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New SARS-CoV-2 sub-variant JN1: Why panic and propaganda shouldn’t prevail

By Dr Amitav Banerjee, MD* 

“The Art of War teaches us to rely not on the likelihood of the enemy’s not coming, but on our own readiness to receive him; not on the chance of his not attacking, but rather on the fact that we have made our position unassailable.” -- Sun Tzu
***
A new sub-variant of the SARS-CoV-2 is in the headlines. Identified in Luxembourg in August 2023, the sub-variant JN.1 has reached 41 countries, which include USA, China, Singapore and India. The rise in Covid-19 cases has sent the nation into a tizzy. 
A single spike of 628 new Covid-19 cases on 26 December 2023 pushed the caseload to 4,054 with an odd death in some states. Of the new cases, 63 were due to the JN.1 sub-variant. The southern states of Goa (34), Maharashtra (9), Karnataka (8), Kerala (6), Tamil Nadu (4), and Telangana (2) are reporting most of the cases.
JN.1 belongs to the lineage of the Omicron variant of the SARS-CoV-2, a descendent of the variant BA.2.86. It differs from the BA.2.86 due to L455S mutation in the spike protein.

How lethal is JN.1?

The WHO has classified it as a variant of interest (VOI) as the symptoms are mild and recovery is rapid. There is negligible risk of hospitalization or death. While an occasional Covid-19 death has been reported from Kerala and Karnataka we are not certain whether we can attribute them to JN.1. Earlier variants like the BA.2.86 as well as influenza viruses also do circulate in the winter. We do not always have information about underlying co-morbidities either. Since the pandemic cause of death is ambiguous. 
We never know for certain whether people are dying “of Covid-19” or “with Covid-19.” We harbour millions of microbes in our skin, throat and gut from womb to tomb. Any organisms picked up from a dying person even if not contributing to death may get falsely attributed to it (Post Covid-19 era death certification defied all earlier norms).

Do mutants give rise to more lethal strains?

Coronaviruses mutate continuously. Four circulating coronaviruses cause the common cold. Recovery from a cold does not render one immune against another strain. The immunity wanes and the person can again catch a cold. The constant mutation of the common cold viruses prevents development of an effective vaccine. However there is no record that mutants are more lethal. Rather, they are milder and serve as nature’s vaccine.
SARS-Cov-2, a coronavirus, is behaving in the same way. Given the mutating nature of coronaviruses it is doubtful whether we can develop an effective vaccine against Covid-19.

Omicron, the game changer

The emergence of Omicron was a game changer in the Covid-19 marathon which started as a sprint. Fortunately, it was good forthe pandemic. True to the nature of mutants the Omicron was much milder than the Wuhan strain. 
This is explained by Darwin’s law of natural selection. Virulent mutants lose in the race for survival as symptomatic cases will isolate themselves and those who die will carry the strain with them to the tomb. So lethal mutants so not spread far and wide and lose the survival race. Mutants too “stoop to conquer!” Instead of killing the host it enters into a “treaty” of live and let live! 
These milder strains spread fast by a large number of asymptomatic cases mixing with others spreading the friendly mutant across countries and continents. They are nature’s updated vaccine deployed in record time. No human made vaccine can catch up with nature’s speed.
By this logic, the JN.1 strain which is a sublineage of the Omicron variant and a “grand-daughter” of Omicron, as we had BA.2.86 variant in between, is likely to be much milder and faster in its spread than the old grandpa Omicron.
By the time a new strain is announced by a “Eureka” moment of a career scientist, the strain has already spread across countries. It amounts to closing the stable door after the horse has bolted!
We should take the emerging strains of the virus in our stride like any common cold virus. Let genomic surveillance be an academic venture without media hype. This leads to panic and a stampede for scarce hospital resources.

What should be the contingency plan?

Some states are on the brink of an exaggerated response with calls for testing, contact tracing, masking and isolation. All mean well but are highly inappropriate. They will harm without benefits. At this stage we need a calm analysis of each action contemplated. Common sense can serve better than science sans the art.
At this stage of the pandemic, there is no purpose served in testing, contact tracing and isolation. This will be chasing the impossible as illustrated in the Nordic mythology below:
“Thor, the god of thunder and lightning, faced the King of the giants. The King had challenged Thor to empty the drinking horn. The horn was placed before Thor. He took the goblet to his lips and took strong gulps but no matter how hard he tried he could not empty the horn. 
"He lost his breath many times in his attempts but still the level of water in the horn fell only marginally. Thor was confused. He was seeing only the tip of the task he was given. As an act of deception, the goblet Thor was drinking from was connected by a conduit to a nearby ocean! And Thor was attempting unknowingly to drain the ocean. Naturally, his efforts were in vain.”
The story has lessons for Covid-19 strategy today. By testing and contact tracing what are we going to achieve? Can we eradicate coronaviruses? It will lead to the same situation as in the tale of Thor who was unknowingly trying to drain an ocean?
Thousands of mutating pathogens exist in nature. Chasing them with vaccines is like chasing deers and cheetahs in the forest
We are an ocean of people. Most have been infected with earlier strains of the virus which gives stronger mucosal immunity which the vaccine cannot confer and hence fail to prevent the virus entering the lungs. Due to high population density, the newer strains by all probability will have spread far and wide rendering immunity to large swathes of the population. We should practice “masterly inactivity” and let nature do its work unobtrusively, silently. The following advice from a rebellious general during Hitler’s time illustrates this well.
Kurt von Hammerskin-Equard, a German general and long term dissenter of Adolf Hitler and Nazism, classified leaders into the following categories:
“I distinguish four types. These are clever, hardworking, stupid and lazy. Mostly two categories go in tandem. Some are clever and hardworking; their place is in general staff. The next category is stupid and lazy. They make up 90% of any work force and are suited for routine duties. 
"Anyone who is intelligent and lazy is qualified to be the leader as he has mental clarity and strength of nerve necessary for a crisis. One must beware of anyone who is both stupid and hardworking; he must not be given any responsibility because he will cause immense harm by hardworking efforts in the wrong direction.”
It has been unfortunate for humanity that since the beginning of the pandemic, we have had stupid and hardworking people at the helm of affairs in almost all countries of the world. It is time to halt this.

What would be the most rational way forward?

We should improve the general health of our people. We have a major problem of child malnutrition due to which more than 2000 children die daily due to the vicious cycle of “malnutrition-infection-malnutrition.” The middle class is increasingly becoming overweight due to sedentary lifestyle and unhealthy food. The Covid-19 pandemic established that obesity and associated co-morbidities make people succumb to viral infections.
We have two windows of opportunity to make our people safe from future pandemics. Firstly, we should eliminate child malnutrition which will make our young survive infections. Secondly, we should promote healthy lifestyle among our increasingly affluent population. This will require effort and political will as market forces are penetrating the suburbs and rural areas to sell ultra-processed fast foods and sugary drinks.
And last but not the least, we should strengthen our public hospitals and health centres which are in a state of neglect. Corporate hospital and insurance schemes only promote tertiary care in large cities, while we need better primary and secondary health care centres at the periphery.
Thousands of mutating pathogens exist in nature. Chasing them is like chasing deers and cheetahs in the forest as vaccines cannot keep on pace with the mutants. However, if our general health is good, and our public hospitals and health centres are easily accessible to people we will make our position unassailable in any pandemic. 
Failing this, there will be frequent “chaos and anarchy,” due to medical stampede as witnessed during the second wave of the pandemic.
---
*Epidemiologist, presently Professor in a Medical College at Pune; had served as epidemiologist in armed forces for over two decades; recently ranked in Stanford University list of world’s top 2% scientists; has written the book, “Covid-19 Pandemic: A Third Eye”

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