„How these determinants will influence the next pandemic wave in our country, it's up to us, the people. We're with the command desk in our hand. If we press the buttons wrong – we'll have to face a tsunami. And that certainly won't be a pleasant experience..."
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The past two weeks the world has been horrified by images from India, generated by a second pandemic wave, called a tsunami, due to its high growth rate and height. This article is about the causes that caused this wave and what we have in common with India now.

How did the pandemic tsunami wave come across India?

In late February, India's electoral authorities announced key elections in five states with a population of 186 million people. Since March 27, the polls have been open for a month in these states. The election campaign had begun in full force, with no safety protocols and social distancing. In mid-March, authorities allowed more than 130,000 fans, most of them without a mask, to attend two international cricket games between Indian and England selections at Gujarat's Narendra Modi Stadium. More than three million Hindu believers bathed in the Ganges River on 14 April to mark the divine pinnacle of a two-month religious festival. Hindus believe that the Ganges River is holy, and a dip in the water will cleanse them of their sins and bring salvation.

In less than a month, things started to get complicated. India came under control of a second devastating wave of the pandemics and cities were facing fresh restrictions. By mid-April, the country had an average of more than 100,000 new cases a day. On April 30, India recorded more than 400,000 new cases and more than 3,522 deaths, both record-breaking in a single day.

India is now at the epicentre of a public health emergency. Social media and news channels are filled with videos of funerals at crowded cemeteries, relatives bemoaning dead outside hospitals, long queues of ambulances carrying suffocating patients, patients, sometimes two in bed, in corridors and hospital hallways. Frenetic calls for help for beds, oxygen, essential medications, and tests persist. The health system has collapsed, vital medicines are being sold on the black market, and test results last several days.

In late March, more information emerged that a new "double mutant" variant of coronavirus was detected from samples collected in India. Scientists immediately began to check whether the variant, in which two mutations come together in the same virus, may be more infectious or less affected by vaccines.

What's a "double mutant" variant?

Like all viruses, the coronavirus changes in small ways as it passes from person to person. Most of these mutations are inconsistent and do not alter the way the virus behaves. But some mutations trigger changes in the spike protein that the virus uses to catch and enter human cells - these variants could be more infectious, cause more severe diseases or protect themselves from vaccines. Scientists deciphered the Indian genome and detected a so-called "double variant" (with two mutations: E484Q and L452R) of the new coronavirus. In fact, GISAID, an open sharing database, lists 43 viruses that have both the E484Q and L452R mutations, now found in India. The first reports of these two new mutations appeared as early as December 2020. Now the fraction of these mutations has increased in the number of new cases investigated in India.

Such (double) mutations give immune escape and increased infection, say researchers from various countries. If enough mutations occur in a viral family tree or in a lineage, the virus may start to function differently, and the lineage can become a so-called "variant of concern". The variant of India is currently in intense study as a "variant of interest".

It should be noted that the E484Q mutation is like the E484K mutation - a mutation seen in variants B.1.351 (South Africa) and P.1 (Brazil), which have appeared independently several times. As for the L452R mutation - also found in India’s "double mutation", it first received attention as part of line B.1.427 / B.1.429 in the US, which is sometimes referred to as the "California variant".
 
The variant of India contains two "famous" mutations already, namely it has determined its name as "double mutant". In reality, the variant of India has more than 10 mutations in total and is named in scientific databases as B1.617.

Preliminary evidence suggests that B1.617 is more contagious than previous strains of the virus. A recently published study found that the L452R mutation can enhance the ability of viruses to infect human cells in the lab. The California variant, which carries the same mutation, is about 20 percent more transmissible than older strains of the virus.

B.1.617 is spreading very rapidly in India. In recent months, it has become the dominant strain in the state of Maharashtra, one of India's worst-affected states, recently reported a study published in the journal Nature.

But no one yet knows for sure whether B.1.617 is more transmissible and thus drives India's rise. It is known that B.1.1.7 (the variant first detected in the United Kingdom) circulates in India and that P.1 is also. (Variance detected for the first time in Brazil) is also circulating there, and both have a role in this sudden increase.

It is premature to draw conclusions about all the causes of the pandemic tsunami phenomenon in India. From the international media is selected the following information:
 

• A continuous series of events (elections, religious festival, sporting events) took place over a period of 2 months with the participation of many people in many Indian states.
• The recommendations of experts on postponing the election campaign have been neglected by politicians.
• Protocols on compliance with precautionary measures such as wearing masks and social distance have not been approved and implemented at mass events.
• In India, the concomitant movement of several mutant strains, including new strains, with "double mutant" is confirmed.
• The level of covid vaccination in the population is very low (10% received the first dose; 2% received 2 doses) due to limited vaccine stocks.
• The number of new illnesses increased very quickly and caused the collapse of the medical system on all dimensions.

What do we have in common with India?

At the moment the pandemic situation in our country is different from that in India in terms of new cases. Ideally, it would be good to make collective efforts to keep it that way. There are here, however, some early signs that insistently tell us to remain vigilant.

The country is now going through the Easter holidays, during which many group interactions are accumulated. We are on the verge of an election campaign, which will last the next 2 months and will include multiple election meetings. It is not excluded that the "double mutant" strain will reach Moldova soon. At the same time, we already have in Moldova several mutant strains, circulating simultaneously. Vaccination levels are also very low in the Republic of Moldova. There are a lot of people who don't wear a mask and don't respect social distance. So, we already tick off basically 5 out of 6 causes mentioned above for India as being existing here.

How these determinants will influence the next pandemic wave in our country, it’s up to us, the people. We're with the command desk in our hand. If we press the buttons wrong – we'll have to face a tsunami. And that certainly won't be a pleasant experience.