Prof Salim Abdool Karim Weekly COVID-19 UPDATES

24 April 2023

Today’s missive comes to you from Portsmouth, New Hampshire, where I am attending the NEJM Board meeting. The situation at global level has changed little from last week with a continuing downward trend in cases and deaths (Figure 1). 

The situation in South Africa has similarly shown little change (Figure 2). The number of cases and deaths remains low.

But some countries continue to have high numbers of reported cases. South Korea, India and Japan lead the way as countries with the highest numbers of cases in the past week (Figure 3). The country with the largest increase in reported cases is India.

Today’s email focuses on India as a response to a question I received on India’s Covid-19 situation from Rudo Mathiva, who is the Head of the Intensive Care Department at Baragwanath Hospital. The rise in reported cases in India has increased markedly as seen the graph in slide 4 below. They use the nickname given to XBB.1.16 – Arcturus to refer to this new variant.  The extent to which XBB.1.16 is spreading in India is not really known since most cases are asymptomatic or mildly symptomatic, but the tip of the iceberg is evident, suggesting a rapidly spreading virus.

The new omicron sub-lineages have continued to evolve to become more infectious, which each new variation of the virus having higher transmissibility. As India goes into the grip of a wave of infections, protecting the elderly and vulnerable is going to be important as bed occupancy rises (Figure 4). 

In this regard, the protection offered by a combination of vaccination and early treatment is going to be important to keeping infections, hospitalisations and deaths low. Testing is key to identifying staff and others who may pose a risk to the elderly, especially in old age homes.

Fortunately, India has high vaccine coverage (Figure 5). As a result, most cases are mild. But vaccination is not going to be enough to keep this virus at bay due to waning immunity, which has enabled the virus to spread. To deal with the breakthrough infections, testing is needed for both early treatment initiation with drugs like Paxlovid in the elderly and those with co-morbid conditions and for initiation of public health measures such as masks and quarantine to reduce the risk of exposing the elderly to infected individuals.

Some states in India have already initiated public health measures like mask mandates.

And just in case you are not aware, the USA still has about 250 deaths a day from Covid-19. The Washington Post reminded us of this in its recent article “Covid is still a leading cause of death as the virus recedes” (Figure 6). It is simply that we do not consider this serious or concerning, as we have come to accept an ongoing pandemic with occasional waves and ongoing deaths even between waves.  

Have a great week.


Salim S. Abdool Karim, FRS
Director: CAPRISA
CAPRISA Professor of Global Health: Columbia University