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ORIGINAL ARTICLE
Year : 2022  |  Volume : 66  |  Issue : 1  |  Page : 45-48  

Prevalence of novel Corona Virus (severe acute respiratory syndrome Coronavirus 2) and its uncertain future in the different regions of Punjab


1 Associate Professor, Department of Microbiology, Government Medical College, Amritsar, Punjab, India
2 Professor, Department of Microbiology, Government Medical College, Amritsar, Punjab, India
3 Research Scientist, Department of Microbiology, Viral Research Diagnostic Laboratory, Government Medical College, Amritsar, Punjab, India

Date of Submission14-Sep-2021
Date of Decision25-Oct-2021
Date of Acceptance26-Nov-2021
Date of Web Publication5-Apr-2022

Correspondence Address:
Mohan Jairath
Viral Research Diagnostic Laboratory, Government Medical College, Amritsar, Punjab
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijph.ijph_1793_21

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   Abstract 


Background: Coronavirus disease-19 (COVID-19), produced by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has become a global pandemic, giving rise to a serious health threat globally. Many countries have seen a two-wave pattern in there reported cases during the period of pandemic. Similarly, our country has reported the first peak between March and October 2020 followed by the second peak between April and June 2021. Objectives: The objective of this study was conducted to describe the spatiotemporal patterns and early epidemiological features of COVID-19 cases from November 2020 to May 2021 in the central (Majha) region of Punjab state of India which was considered as the epicenter of the infection. Methods: The multiplexed real-time reverse transcription–polymerase chain reaction (RT-PCR) method was used to detect SARS-CoV-2, with co-amplification of specific target genes using real-time PCR kits. Results: During the second wave, test positivity rate for COVID-19 in our laboratory (the central region of Punjab) was recorded as 4.8%. The study revealed that an increased sustained proportion of COVID-19 incidence is present in young adult age group (20–39 years) with 8.65% positive rate followed by the older age group and least in young ones. It was observed that during the second wave, more symptomatic individuals are positive (10.26%) alongside it was also observed that male population (5.61%) was more prone to infection in comparison to females (3.78%). Whole-genome sequencing carried out on 120 random samples selected from all the districts of Majha region of Punjab state showed two prominent strains, namely alpha variant (95 cases) and delta variant (19 cases). Conclusion: A higher positivity rate in the second wave demonstrates the rapid spread of the new emerging virus variants and warrants the implementation of strict vaccination regimes and quarantine in the affected region.

Keywords: Coronavirus disease-19, severe acute respiratory syndrome coronavirus 2, test positivity rate, whole-genome sequencing, mutation


How to cite this article:
Sidhu SK, Singh K, Tuli AK, Bigdelitabar S, Jairath M. Prevalence of novel Corona Virus (severe acute respiratory syndrome Coronavirus 2) and its uncertain future in the different regions of Punjab. Indian J Public Health 2022;66:45-8

How to cite this URL:
Sidhu SK, Singh K, Tuli AK, Bigdelitabar S, Jairath M. Prevalence of novel Corona Virus (severe acute respiratory syndrome Coronavirus 2) and its uncertain future in the different regions of Punjab. Indian J Public Health [serial online] 2022 [cited 2022 May 24];66:45-8. Available from: https://www.ijph.in/text.asp?2022/66/1/45/342595




   Introduction Top


Coronavirus disease-19 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has become a global pandemic, giving rise to a serious health threat globally. An epidemic spreads rapidly and extensively while a pandemic threatens people worldwide leading to higher morbidity and ultimately leads to mortality. The worst pandemics transmit easily and rapidly among humans and have long asymptomatic infectious periods. Developing countries are always under the great risk of such pandemics due to the higher level of malnutrition among the population and insufficient availability of good medical and diagnostic facility, namely the doctor–population ration in India is 1:1456 against the ratio of 1:1000 recommended by the World Health Organization (WHO).[1] On January 30, 2020, COVID-19 was declared a Public Health Emergency of International Concern, which owing to the alarming levels of spread and severity were eventually declared a global pandemic on March 11, 2020.[2] Extensive measures have been taken by nations to accelerate the vaccination drive to control the pandemic at the earliest. A public health challenge has appeared due to ongoing mutations of the SARS-CoV-2 virus which make it highly contagious and transmissible. A change in the genetic sequence of the SARS-CoV-2 virus results in the emergence of a new variant having one or more mutations that differentiates it from the available reference sequences. The mutant variants spread quickly, show signs of resistance, or may have no impact to existing treatments when compared with the circulating viruses. The presence of mutations in the SARS-CoV-2 virus in a patient's sample can affect the diagnostic test performance which is influenced by various factors, including the sequence of the variant, the design of the test, and the prevalence of the variant in the population. Since, RNA viruses are more prone to mutations in comparison to DNA virus; it has been observed that the rate of mutation in coronaviruses is slow in comparison to other RNA viruses because of adequate proofreading activities of the enzyme which makes it difficult to detect in individuals at an early stage.[3] The rate of mutation in SARS-CoV-2 virus is two single-letter mutations per month, which is only half of influenza and one-quarter that of HIV virus.[4] The WHO globally announced four significant variants of concerns (VOCs) that are informally associated with the name of the country in which they were first reported. They are referred to as the UK (B.1.1.7), South Africa (B.1.351), Brazil (P1), and India (B.1.617.2). The WHO reported total of more than 153 million COVID-19 confirmed cases and 3.2 million deaths till May 1, 2021. A total of 23.1 million cases have been reported in Southeast Asia region, of which more than 86% have been attributed to India.[2] Scientists are investigating to understand several coronaviruses that are now circulating in India, where another brutal wave of COVID-19 devastates the nation. Although India is struggling with the second wave of COVID-19 infections, which some scientists and authorities believe has worsened due to the double mutation virus variant, there are now reports of a triple mutation in parts of India that has been discovered. Traces of the triple mutations have been found in Maharashtra, Delhi, West Bengal, and Kerala.[5] The objective of the present study is to evaluate and analyze the clinical epidemiological profile and prevalence of COVID-19 and to detect the comparative infectious rate of the virus between the two waves after diagnosis through RT-PCR from the samples received in the Virus Research and Diagnostic Laboratory (VRDL), Amritsar, among various districts of Punjab. Therefore, this study aimed to describe the sociodemographic characteristics, pattern, or extent of virus infection during the period of this pandemic and viral load in the population of people infected with SARS-CoV-2.


   Materials and Methods Top


Test for the SARS-CoV-2 viral RNA using the reverse transcription–polymerase chain reaction (RT-PCR) is pivotal for detecting current COVID-19 and its duration of detectable virus indicating potential for infectivity. This anonymized retrospective epidemiological study includes nasopharyngeal and/or oropharyngeal swabs from suspected patients at different collection centers across the six districts (Amritsar; Pathankot; Tarn Taran; Gurdaspur; Hoshiarpur; and Kapurthala) comprising the Majha and Doaba regions of Punjab state of India. A total of ~1.27 million samples were received and tested at VRDL, Government Medical College (GMC), Amritsar, overall period of 7 months, i.e., between November 2020 and May 2021. The RNA was extracted using automated RNA Extraction System as per the standard protocol. The multiplexed real-time RT-PCR method was used to detect SARS-CoV-2, with co-amplification of different targets, namely RdRp gene (RNA-dependent RNA polymerase gene), E gene (envelope protein gene), and N gene (nucleocapsid protein gene), using real-time PCR kits approved by the Indian Council of Medical Research (ICMR). For a test to be considered positive, an amplification curve for each molecular target along with one positive and negative control was observed and analyzed for the presence of an exponential amplification curve with a Ct value (cycle threshold) below a given threshold and dependent on the total number of cycles programmed for the test. The cycle threshold values of RT-PCR were used as the indicators of the copy number of SARS-CoV-2 in specimens with lower cycle threshold values corresponding to higher viral copy numbers.


   Results Top


This study was conducted to describe the spatiotemporal patterns and early epidemiological features of COVID-19 cases from November 2020 to May 2021, i. e., during the period of the second wave and its comparison with the first wave in the Majha region of Punjab state of India which was considered as the hotspot of infection. Our findings showed that the total positivity was 4.80% out of 1.2 million RT-PCR tested samples at VRDL, GMC, Amritsar, (95% confidence interval rate; 0.048 ± 0.0003) which was slightly higher than the first wave which was 4.15% [Table 1]. The present study also revealed that during the second wave, an increased sustained proportion of COVID-19 incidence is present in young adults with age group 20–39 years, i. e., 14508/168606 (8.60%) which was quite higher in comparison to the first wave, namely 3.58%. The previous study done in our laboratory reported that elderly population (≥61 years) was more prone to COVID-19 infection 2252/292,927 (7.68%), whereas comparatively controlled cases were observed during the second wave from the same age group, i. e., 5.75% [Table 1].[6] Thus, indicating an elevated role in disease spread during the epidemic creating a possible reservoir of disease with spillover risk to more vulnerable older persons and those with comorbid conditions. The finding revealed an escalated prevalence of COVID-19 among the male patients (5.61%) in comparison to the female (3.78%) [Figure 1]. A similar trend was also observed, i. e., male patients with positive percentage of 4.82% and females with 2.73% during the first wave as reported in our previous study.[6] During the second wave, the total positive individuals percentage (out of total symptomatic cases) was found out to be 10.26%, whereas from the total asymptomatic individual, only 3.88% were positive.
Table 1: Total positivity rate of Majha region of Punjab during two waves among different age group

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Figure 1: Bar graph depicting the escalated prevalence of COVID-2019 patients on the basis of gender in both waves.

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Throughout the study, a 4.8% test positivity rate (TPR) was recorded for all the six tested districts of Majha region of Punjab state at the VRDL, Amritsar. The TPR for each individual district came out to be, Amritsar (10.9%), Gurdaspur (2.4%), Kapurthala (2.6%), Pathankot (5.2%), Tarn Taran (2.2%), and Hoshiarpur (2.6%). For the effective implementation of health-care programs, the recommended value of TPR according to the WHO should be less than 5%. This indicates the adequate number of tests conducted in the laboratory to contain the spread of the virus by isolating and quarantining the positive cases.

This study also reported the month-wise distribution of the total positive cases, i.e., from November 2020 to May 2021. An increasing trend was observed during the month of March 2021 (n = 119,28) which showed the arrival of the second wave and reached the peak at around May 2021 with total positive cases of 23,500. Before that, a significantly constant number of positive cases was observed from the month of November 2020 to February 2021 [Figure 2]. While combining our previous study of month-wise distribution during the first wave[6] with the present study, we observed two peaks in the months of September 2020 (n = 13670) and May 2021 (n = 23500), respectively [Figure 2]a, which was in consensus with the data published by the public health officials of the country [Figure 2]b. A total of 120 samples were randomly selected from all the districts of Majha region of Punjab state and sent for whole genome sequencing and the data showed two different strains, i. e., B.1.1.7 variant (95 cases) and B.1.617.2 variant (19 cases), whereas the remaining six samples were inconclusive [Table 2].
Figure 2: (a) Epidemic curve of COVID-2019 cases from March 2020 to May 2021 in Majha region of Punjab state. (b) Graph depicting the epidemic wave dynamic of COVID-2019 cases in Majha region of Punjab and overall India.

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Table 2: Variants/lineages detected in the study group

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   Discussion Top


The official estimated figures in India were nearly 31 million confirmed cases of SARS-CoV-2 infection and 4 hundred thousand deaths by the end of June 2021. Among the 6 zones of the country including 28 states and 8 union territories, the most affected region was the western region followed by the northern region. In north India, New Delhi was one of the epicenters of the pandemic and experienced large surges of the disease during the two waves (first wave during monsoon, i.e., between August and October 2020 and second wave in summer, i.e., between April and June 2021) followed by Punjab.[5] Goldstein et al. reported in their study that in Germany from March to April 2020, relatively increased number of COVID-19 cases were observed in the adults age group (15–34 year old) compared to younger and older age groups.[7] Yu et al. also observed the same in South Korea, that people aged 20–39 years numerically led the epidemic, although the elderly suffered the majority of morbidity and mortality.[8] Moreover, similar trend of infection was observed in the Southern United States, where Boehmer et al. reported higher positive COVID-19 incidence among 20–39 years old in comparison to older age groups during the second wave.[9]

Yang et al.[10] and Owusu et al.[11] studied the effect of infection on the basis of gender where they found that males had higher infection rates compared to females. Khan et al. also reported that the positive male (70.25%) population were infected predominantly by COVID-19.[12] Their results are in concordance with our study. The male preponderance to the infection has been explained on the basis of the more active immune response in females in which the mast cells help them to fight infectious diseases better than the males.[13] Furthermore, a genetic component such as X chromosome and sex hormones, especially estrogens in females, has provided significant level of protection against SARS-CoV-2.[14] Tuli et al. in their study revealed that during the first wave of COVID-19 more positive patients showed specific symptoms in comparison to asymptomatic.[6] Our results are also in coherence with the study done by Owusu et al.[11] in which symptomatic patients had more positivity rate than asymptomatic patients.

Since, viruses are continuously evolving through replication, which results in the emergence of new viral strains over the time. RNA viruses, such as SARS-CoV-2, are more susceptible to genetic variation than DNA viruses. Thus, resulting in a variety of variants which leads to prediction of a new form of the virus over the time which is basically responsible for the arrival of the second wave.[15] Throughout the pandemic, several strains of SARS-CoV-2 have been identified from various geographical locations worldwide and are depicted in [Table 2].


   Conclusion Top


Since the new variants of the virus have been reported, our finding suggests that COVID-19 will not disappear in the short or medium term, and the mass vaccination process will predictably last all year around. A higher positivity rate in the second wave is possibly attributed to the rapid spread of the virus as a result of the emergence of new variants which bypass the conventional immune defense in the body. The evolution of the virus has also resulted in an increase in its ability to cause severe infections in individuals under the age group of 40 years, thus requiring statewide awareness and adequate control measures. Since, more symptomatic individuals appear in the infected population, this can be helpful in apparent diagnosis and treatment as compared to tracking asymptomatic individuals. Underlining this issue, it is also important to curtail the spread of the new delta variant whose numbers are constantly on the rise and which is twice as contagious as the former variants. Therefore, with immediate effect, this matter needs utmost attention in the form of mass vaccination and implementing strict lockdowns for long periods, although it has its own consequences from an economic, social, and psychological point of view. Besides this tactic, the government should also consider and be prepared for managing the sociocultural, economical, and psychological burdens of the lockdown, if it will be continued further.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
The Doctor-population Ratio in India is 1:1456 against WHO Recommendation. Deccan Herald; 2020. Available from: https://www.deccanherald.com/business/budget-2020/the-doctor-population-ratio-in-india-is-11456-against-who-recommendation-800034.html. [Last accessed on 2021 Jul 12].  Back to cited text no. 1
    
2.
WHO. India Situation Report-9 and 13; 2020. Available from: https://www.who.int/india/emergencies/coronavirus-disease-(covid-19)/india-situation-report. [Last accessed on 2020 Jul 19].  Back to cited text no. 2
    
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Sanjuán R, Domingo-Calap P. Mechanisms of viral mutation. Cell Mol Life Sci 2016;73:4433-48.  Back to cited text no. 3
    
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The Coronavirus is Mutating — Does it Matter? Available from: https://www.nature.com/articles/d41586-020-02544-6. [Last accessed on 2021 Jul 09].  Back to cited text no. 4
    
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COVID Cases in India – Google Search. Available from: https://www.google.co.in/search? [Last accessed on 2021 Aug 09].  Back to cited text no. 5
    
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Tuli AK, Bigdelitabar S, Singh K, Sidhu SK, Jairath M. Clinical epidemiological profile and prevalence of severe acute respiratory syndrome coronavirus 2 by real-time polymerase chain reaction. GJRA 2021;10:2277-8160.  Back to cited text no. 6
    
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Goldstein E, Lipsitch M. Temporal rise in the proportion of younger adults and older adolescents among coronavirus disease (COVID-19) cases following the introduction of physical distancing measures, Germany, March to April 2020. Euro Surveill 2020;25:2000596.  Back to cited text no. 7
    
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Yu X, Duan J, Jiang Y, Zhang H. Distinctive trajectories of the COVID-19 epidemic by age and gender: A retrospective modeling of the epidemic in South Korea. Int J Infect Dis 2020;98:200-5.  Back to cited text no. 8
    
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Boehmer TK, DeVies J, Caruso E, van Santen KL, Tang S, Black CL, et al. Changing age distribution of the COVID-19 pandemic – United States, May-August 2020. MMWR Morb Mortal Wkly Rep 2020;69:1404-9.  Back to cited text no. 9
    
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Yang J, Zheng Y, Gou X, Pu K, Chen Z, Guo Q, et al. Prevalence of comorbidities and its effects in patients infected with SARS-CoV-2: A systematic review and meta-analysis. Int J Infect Dis 2020;94:91-5.  Back to cited text no. 10
    
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Owusu M, Sylverken AA, Ankrah ST, El-Duah P, Ayisi-Boateng NK, Yeboah R, et al. Epidemiological profile of SARS-CoV-2 among selected regions in Ghana: A cross-sectional retrospective study. PLoS One 2020;15:e0243711.  Back to cited text no. 11
    
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Khan M, Khan H, Khan S, Nawaz M. Epidemiological and clinical characteristics of coronavirus disease (COVID-19) cases at a screening clinic during the early outbreak period: A single-centre study. J Med Microbiol 2020;69:1114-23.  Back to cited text no. 12
    
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Guan WJ, Liang WH, Zhao Y, Liang HR, Chen ZS, Li YM, et al. Comorbidity and its impact on 1590 patients with COVID-19 in China: A nationwide analysis. Eur Respir J 2020;55:2000547.  Back to cited text no. 13
    
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Jaillon S, Berthenet K, Garlanda C. Sexual dimorphism in innate immunity. Clin Rev Allergy Immunol 2019;56:308-21.  Back to cited text no. 14
    
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Yan H, Jiao H, Liu Q, Zhang Z, Xiong Q, Wang BJ, et al. ACE2 receptor usage reveals variation in susceptibility to SARS-CoV and SARS-CoV-2 infection among bat species. Nat Ecol Evol 2021;5:600-8.  Back to cited text no. 15
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2]



 

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