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What India Should Have Learnt From The Pandemic Years

Pandemic lessons | Research supports enhancing disease surveillance with environmental monitoring, but government funding for nationwide initiatives and additional hospital staff remains pending.

By Charu Bahri, IndiaSpend
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What India Should Have Learnt From The Pandemic Years | Photo courtesy: Coldsnowstorm, iStockPhoto.com

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What India Should Have Learnt From The Pandemic Years

On December 16, 2023, India confirmed its first JN.1 strain Covid-19 patient, a 79-year-old woman in Kerala. Within the next 10 days, neighbouring Karnataka reported 34 cases, 20 in Bengaluru alone, and three deaths.

In the laboratory of the Tata Institute for Genetics and Society (TIGS) in Bengaluru, scientists knew of the sub-variant JN.1’s presence in the city around December 10, well before doctors started to see an increase in the number of patients presenting with influenza-like symptoms, in the case of JN.1, sore throat, congestion, cough, fever, fatigue, nausea, diarrhoea, and body ache.

They knew this because they had been analysing wastewater samples from 28 sewage collection points across Bengaluru for Covid-19 since January 2022.

Over four years since the pandemic first hit India, how has the public health system re-oriented to prepare for such health emergencies, which multiple studies (see this, this and this) predict are likely to be more frequent? Critical information that could be gained from sewage surveillance for quick action is missing, thanks to a paucity of funds, and while India has improved its hospital infrastructure including the number of beds and ventilators, experts say this has not been matched with a corresponding increase in manpower.

The Case for Wastewater Surveillance

Covid-19 samples are taken as swabs from the throat. However, the virus is also known to live and replicate in the gut, leading to a high viral load in excreta, making wastewater sampling and analysis an effective way to predict whether a community is on the verge of an outbreak. Essentially, when the concentration of the virus in wastewater shows an increasing trend, an outbreak in the community may be imminent.

“Increases in the concentration of the Covid-19 virus in wastewater occur in advance of any increase in the number of cases confirmed clinically because the shedding of the virus in excreta starts when the person is still asymptomatic, so, well before the individual approaches a doctor and gets tested,” explained Farah Ishtiaq, principal scientist, TIGS.

In the Americas, Covid-19 genetic material was seen in wastewater 56 days before the first clinically confirmed case, and 90 days before the first clinically confirmed case in Brazil.

The Centre for Cellular & Molecular Biology (CCMB), Hyderabad, a constituent laboratory of the Council of Scientific & Industrial Research (CSIR), has also monitored wastewater samples for Covid-19 in Hyderabad, Kolkata, Delhi, Chennai, Prayagraj, Mumbai and 13 cities in Maharashtra, with similar outcomes.

“Our work has shown that wastewater surveillance can provide a 1-2 week advance warning for Covid-19,” Archana Bharadwaj Siva, Senior Principal Acientist at CCMB, told IndiaSpend.

Why the Govt isn’t Allocating Funds to Sewage Surveillance

Sewage samples can be tracked for their Covid-19 viral load as well as put through genomic sequencing to identify new and emerging variants of concern.

Across 72 countries worldwide, sewage samples from more than 4,648 sites continue to be routinely monitored for the genetic material causing coronavirus.

“Such

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