India is witnessing a subtle but steady rise in COVID-19 cases, stirring memories of the devastating second wave in 2021, though the current situation is far less severe. Since mid-April 2025, the virus has shown increased activity, with 257 active cases reported as of 20 May, primarily in Kerala with 69 cases, followed by Maharashtra and Tamil Nadu. Maharashtra’s positivity rate stands at 12%, a sign of the virus’s persistent spread. Based on past trends, experts anticipate this heightened activity may continue for several weeks, driven by waning immunity and increased social interactions. Yet, the cases remain mostly mild, with most patients recovering at home, a stark contrast to the panic of earlier years.
The dominant variant in India is JN.1, a descendant of Omicron’s BA.2.86 lineage, making up 53% of tested samples. BA.2 accounts for 26%, with other Omicron sublineages comprising 20%. JN.1, known since August 2023, is not considered lethal and rarely leads to severe illness, though its high transmissibility keeps it circulating. Newer subvariants have emerged: one case of NB.1.8.1 was identified in Tamil Nadu in April, and four cases of LF.7 were detected in Gujarat in May. The World Health Organization (WHO) classifies both NB.1.8.1 and LF.7 as “Variants Under Monitoring,” not “Variants of Concern” or “Variants of Interest,” and assesses the global public health risk of NB.1.8.1 as low. Current vaccines targeting JN.1 remain effective against severe disease and hospitalisation, though they are less effective at preventing transmission of these newer variants.
The human impact is felt across India’s regions. Kerala reports the highest number of cases, while Maharashtra’s Thane has seen 18 cases, including one death and eight new infections in the past week, with one patient hospitalised. Karnataka recorded 35 cases in 2025, mostly mild, though an 84-year-old man with comorbidities passed away. Delhi has 23 cases, prompting the government to issue advisories ensuring the availability of hospital beds, oxygen, medicines, and vaccines. Haryana reported four cases—two in Gurugram and two in Faridabad. In Uttar Pradesh, Noida has a 55-year-old woman under home quarantine, and Ghaziabad confirmed four cases. Uttarakhand’s AIIMS Rishikesh reported three cases, including one resident doctor, underscoring the risk to healthcare workers. In Telangana, a Hyderabad pulmonologist tested positive but has fully recovered, while Andhra Pradesh noted four cases, one involving a postgraduate student.
Globally, similar patterns are emerging. Singapore reported 14,200 cases in the week ending 3 May, Hong Kong saw 1,000 weekly cases by 10 May, and Thailand recorded over 91,000 cases. These surges are driven by JN.1 and its descendants, including LF.7, NB.1.8, XEC, and LP.8.1, which carry spike protein mutations enhancing transmissibility. XEC, first identified in Germany in June 2024, and LP. 8.1 are noted for potential increased spread. WHO reports that only 34% of countries provided case data in early 2025, with a global test positivity rate of 5% in February. Most cases are mild, presenting symptoms like cough and fatigue, though the elderly and immunocompromised face higher risks of severe outcomes. Reinfections are common due to waning immunity and increased social mixing.
Vaccination remains critical. In India, 58.8% of the population is fully vaccinated, and 70% have received at least one dose. Boosters are recommended, especially for high-risk groups like the elderly and those with comorbidities, to counter variants like XEC and LP.8.1. Current vaccines reduce severe disease and hospitalisation, though their impact on transmission is limited. A new vaccine, Zapomeran (Kostaive), a self-amplifying mRNA vaccine approved in Japan in November 2023 and the EU in February 2025, is being rolled out. Its replicase protein enhances efficacy by amplifying the immune response to the SARS-CoV-2 spike protein. WHO’s Technical Advisory Group on Covid-19 Vaccine Composition, meeting on May 6–7, 2025, recommended JN.1-based vaccines and urged stronger surveillance due to inconsistent global case and genomic reporting. They also emphasised a “One Health” approach to monitor zoonotic risks.
India’s health authorities stress simple precautions: maintaining hand hygiene, wearing masks in hospitals or crowded places, practising respiratory hygiene, and testing if symptoms appear. The risk to doctors, like the resident at AIIMS Rishikesh or the Hyderabad pulmonologist, highlights the need for vigilance in healthcare settings. With hybrid immunity from past infections and vaccinations, India is better prepared than before, but the virus’s persistence demands a balance of caution and resilience. As the nation navigates this mild resurgence, staying vigilant without succumbing to fear is the path forward.
