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Published on: Apr 25, 2021
2 minute read
By: Dr Rajan Choudhary

COVID 19 Mutations: An Update

COVID 19 Mutations: an update

India is currently experiencing a very high rate of infections across the country, resulting in record hospitalisations, ICU admissions and now a severe shortage of oxygen. How did this happen? As with all things, it is likely multifactorial, and blame cannot be associated with one single issue. Socioeconomic issues preventing effective lockdown, stretched healthcare resources, poor communication and maintenance of social distancing and mask use. And of course, viral variants, something we will be discussing below.

GENETIC MUTATIONS

Mutations are integrated deeply into the backbone of genetics. When DNA replicates, its two strands split apart and are used as blueprints to create two new strands, each containing half the original DNA. Mutation’s sneak into the replication phase, and can change the proteins the DNA encodes. If these mutations are compatible with life, they survive and may be passed down the generations. If the mutations provide an evolutionary benefit that improves the survival of the organism and allows it to outcompete other organisms, its descendants will survive, and the mutation will flourish.

Complex organisms such as plants and animals have inherent DNA repair mechanisms that reduce the rate of mutations. This is because most mutations are incompatible with life, as they destroy critical proteins required for the most basic functions of cell function and life. Cancer is evidence of what happens when these repair mechanisms fail. Viruses do not have such protection; when the high mutation rate is combined with the high replication rate, viral variants are inevitable.

COVID MUTATIONS

Scientists have been tracking mutations of the SARS-CoV-2 virus closely. Countries across the world are basing the re-opening and recovery of their societies on reducing infection rates and preventing re-infections through vaccination programmes. If the virus mutates, it can result in increased infectivity, mortality, and potentially the ability to escape from natural immunity offered by antibodies.

Indian genome scientists first detected the “double variant” of the novel coronavirus in October 2020, and in the UK in Feb 2021. It has been on the rise, and B.1.617 accounts for almost 70% of genomes submitted by India to the global database GISAID. It has a total of 13 mutations, which in turn lead to the change in multiple amino acids. B.1.617 has multiple mutations and describing it as a “double mutant” virus is therefore inaccurate.

L452R

B1617 s more contagious because of a mutation in the spike protein known as L452R.This mutation has been studied as it has also been found in variants identified in California (including apes in San Diego Zoo). It is thought this improves the binding to the ACE2 receptors in the lung and may also have some ability to escape from neutralising antibodies.

E484Q

The second mutation is E484Q, which also affects the spike protein to make it less susceptible to pre-existing antibodies, though there is limited evidence for this. Looking at convalescent plasma donated by people it appears to have weaker neutralisation of B.1.617 in some people, though this isn’t a consistent finding.

Mutations at position 484 have also been found in other global variants, though these E484K mutations lead to different functions. One study looking at the UK B.1.1.7 variant looked at how this E484K mutation affected viral interactions in vaccinated patients. Patients who have been vaccinated produce antibodies with a wide range of actions targeting multiple sections of the spike protein. When these patient serums were exposed to the B.1.1.7 mutation, it was found to have decreased neutralisation. This raised the risk of reduced vaccine efficacy and threatened the vaccine programme. Currently, public health officials are confident our vaccine programmes cover the emerging variants.

CONCERNS

Whilst B.1.617 is concerning, it currently accounts for about 20% of cases in Maharashtra, and likely a low percentage of total infections in the country. There is not yet enough evidence to classify it as a “variant of concern”, and further research is required. Though it has increased potential for spreading, currently the UK variant B.1.1.7 may be on the rise, and more concerning. It has over 50% increased transmissibility and 60% lethality and contributed to the UK’s most recent wave of infections. Genomic studies have shown it is now the dominant form of the virus in the Indian state of Punjab.

What is most concerning, however, is the risk of more variants emerging. As the infection spreads unimpeded through the population, viral replication remains at an all-time high, which in turn increases the risk of mutations. Current mutations are covered by vaccines, future mutations may not be. This is why we need to lower infection rates as soon as possible.

Social distancing, use of masks, vaccinations, lockdowns, and quarantine when expressing symptoms. We have to follow public health advice, to prevent our infection rates from spiralling further out of control

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Asthma Symptoms in Adults: Early Signs, Triggers, and When to Seek Care

Asthma is often perceived as a childhood condition, but a significant number of cases develop or persist into adulthood. In India, adult asthma is increasingly recognised due to rising air pollution, occupational exposure and lifestyle-related risk factors. Unfortunately, asthma symptoms in adults are frequently misdiagnosed as recurrent infections, allergies or age-related breathlessness, leading to delayed treatment.

Understanding adult asthma symptoms is critical for early diagnosis, effective control and prevention of severe attacks.

What Is Asthma?

Asthma is a chronic inflammatory disease of the airways. In asthma, the airways become:

inflamed
narrow
overly sensitive to triggers

This leads to difficulty in breathing, especially during exposure to specific stimuli.

Why Adult Asthma Is Often Missed

Adult asthma symptoms may:

appear gradually
vary in severity
mimic common respiratory conditions

According to Indian Council of Medical Research and WHO data, many adults remain undiagnosed for years, increasing the risk of complications.

Common Asthma Symptoms in Adults

Wheezing

A high-pitched whistling sound while breathing, especially during exhalation, is a classic asthma sign.

Shortness of Breath

Adults with asthma often feel:

breathless during routine activities
difficulty taking deep breaths

This may worsen at night or early morning.

Chest Tightness

Many describe a sensation of pressure or tightness in the chest, which can be mistaken for heart-related issues.

Chronic Cough

A persistent cough, especially:

at night
early morning
after exercise

is a common but overlooked asthma symptom.

Symptoms That Worsen With Triggers

Asthma symptoms often intensify after exposure to specific triggers.

Air Pollution and Smoke

Urban pollution, vehicle emissions and indoor smoke significantly worsen asthma symptoms in adults.

Allergens

Dust mites, pollen, mould and pet dander are common triggers.

Respiratory Infections

Viral infections can trigger asthma flare-ups or reveal undiagnosed asthma.

Physical Activity

Exercise-induced asthma causes breathlessness and wheezing during or after physical exertion.

Weather Changes

Cold air, humidity and sudden temperature changes can aggravate symptoms.

Adult-Onset Asthma

Adult-onset asthma differs from childhood asthma.

Characteristics include:

onset after age 20–30
less association with childhood allergies
more persistent symptoms
higher likelihood of severe disease

Occupational exposure and hormonal changes contribute to adult-onset asthma.

Risk Factors for Asthma in Adults

Several factors increase asthma risk:

long-term exposure to pollution
smoking or passive smoking
occupational chemicals or dust
obesity
family history of asthma
chronic sinusitis or allergies

Women may experience asthma onset or worsening during hormonal changes.

When Asthma Symptoms Become Serious

Seek immediate medical attention if experiencing:

severe breathlessness
difficulty speaking in full sentences
bluish lips or fingertips
rapid worsening of symptoms
poor response to usual inhalers

These signs indicate a potentially life-threatening asthma attack.

How Adult Asthma Is Diagnosed

Diagnosis includes:

detailed symptom history
physical examination
lung function tests (spirometry)
response to bronchodilators

Early diagnosis improves long-term outcomes.

Impact of Untreated Asthma

Untreated asthma can lead to:

frequent attacks
reduced lung function
sleep disturbances
missed workdays
reduced quality of life

According to Lancet respiratory studies, uncontrolled asthma increases hospitalisation risk.

Managing Asthma Symptoms in Adults

Effective asthma management focuses on:

identifying and avoiding triggers
using prescribed inhalers correctly
monitoring symptoms regularly
maintaining follow-up care

Asthma action plans help patients recognise worsening symptoms early.

Role of Preventive Healthcare

Preventive healthcare helps:

detect asthma early
assess lung function
guide lifestyle modifications

Regular health checkups are especially important for individuals with respiratory symptoms or occupational exposure.

Lifestyle Measures That Support Asthma Control

Helpful practices include:

avoiding smoking
improving indoor air quality
wearing masks in polluted environments
maintaining healthy weight
regular, moderate exercise

Lifestyle support complements medical treatment.

Mental Health and Asthma

Stress and anxiety can worsen asthma symptoms.

Stress management:

reduces symptom frequency
improves medication response

Holistic care improves asthma outcomes.

Importance of Medication Adherence

Asthma medications work best when:

taken regularly as prescribed
inhaler technique is correct

Skipping treatment increases flare-up risk.

Long-Term Outlook for Adults With Asthma

With proper management:

symptoms are well controlled
severe attacks are preventable
normal activity levels are achievable

Most adults with asthma lead active, productive lives.

Conclusion

Asthma symptoms in adults are often subtle, variable and easily mistaken for common respiratory problems. Wheezing, breathlessness, chest tightness and chronic cough should not be ignored, especially when triggered by pollution, exercise or weather changes. Early diagnosis, trigger control and consistent treatment are essential to prevent severe attacks and preserve lung health. Recognising adult asthma early empowers individuals to manage symptoms effectively and maintain a good quality of life.

References

Indian Council of Medical Research (ICMR) – Respiratory Disease and Asthma Studies
World Health Organization (WHO) – Asthma Management and Prevention Guidelines
National Family Health Survey (NFHS-5) – Respiratory Health Indicators
Lancet Respiratory Medicine – Adult Asthma Outcomes and Management
NITI Aayog – Air Pollution and Respiratory Health Reports
Statista – Global Asthma Prevalence and Trends

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