Should India be worried about China's COVID explosion?

India has been monitoring China's unprecedented wave of COVID-19 cases and is taking proactive contingency measures to prevent a potential outbreak of the virus.

Several Indian states have issued safety advisories, recommending that people wear masks and take precautions to keep infections at bay.

Earlier last year, India relaxed its COVID-19 restrictions after a drop in infections, and most people stopped wearing masks outside. However, last week, authorities conducted mock drills across a number of health facilities in several states to ensure their readiness.

India on alert

Meanwhile, the virus is spreading rapidly through China, where the authorities dropped the country's "zero-COVID" policy.

The move has triggered a surge of cases and deaths in a population with little natural immunity and low levels of vaccine boosting.

Experts observing the outbreak are predicting hundreds of thousands of deaths in the coming months.

In a fresh advisory, airports and entry points across India have been asked to strengthen surveillance and conduct genome sequencing to detect new variants. Random tests have been mandated for travelers from China and five other nations, along with random sampling of 2% of all international passengers.

"Early detection of new variants of the virus and their containment are among the key surveillance measures the government is focusing on," NK Arora, chairman of the COVID-19 working group of the National Technical Advisory Group on Immunization told DW.

Over 90% of India's adult population had been fully vaccinated by July last year. In addition, at least a quarter of adults have received booster shots and a large percentage of the population have been naturally infected. As such, experts say that the chances of India witnessing large-scale deaths — as seen during the second wave in 2021 — from existing variants are slim.

However, given that the virus has changed and mutated so much in the past two years, authorities are aware of the potential for further mutations and have been deploying resources.

Many virus experts have their attention on the XBB.1.5 and BF.7 variants as well as other, more transmissible subvariants.

"Hospitalizations have not risen despite the detection of XBB and BF.7 cases, indicating that Indians may be better protected because of hybrid immunity [vaccine plus infection]," Giridhara Babu, an epidemiologist at the Public Health Foundation of India, told DW.

"But we need to be proactive and sustained strengthening of surveillance mechanisms to detect new variants early enough and respond appropriately."

"Currently, there are no signs of increasing cases based on the data. The transmission rate and severity of a variant cannot be uniform everywhere; it varies depending on the susceptibility of the local population and the environment," added Babu.

Vigilance is vital

The Indian Sars CoV-2 Consortium on Genomics — a network of laboratories monitoring genomic variations of the COVID virus — will hold a meeting this week to review data from China on the viral wave that's gripped the country.

Given that a large percentage of the population enjoys hybrid immunity leading to all Omicron sub-lineages causing only a mild disease, some feel the focus in India should not be on daily new infections but only on any increase in hospitalizations, particularly ICU admissions.

"Until recently the BF.7 variant was not found in any measurable numbers in India," Vineeta Bal, an immunologist from the Indian Institute of Science Education and Research told DW.

"That situation might change with rapidly rising infections in China. India's worry should be about monitoring the new cases, identifying which variant is responsible for increase in the number of cases."

'No worries'

Bal also pointed out that — based on India's vaccination history and last year's high Omicron infection rate which resulted in significant hybrid immunity — India should not be worried about the rapid and uncontrollable spread of severe COVID infections.

Gautam Menon, a professor of physics and biology at Ashoka University, pointed out that the India's at-risk population has largely been vaccinated, although booster coverage could be increased.

"We should be vigilant against variants which might lead to more severe disease. For this, integrated surveillance — both genomic and clinical — is necessary," Menon told DW. "We could, and should, encourage our population to get booster shots."

Menon, who works on mathematical and computational models tracking the spread of COVID-19, maintained that authorities should be attentive against variants which might lead to more severe disease. 

"For this, integrated surveillance, both genomic and clinical, is necessary," he said. "It may be essential to explore the use of the new protein sub-unit vaccines as additional boosters for the vulnerable population."

"Transparency is important, an area where the Chinese government appears to be failing at the moment. We should not fall into the same trap."

Last April, India approved two homegrown vaccines for children under the age of 12. Covaxin, made by Hyderabad based Bharat Biotech, was granted emergency use permission.

Two other vaccines were also given emergency approval: Corbevax for children aged between 5 and 12 years of age, and Zydus's two-dose jab for children over 12.

"One has to be watchful and practice COVID-appropriate behavior," Shally Awasthi, pediatric pulmonologist at Lucknow's King George's Medical University told DW. "The BF.7 variant in India will be like influenza where there could also be mortality. The word is caution and prevention, even if deaths are low."

According to the Health Ministry's website, over 2.2 billion doses of COVID vaccine have been administered in the country under the nationwide vaccination drive so far. The overall death toll to date stands at 530,707.