in, he said. 

Health experts said there is no need to worry about H3N2 and H1N1 viruses. They normally affect children below 15 years and senior citizens over 65. There is no cause for worry as most of the people have been treated as outpatients, they said. 

Dr Lakshmipathy from KC General Hospital said most hospitals are not testing all the samples as it is practically not possible and is expensive. Most patients are treated for symptoms and only critical cases are admitted. This may have led to underreporting of cases, he added.

Health dept on vigil, no need to panic: Sudhakar 
Health Minister Dr K Sudhakar said the health department is keeping a constant vigil on the spike and requested citizens not to panic but to take precautionary measures. Masks have been made mandatory for healthcare workers and all those working in hospitals. 

On the influenza virus, health officials said testing has been increased and it has been made affordable. Since the anti-influenza vaccine is expensive and needs to be taken every year, the government has not added it in the universal immunisation programme. The influenza virus mutates quickly and the vaccine formulation has to be changed every year to cover maximum variants. The government has, however, said people should take the vaccine if they can afford it.

Mild infection settles in less than a week
Dr Swati Rajagopal, Consultant - Infectious Disease & Travel Medicine, Aster CMI Hospital, Bengaluru said it is more likely that Omicron offsprings - XBB 1.15 and XBB 1.16 - could be responsible for the rise in cases in the state. These variants reportedly have greater transmissibility and infectivity, she said and added that pre-existing immunity along with the vaccination status of the community could be important factors.

Covid-19, influenza A, B and sub-variant H3N2 among adults along with respiratory syncytial virus (RSV) and adenovirus infections have been reported in the last month, she said. Influenza cases were not the focus over the last three years as the emphasis was on Covid, she added.

“So far, the majority of reported cases appear to have a mild infection and settle in a week. However, individuals who are immuno-compromised or suffering from pre-existing medical issues need to be watchful and report any symptoms of viral illnesses to the doctor,” she said.

Doctors said that most patients showed symptoms of fever, cold and cough. Dr Rajath Athreja, Head of Department (Paediatrics), Sakra World Hospital, said, “We saw a rise in the number of patients coming with ILI symptoms in January. Around 100 patients came daily with symptoms like cold, cough and fever. However, the cases of severe infections needing hospital admissions remained low.” At Sakra, only samples of inpatients with extreme conditions are sent for testing. 

Get precautionary dose 
Dr Swati Rajagopal stressed the need to take the third precautionary anti-Covid vaccine and to continue to wear masks to avoid infection. She said the vulnerable should protect themselves in closed environments.

“Testing along with sequencing still holds the key to tracking new variants. Usually, respiratory viral infections are common during winter. However, monsoon is traditionally the time we see a rise in cases. It is vital to be aware, but not panic. The basics of hand hygiene, cough etiquette, masks in crowded indoor areas, vaccination and testing still hold the key,” she said.

Deaths due to the H3N2 virus 
Karnataka reported the first death due to the H3N2 virus in India on March 10. An 87-year-old man from Hassan passed away on March 1. The state health department said he suffered from fever, cough and breathlessness, was asthmatic and had an acute kidney injury. 

Health officials said the death occurred only due to the patient’s old age and his comorbidities.
According to data from the Union Health Ministry, Karnataka has seen 16 H3N2 cases from January to March 2023 and 4,700 H1N1 cases from 2018 till March 2023. In all, 201 have been declared dead.
India’s first Covid death was also reported in the state, that of a a 76-year-old man from Kalaburagi on March 10, 2020. 

What are the ILIs to look out for (H3N2, H1N1, Adenovirus)
Seasonal flu/influenza is an infectious disease spread through the cough or sneeze of an infected person or through contact with droplets. The World Health Organisation (WHO) defines ILI as an acute respiratory infection with a measured fever of 38 degrees Celsius or more and a cough lasting ten days. SARI cases are similar to ILI, but the need for hospitalisation is higher.  

The disease is self-limiting and lasts five to seven days and has low morbidity and mortality rates. Infants, elderly, pregnant women and those on long-term medication, particularly steroids, are at higher risk. 

What is XBB 1.16? Should you worry? 
XBB 1.16 is a recombinant lineage of the virus and belongs to one of the many XBB lineages of Covid that is currently in circulation in India and abroad. The new variant is highly contagious and is said to evade immunity. Experts opined that the XBB 1.16 variant which causes symptoms like a blocked nose, sore throat, headache, fever, muscle pain and others lasts up to four days. Doctors said patients get cured without any major treatment and need for hospitalisation. However, they cautioned people against letting their guard down and said that those with co-morbid conditions and the elderly should take extra precautions.

Symptoms
Fever, chills, malaise, loss of appetite, nausea, sneezing and dry cough lasting several days are the most common symptoms lasting up to three weeks. The symptoms for Covid and ILI/SARI are primarily the same. Covid symptoms appear after 2 to 14 days but the influenza symptoms show within 1 to 4 days 

Precautions 

Cover your mouth and nose while coughing/sneezing  

Wash hands regularly with soap and water

Follow Covid Appropriate Behaviour & avoid crowded places

Drink plenty of water and consume nutritious food  

Avoid touching eyes and nose

Don’t spit in public

Don’t eat together sitting close to one another

Don’t take antibiotics without consulting a physician  


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