New Delhi: India is witnessing a significant rise in SARS-CoV-2 cases, prompting speculation about whether COVID-19 is transitioning into a seasonal disease.
National reports confirm increased case detections in India during epidemiological week 20, contributing to a regional surge in the South-East Asia region of the World Health Organization (which includes India), where test positivity rates have risen sharply from 0.5% in early April to 5% by mid-May. This trend, also seen in Thailand and the Maldives, remains below the 10% peak observed in June 2024.
Despite this uptick, there is insufficient duration and data to classify COVID-19 as a seasonal illness like influenza, given the virus’s unpredictable evolution.
Variant surveillance reveals shifts in global SARS-CoV-2 dynamics. The JN.1 subvariant of Omicron, dominant since January 2024, continues to circulate widely, but the previously prevalent LP.8.1 is declining. Meanwhile, NB.1.8.1, a Variant Under Monitoring (VUM) and descendant of XDV.1.5.1 and JN.1, has risen to 10.7% of global sequences by mid-May, up from 2.5% in early April. NB.1.8.1 carries key spike mutations—T22N, F59S, G184S, A435S, V445H, and T478I—which may enhance transmissibility, modestly reduce antibody neutralisation, and improve immune evasion. Notably, only five NB.1.8.1 sequences have been reported from South-East Asia, highlighting significant surveillance gaps. WHO assesses that neither NB.1.8.1 nor LP.8.1 poses additional public health risks compared to other circulating variants.
The Indian government is advised to ensure vaccine availability for high-risk groups, including the elderly, immunocompromised individuals, and those with advanced diabetes, chronic kidney disease, chronic obstructive pulmonary disease, or those on steroids. These groups are urged to wear masks and avoid gatherings to reduce transmission risks, while no vaccine mandate is recommended for the general public.
Globally, the World Health Organization’s (WHO) on May 28, 2025, reported a parallel increase in SARS-CoV-2 activity since mid-February, with the global test positivity rate reaching 11% by May 11, a level comparable to the 12% peak in July 2024. This surge is primarily driven by the Eastern Mediterranean, South-East Asia, and Western Pacific regions.
In the Eastern Mediterranean, positivity has climbed to 15% by mid-May, with increased circulation reported in Egypt, Kuwait, Oman, Saudi Arabia, the United Arab Emirates, and Pakistan. The Western Pacific region saw positivity rise from 5% to 11%, with Cambodia, China, Hong Kong SAR, and Singapore affected.
In contrast, the African, European, and American regions report lower activity, with positivity rates ranging from 2% to 3%, though the Caribbean and Andean subregions show rising trends. Publicly available wastewater monitoring data from Europe and North America indicate no significant increase as of 11 May 2025. Limited reporting of hospitalisations, ICU admissions, and deaths from high-burden regions restricts the WHO’s ability to assess the impact on health systems.
Vaccination uptake remains critically low, particularly among high-risk groups. In 2024, only 1.68% of older adults across 75 countries and 0.96% of health and care workers across 54 countries received a COVID-19 vaccine dose, with significant regional and income-based disparities. High-income countries report 4.3% coverage for older adults, compared to less than 0.5% in low-income countries, with similar patterns for health workers (2.1% in upper-middle-income countries versus 0.3% in low-income countries). Globally, 39.2 million individuals across 90 countries, covering 31% of the global population, received a dose in 2024, including 14.8 million in the third quarter. The WHO’s Technical Advisory Group on COVID-19 Vaccine Composition recommends monovalent vaccines targeting JN.1 or KP.2 lineages, with LP.8.1 as a suitable alternative, urging prompt vaccination for high-risk groups to prevent severe disease and death. Countries are advised not to delay vaccination in anticipation of variant-specific vaccines.
WHO recommends a risk-based, integrated approach to managing COVID-19, embedding it within broader respiratory disease programmes, such as the Global Influenza Surveillance and Response System (GISRS) and Coronavirus Network (CoViNet). This includes maintaining multi-source surveillance, including sentinel and wastewater monitoring, to track variants and disease burden. Countries should strengthen healthcare systems to ensure high-quality clinical management of COVID-19 and post-COVID-19 conditions (long COVID), alongside robust infection prevention and control. Risk communication and community engagement are vital to counter misinformation and empower informed decision-making. Despite the end of the public health emergency in May 2023, WHO’s global risk assessment for July–December 2024 deems the public health risk high due to ongoing circulation, unpredictable evolution, and high population immunity from prior infections and vaccinations. WHO advises against travel or trade restrictions but urges sustained investment in surveillance, vaccination, and healthcare capacity, particularly as health systems face competing priorities like non-communicable diseases, workforce strain, and economic pressures.
