Review: What are the latest Research Studies about COVID-19 in India saying?
Sai Krishna Muthyanolla
July 15, 2020
Ever since the onset of COVID-19 in India, efforts are on to understand the virus and its effects with more clarity. The latest issue of Indian Journal of Medical Research published a few of these studies. Here is a summary of the important ones.
The first COVID-19 case in India was reported on 30 January 2020. With an increase in the number of cases in subsequent months, the country went into a nation-wide lockdown in an attempt to mitigate the spread of virus and to ramp up testing and health care facilities to identify and treat the infection.
These early measures were based on the understanding of COVID-19 at that point of time and experiences from across the world. Over the last few months, India and the world are developing newer understanding of the virus, thanks to the continuous research being carried on varied aspects concerning COVID-19.
In an earlier story, we looked at some important COVID-19 research being carried out in India. We referred to the research articles published on ICMR (Indian Council of Medical Research)’s Indian Journal of Medical Research.
In this story, we look at few other research studies undertaken recently and the relevant developments in understanding COVID-19. The latest issue of Indian Journal of Medical Research has published some of these studies.
Analysis of RNA sequences show evolution of Coronavirus spread & rapid spread of one of the types across globe.
The aim of this research study was to investigate the diversification and evolution of coronavirus SARS-CoV-2, and its progression over the period of time and across geographical locations.
For this purpose, publicly available data on type definition based on whole-genome sequences of the SARS-CoV-2 between December’19 to March’2020 was considered. These samples were from 3636 patients across 55 countries.  The major findings of this study are:
Based on the results from the research study, it can be understood that :
A recent research study by CCMB (Centre for Cellular and Molecular Biology) in Hyderabad has identified that A2a and A3I strains as being wide spread in India. This is based on the study of  more than 1,573 genomes from across India, with around 2,581 variants catalogued.
National Sero-Surveillance to monitor trend & spread of Infection in India
Examples from around the world like in the case of South Korea, New Zealand show that active case finding, testing and contact tracing are key in minimising the spread of COVID-19. There is large uncertainty regarding the extent of the population that is infected by COVID-19 infection, with reports and data suggesting that a significant proportion of the infected population remain asymptomatic or pre-symptomatic.
Hence, surveillance is key in enabling tracing and testing of COVID-19 cases, but the scope would be limited if this is restricted to medical facility-based surveillance, as there are high chances that mild and asymptomatic cases are missed
Surveillance can be made more effective through household-targeted, antibody-based serologic testing, especially regarding the role of asymptomatic infection in driving transmission and would be able to effectively estimate the extant of infection in a given population.
Hence, ICMR has proposed to establish a community-based district-level Sero-surveillance system to monitor SARS-CoV2 infection in general population.
The initial survey would serve as a baseline to determine the sero-prevalence of SARS-CoV-2 infection in the community. The subsequent rounds of survey would help in monitoring the trends of infection.
The protocol for the survey is as follows
Such a Sero-based community survey conducted in Spain was successful in providing insights about the spread of infection, especially asymptomatic cases. Finland, USA, France, Scotland, Sweden, Germany etc are among the countries which conducted serology based community surveys.
The results of the initial survey were recently announced by the government on 11 June 2020. The study found that
Development of indigenous IgG ELISA for the detection of COVID-19 antibodies
Most of the diagnostic tools available for Diagnosis of COVID-19 are mainly based on Molecular assays. WHO has recommended only ‘Real-time reverse transcription-polymerase chain reaction’ as the diagnostic method to be used for COVID-19.
However, the rapid spread of the COVID-19 has created a need to use other testing methods. Serological assays are also used as a screening tool for surveillance. However, they are not recommended by WHO for case detection and are not part of WHO’s laboratory testing guidelines.
The burden of infection and the spread can be determined by using detection of IgM and IgG antibodies against SARS-CoV-2 by serological assays like ELISA (Enzyme Linked Immunosorbent Assay).
Development of such testing kits would be effective in detection and surveillance of COVID-19. ICMR-NIV (Pune) have attempted to develop and evaluate IgG-based ELISA for COVID-19.
After following this method, the developed ELISA was found to be 92.7% sensitive, 97.9% specific, robust and reproducible. The Positive predictive value was 94.44% and Negative predictive value was 98.14%.
As per ICMR Journal, this indigenously developed IgG ELISA was found to be sensitive and specific for the detection of anti-COVID-19 antibodies in serum samples. This can help in determining seroprevalence of the infection in population exposed to the virus.
Suggestions for Ophthalmologists in view of COVID-19 spread
Healthcare professionals are among the high-risk individuals for contacting COVID-19. Among others medical professionals, ophthalmologists are also identified to be at high risk of being infected by COVID-19.  The higher chance of risk is due to :
In view of this scope of risk, guidelines are being issued for Ophthalmologists to continue with their practice during this pandemic.
COVID-19 infection might impact multiple organs in the body
One of the initial assumptions regarding COVID-19 infection was that it effects the lungs and the respiratory system.  However, as more & more COVID-19 cases are being studied, it has been observed that COVID-19 virus does infect multiple other parts in the body.
In an interview given to News agency, the Director of AIIMS has confirmed that COVID-19 does infect multiple body parts. It has been observed that COVID-19 causes inflammation in the inner lining of the blood vessels, which leads to narrowing of their area. This causes clotting and blocking of the blood vessels. In few of the cases,  it has been observed that apart from lungs, kidneys have also been affected. As per a few international research studies, COVID-19 could affect Brain, Lungs, Heart, Blood Vessels, Kidneys  Liver & Gut.
Featured Image: Studies about COVID-19