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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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Lower Premiums for Health Score Achievers: How Preventive Wellness Rewards Healthy Choices

Healthcare costs are rising steadily across India, driven largely by lifestyle-related diseases and late-stage diagnosis. In response, organisations and insurers are shifting focus from reactive treatment to prevention. One of the most effective approaches emerging from this shift is offering lower premiums for health score achievers.

This model aligns personal health responsibility with financial incentives, creating a win–win situation for individuals, employers and insurers.

What Is a Health Score?

A health score is a composite indicator that reflects an individual’s overall health status.

It typically considers:

preventive health checkup results
lifestyle habits such as physical activity and sleep
key biomarkers like blood sugar, cholesterol and blood pressure
body composition indicators

The focus is on risk reduction, not perfection.

Why Health Score–Based Premiums Are Gaining Importance

According to NITI Aayog and EY-FICCI reports, preventive healthcare can reduce long-term medical costs by up to 30–40 percent.

Health score–linked premiums:

reward proactive behaviour
reduce claim frequency
encourage early detection

This shifts healthcare from illness management to health preservation.

The Preventive Healthcare Gap in India

NFHS-5 and ICMR data show:

many chronic diseases remain undiagnosed until advanced stages
preventive screenings are underutilised
lifestyle risks are increasing among working adults

Health score incentives help close this gap.

How Lower Premiums Motivate Behaviour Change

Financial Incentives Drive Consistency

When healthy habits are rewarded financially, individuals are more likely to:

attend regular screenings
improve diet and activity
monitor health metrics

Behaviour change becomes sustainable.

Focus on Improvement, Not Punishment

Modern health score models emphasise:

gradual improvement
personalised targets
achievable milestones

This avoids discouragement and promotes inclusion.

Benefits for Individuals

Reduced Insurance Costs

Lower premiums directly reduce out-of-pocket insurance expenses.

Better Health Awareness

Tracking health scores increases understanding of:

personal risk factors
lifestyle impact
preventive actions

Knowledge leads to better choices.

Early Disease Detection

Regular monitoring identifies:

prediabetes
early hypertension
lipid abnormalities

Early intervention prevents complications.

Benefits for Employers

Lower Healthcare Claims

Preventive health programs reduce:

hospitalisations
long-term treatment costs

This improves corporate insurance sustainability.

Improved Productivity

Healthier employees experience:

fewer sick days
better energy levels
improved focus

Wellbeing translates to performance.

Stronger Wellness Culture

Reward-based programs signal genuine employer commitment to health.

Benefits for Insurers

Health score–based premiums help insurers:

manage risk more accurately
reduce high-cost claims
promote preventive engagement

This supports long-term viability of insurance models.

Role of Preventive Health Checkups

Preventive screenings form the backbone of health scoring.

They help track:

metabolic health
cardiovascular risk
nutritional deficiencies

NITI Aayog identifies screening as the most cost-effective health intervention.

Addressing Privacy and Fairness Concerns

Responsible programs ensure:

data confidentiality
voluntary participation
non-discriminatory design

Transparency builds trust and engagement.

Making Health Scores Inclusive

Inclusive programs:

adjust for age and baseline health
reward progress
offer support for high-risk individuals

Equity is essential for success.

Integration with Digital Health Platforms

Digital tools enable:

real-time health tracking
personalised insights
long-term trend monitoring

This improves engagement and accuracy.

Long-Term Impact on Public Health

Widespread adoption of health score incentives can:

reduce lifestyle disease burden
shift focus to prevention
improve population health outcomes

WHO supports incentive-based preventive health strategies globally.

Challenges and How to Overcome Them

Common challenges include:

low initial engagement
lack of awareness
resistance to change

Solutions involve education, simplicity and continuous support.

Why Lower Premiums Are More Effective Than Penalties

Positive reinforcement:

motivates sustained behaviour change
reduces anxiety
builds trust

Punitive models often discourage participation.

Future of Health Score–Linked Premiums in India

As digital health infrastructure expands, health score–based models are expected to:

become more personalised
integrate AI-driven insights
support nationwide preventive strategies

This marks a shift toward value-based healthcare.

Conclusion

Lower premiums for health score achievers represent a powerful shift toward preventive, value-driven healthcare. By rewarding healthy behaviours, early screening and consistent wellness practices, these programs benefit individuals, employers and insurers alike. Financial incentives aligned with health outcomes encourage long-term behaviour change, reduce disease burden and create a sustainable healthcare ecosystem. In a country facing rising lifestyle diseases, health score–linked premiums are not just an incentive—they are a strategic investment in healthier futures.

References

World Health Organization (WHO) – Preventive Healthcare and Incentive Models
Indian Council of Medical Research (ICMR) – Lifestyle Disease and Prevention
National Family Health Survey (NFHS-5) – Adult Health Indicators
NITI Aayog – Preventive Healthcare and Insurance Reform Reports
EY-FICCI – Corporate Wellness and Healthcare Cost Studies

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