Voluntary use of masks must be promoted, say health experts as XE variant stokes fourth wave fears

According to the WHO, the XE variant is a combination or recombinant of both sub-variants -- BA.1 and BA.2 -- of Omicron.

New Delhi: Voluntary use of masks must be promoted in the country in view of Covid-19's new XE variant, healthcare experts said, calling it the single-most effective intervention against all variants of the coronavirus.

After more than two years, the mandatory wearing of masks was lifted in Maharashtra and Delhi. Wearing masks was mandatory in public in view of the Covid-19 infection and not following this protocol drew a fine as high as Rs 2,000.

The World Health Organisation (WHO) has issued a warning against XE, a new variant of Omicron first detected in the UK, and suggested that it could be more transmissible than any COVID-19 strain so far. The XE variant is a combination or recombinant of both sub-variants -- BA.1 and BA.2 -- of Omicron.

Asked about the new variant's impact on India, which is witnessing a dip in cases ever since the Omicron driven wave started receding in February, the experts said that there is no need to panic but advocated for voluntary use of masks in public.

Gujarat reported its first case of the XE variant on Saturday after authorities got the genome sequencing results of the sample taken from a man from Mumbai, who had tested positive for COVID-19 during his visit to Vadodara on March 12, a state official said.

Earlier to this, Mumbai civic body officials had said that a woman who had arrived from South Africa in February-end and tested positive in March has been infected by the XE variant, but the health ministry has not confirmed it to be so.

Eminent virologist T Jacob John said XE means there were XA, XB, XC and XD earlier but none of them were given much attention.

"XE gained attention since it became common in the UK. It had about 10 per cent higher transmissibility than the BA.2 lineage of Omicron. Many media persons misread this as 10 times more transmissible than BA.2 and thus, XE gained false notoriety," he said.

"After the Omicron wave (predominantly BA.2) receded by the third week of February, there was no cause for alarm even if this one virus is confirmed as XE. No change in our tactics is called for. While masks have many benefits other than Covid control and should be generally promoted by health education, mandate with punishment for non-compliance is quite unnecessary," he added.

Giridhara R Babu, professor and the head of life course epidemiology at the Public Health Foundation of India, said reporting of the XE variant should be seen as a strength of the surveillance system.

"XE is a recombinant sublineage of one of the many Omicron BA.1 and BA.2 variants. It is not a variant of concern. We should not get worked up due to its reporting. Certainly, we should refrain from implementing any reactive panic measures. We should recollect that the Delta variant had several sublineages before Omicron finally replaced it," he said.

Babu said the precautions followed for Omicron should continue before more data on its transmissibility in India emerges. "I feel that voluntary use of masks should be encouraged as this is the single most effective intervention against all variants. However, there should not be any penalty, and instead of a mandate, ensuring availability and free distribution of masks, especially in closed space settings, will be helpful," he added.

Babu said there is no data to support warranting restrictions in movement. Field investigations of clusters and genomic sequencing should be sustained and strengthened to monitor how newer sublineages might impact, he said.

Dr Chandrakant Lahariya, a physician and leading epidemiologist who has been involved in India's pandemic response, said the hype around the XE variant is "uncalled for and exaggerated".

"It has no relevance and there is no reason to be concerned. The only relevant thing of reporting of XE shows that India's genomic surveillance system is working. In this backdrop, XE being detected and reported from India is a positive public health sign but doesn't change anything for the public or for the COVID-19 response policy," he said.