As India navigates the fifth year since the onset of the Covid-19 pandemic, a subtle yet noticeable resurgence of cases in 2025 has rekindled public health vigilance. The Union Health Ministry reported 1,010 active infections as of May 27, 2025, a sharp rise from 257 cases on May 19, primarily concentrated in Kerala, Maharashtra, Tamil Nadu, and Karnataka. The detection of new subvariants, notably NB.1.8.1 in Tamil Nadu and LF.7 in Gujarat, underscores the virus’s persistent evolution. While the outbreak remains geographically limited and most cases are mild, with minimal hospitalisations, the surge reflects global trends, as seen in South-East Asia, where Singapore reported a rise from 11,100 cases (April 20-26) to 14,200 (April 27-May 3). This resurgence, driven by waning immunity, new variants, and seasonal patterns, is not an emergency but a reminder of Covid-19’s endemic nature, akin to seasonal flu. India’s response, rooted in surveillance, vaccination, and targeted precautions, aims to keep this wave manageable, particularly for high-risk groups.
The current wave, though modest compared to the devastating surges of 2020 and 2021, has spotlighted specific states. Kerala accounts for 43% of active cases (approximately 430), followed by Maharashtra at 21% (209 cases), with Delhi (104 cases), Gujarat (80 cases), and Tamil Nadu (70 cases) contributing 10%, 8%, and 7%, respectively. Karnataka, with 47 active cases, has also reported a slight uptick, including a nine-month-old infant in Bengaluru and an 84-year-old patient with comorbidities who succumbed to the virus. The outbreak is geographically confined, with only nine states reporting double-digit cases, and only Kerala, Maharashtra, and Delhi exceeding 100. Since May 19, seven deaths have been recorded—three in Maharashtra, two in Kerala, and one in Karnataka—but the Health Ministry awaits further details to confirm Covid-19 as the primary cause, noting that most fatalities involved patients with severe comorbidities, such as diabetes or heart disease.
Official hospitalisation data is pending, but major hospital chains, including Apollo and Fortis, report no significant increase in Covid-19-related admissions. The few admitted patients, primarily elderly or immunocompromised individuals, suggest that the new cases are not driving severe outcomes. Dr. Suranjit Chatterjee, Senior Consultant at Indraprastha Apollo Hospital, emphasized, “The situation is under control, with sporadic cases that are mostly mild and manageable at home.” This aligns with the Indian Council of Medical Research (ICMR) and World Health Organization (WHO) assessments that the NB.1.8.1 and LF.7 subvariants, classified as Variants Under Monitoring (VUMs), do not exhibit increased transmissibility or severity compared to earlier strains.
The rise in cases is attributed to multiple factors, reflecting the virus’s integration into a recurring cycle of illnesses, similar to influenza. Waning immunity is a primary driver, as protection from vaccinations or prior infections diminishes over time, leaving individuals susceptible to reinfection. India’s vaccination campaign, launched on January 16, 2021, with Covishield and Covaxin, has administered over 1.7 billion doses, fully vaccinating 720 million people by January 2022. However, booster uptake remains uneven, with only 27% of adults receiving a third dose by mid-2024, according to a 2024 Lancet study. New variants, including JN.1, BA.2, and the recently detected NB.1.8.1 and LF.7, contribute to the surge. JN.1, a descendant of Omicron’s BA.2.86 strain, accounts for 16.3% of sequenced cases globally as of February 2, 2025, and 53% in India, followed by BA.2 (26%). NB.1.8.1, identified in Tamil Nadu in April, and LF.7, with four cases in Gujarat in May, are under scrutiny by the Indian SARS-CoV-2 Genomics Consortium (INSACOG) for potential immune evasion, though no evidence suggests heightened severity.
Seasonal patterns also play a role, with respiratory viruses thriving in colder or humid conditions. India’s monsoon season, coupled with a concurrent rise in other viral flu infections, may amplify transmission. Reduced testing and surveillance, a consequence of Covid-19’s endemic status, has delayed outbreak detection. The Health Ministry’s dashboard, updated daily, relies on voluntary testing, which dropped by 60% from 2022 to 2024, per a 2024 ICMR report. This underreporting may mask the true extent of the surge, though increased testing of symptomatic individuals over the next fortnight is expected to clarify the situation. High-risk groups—those over 60, unvaccinated, or with comorbidities like diabetes, heart disease, or chronic lung conditions—remain vulnerable, particularly as public health measures like mask mandates have been relaxed.
Globally, the WHO reports noticeable increases in South-East Asia, with Singapore’s surge highlighting periodic waves as an expected feature of endemic respiratory diseases. Singaporean authorities noted that LF.7 and NB.1.8, descendants of JN.1, constitute over two-thirds of locally sequenced cases but do not cause more severe disease. Similar trends in China, Hong Kong, and Thailand, driven by these variants, suggest regional transmission dynamics influencing India’s uptick. Posts on X reflect public concern, with users noting 164 new cases between May 12 and May 19, predominantly in Kerala (69), Maharashtra (44), and Tamil Nadu (34), though authorities emphasize the situation remains under control.
The emergence of new variants underscores SARS-CoV-2’s ongoing evolution. The WHO monitors three categories: Variants of Concern (VOCs), Variants of Interest (VOIs), and Variants Under Monitoring (VUMs). No variants are currently classified as VOCs, which are characterized by increased transmissibility, severity, or vaccine evasion. JN.1, a VOI, is noted for its mutations but not for heightened risk. The seven VUMs, including NB.1.8.1 and LF.7, are being tracked for potential changes in behavior. In India, BA.2 and JN.1 dominate, with NB.1.8.1 and LF.7 detected in isolated cases. Health officials, including INSACOG, assure that these variants align with global patterns, showing no significant deviation in severity or transmissibility.
Precautions remain critical, particularly for high-risk groups. The 2023 AIIMS/ICMR-COVID-19 National Task Force guidelines recommend home isolation for mild cases, emphasizing physical distancing, mask-wearing, and hand hygiene. Symptoms of NB.1.8.1 and LF.7, including sore throat, mild cough, fever, fatigue, and nasal congestion, are typically mild, resolving within 3-4 days. Individuals should stay hydrated, monitor temperature and oxygen levels (SpO2), and consult doctors if symptoms persist. Immediate medical attention is advised for breathing difficulties, SpO2 below 93%, or prolonged high fever. Antibiotics are discouraged unless bacterial infection is confirmed. Vulnerable populations—elderly, pregnant women, or those with heart disease, diabetes, tuberculosis, or obesity—are urged to wear masks in crowded places and avoid unnecessary travel.
India’s preparedness is bolstered by robust surveillance and hospital infrastructure. The Health Ministry, in coordination with ICMR and the National Centre for Disease Control (NCDC), has intensified influenza-like illness monitoring and ensured adequate supplies of vaccines, oxygen, and beds. Delhi and Maharashtra have issued advisories to hospitals, with Mumbai’s Brihanmumbai Municipal Corporation confirming arrangements for patient accommodation. Karnataka’s Health Minister Dinesh Gundu Rao announced enhanced testing for severe acute respiratory illness (SARI) cases, while Tamil Nadu and Kerala have ramped up genomic sequencing. The Omicron-specific vaccine GEMCOVAC-19 is available for deployment if needed, and booster campaigns are being promoted, particularly for the elderly and immunocompromised.
The resurgence highlights Covid-19’s enduring challenge as an endemic disease. Unlike the chaotic waves of 2020-21, which saw India’s caseload peak at 414,188 daily cases in May 2021, the current surge is manageable, reflecting improved immunity and healthcare capacity. The first case, reported in Kerala on January 30, 2020, marked the beginning of a tumultuous journey, with 45,041,748 total cases by August 2025. The second wave’s devastation, driven by the Delta variant, exposed vulnerabilities, but India’s vaccination drive and surveillance systems have since matured. A 2025 Financial Express report noted that wastewater surveillance detected NB.1.8.1 and LF.7, enhancing early warning capabilities.
India’s response balances caution with pragmatism. The Logical Indian emphasized collective responsibility, urging empathy and adherence to protocols. While the surge is not alarming, it underscores the need for sustained vigilance, particularly as global travel and relaxed measures facilitate transmission. By prioritizing testing, vaccination, and targeted interventions, India can prevent a repeat of past crises, ensuring that Covid-19 remains a manageable part of its public health landscape.
Dipak Kurmi
Wednesday, July 2, 2025