Thursday, July 18, 2024

Omicron: Bracing for Impact – The Big Story News

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On December 7, India recorded just 6,822 new Covid-19 cases and 200 deaths in 24 hours; the lowest single-day spike in over 18 months. Active cases currently stand at 95,014, the lowest in 554 days. Yet, instead of heaving a sigh of relief, public health officials across the country are gearing up for battle once again. Ever since cases of the new Covid variant, Omicron, have been confirmed in India, both the Centre and states are stepping up measures to ensure that transmission remains as low as possible. Nobody wants a repeat of what happened when the Delta variant was left to spread unchecked. In Delhi’s Shahdara, for instance, a Covid care centre reserved for Delhi police personnel has been revived. Its 78 beds have been dusted and oxygen has been secured for 20 beds. A little further away, the capital’s largest Covid hospital, the Lok Nayak Jai Prakash (LNJP) Narayan Hospital, has also begun taking stock of its beds and oxygen situation. “We just don’t want to take chances. With Covid, it is always better to be prepared. Surges can be sudden and unpredictable. Even as one works towards limiting the spread, they should be ready if the spread does happen,” says Dr Suresh Kumar, medical director, LNJP.

On December 7, India recorded just 6,822 new Covid-19 cases and 200 deaths in 24 hours; the lowest single-day spike in over 18 months. Active cases currently stand at 95,014, the lowest in 554 days. Yet, instead of heaving a sigh of relief, public health officials across the country are gearing up for battle once again. Ever since cases of the new Covid variant, Omicron, have been confirmed in India, both the Centre and states are stepping up measures to ensure that transmission remains as low as possible. Nobody wants a repeat of what happened when the Delta variant was left to spread unchecked. In Delhi’s Shahdara, for instance, a Covid care centre reserved for Delhi police personnel has been revived. Its 78 beds have been dusted and oxygen has been secured for 20 beds. A little further away, the capital’s largest Covid hospital, the Lok Nayak Jai Prakash (LNJP) Narayan Hospital, has also begun taking stock of its beds and oxygen situation. “We just don’t want to take chances. With Covid, it is always better to be prepared. Surges can be sudden and unpredictable. Even as one works towards limiting the spread, they should be ready if the spread does happen,” says Dr Suresh Kumar, medical director, LNJP.

The spread of Omicron has been rapid. Since December 3, when two cases were first detected in Karnataka, the number has grown seven times to 23 in just four days, with cases reported in Rajasthan, Maharashtra, Gujarat and Delhi. While the states have ruled out complete lockdown, they have implemented other measures to limit transmission (see New Virus, New Rules). In Karnataka, for example, only students with fully vaccinated parents will be allowed to attend offline classes. In Maharashtra, only those fully vaccinated can enter public spaces like parks and public transport. Gujarat has extended its night curfew in eight cities and Rajasthan has made masks mandatory in public areas. States have also put restrictions on the number of people at gatherings, and guidelines have been issued for both domestic and overseas visitors. “There could possibly be undetected cases already as one Omicron case in Karnataka had no travel history at all,” says microbiologist and virologist Dr Gagandeep Kang. “What we need to understand urgently is how fast the variant spreads, how severe its symptoms are and how we can keep the public protected.”

Researchers are concerned that the sheer number of mutations in Omicron’s spike protein (its protein binding receptor alone has eight more mutations than the Delta strain that caused India’s lethal second wave) will make the strain more resistant to vaccines or naturally-acquired immunity against Covid. Last week, a group of researchers in South Africa posted a preprint study finding that the risk of reinfection was 2.4 times higher with Omicron compared to Beta and Delta. In India, the Indian Medical Association (IMA) has issued a warning about a third wave of Covid hitting the country if necessary precautions are not taken. “While there is no need to panic about Omicron, wearing masks and practising social distancing remains crucial. Mask usage has dropped with the fall in active cases. The public needs to revert to Covid-appropriate behaviour,” says Dr V.K. Paul, chairman, National Expert Group on Vaccine Administration for Covid-19 (NEGVAC).

Why keeping Omicron’s transmission low is crucial

Preliminary reports of symptoms suggest that the disease caused by Omicron is mild. There are no reported deaths from the variant yet in the world. “It seems to mainly infect the upper respiratory tract and does not cause as much of lower respiratory distress as the Delta variant,” says Dr Ankita Baidya, infectious disease specialist from Delhi’s Manipal Hospital. In Maharashtra, the state with the highest Omicron tally (10), none of the identified cases are currently on oxygen support. “We are mostly hearing reports of fatigue, cough and some mild fever. These symptoms can be treated through medicine, rest and a light diet,” says Dr Rahul Pandit, director of critical care medicine and ICU at Fortis Mumbai and a member of the state’s Covid task force. He adds that unlike the second wave, the country now has the option of antibody cocktails for those at a higher risk of developing severe illness. “What remains crucial is that people take a test and come in for treatment early. Chances of keeping hospitalisation rates low is much higher in the first few days of symptom onset,” he adds.

Finding it difficult to spread with our new tools for prevention and treatment, the virus, in a manner, is learning to live with us”

Dr K. SRINATH REDDY President, Public Health Foundation of India

However, even if the disease caused by Omicron is mild, experts insist that its transmission rates be kept low. “Every time a virus transmits, it stands the chance to mutate. New strains can possibly evade vaccines created against earlier strains. So, keeping transmission low is vital,” says Dr Rakesh Mishra, a member of the Indian SARS-CoV-2 Genome Sequencing Consortia (INSACOG), the government’s genetic strain surveillance body, and director of the Bengaluru-based Tata Institute for Genetics and Society. Experts are also concerned about the new strain infecting senior citizens and those with comorbidities. “All coronaviruses have the potential to reinfect people. But if the reinfections are mild, it is not something to be worried about. What is concerning is Omicron’s potential impact on those with no vaccination or those at a higher risk from severe illness. Currently, we don’t know this,” says Dr Kang. In India, as on December 7, around 486 million adults, or around half the country’s total adult population, had been fully vaccinated. While the government insists the priority right now is to vaccinate everyone, some experts, including those at INSACOG, have begun recommending a booster dose to reduce the impact of newer strains like Omicron.

How useful will a booster dose be?

“The new variant of coronavirus reportedly has more than 30 mutations in the spike protein region and therefore has the potential of developing immune-escape mechanisms. As most target the spike protein, so many mutations in the spike protein region may lead to a decreased efficacy of vaccines,” says Dr Randeep Guleria, director, All India Institute of Medical Science (AIIMS), Delhi. But the jury is still out.

In South Africa, the government reported on December 2 that 74 per cent of the 249 virus genomes it sequenced in November were Omicron cases, suggesting that the variant may already have displaced Delta in the country. But South Africa only has a vaccination rate of 25 per cent. According to experts, data from South Africa is not enough to judge the efficacy of the current vaccines on Omicron. In the coming weeks, results of various neutralisation studies will help scientists gain a better idea of to what degree Omicron can evade existing vaccines. In India, Balram Bhargava, director general, Indian Council of Medical Research (ICMR), says that it is still too early to comment on the efficacy of vaccines against the new strain. “Right now, we are isolating the new variant. It will then be cultured and tested in the lab to ascertain vaccine efficacy against it,” he says.

There remains some speculation that Covaxin, which does not use the spike protein of Covid to prime the body for infection (the part of the virus seeing the most changes in Omicron), will remain effective in preventing severe disease from the new strain. “What is most important right now is to ensure everyone eligible is fully vaccinated against Covid,” says Dr Paul. At present, the government has ruled out giving booster doses. However, some experts feel that senior citizens should be given a third dose for extra protection. India’s elderly population currently stands at 138 million, as per the National Statistical Office’s (NSO) report ‘Elderly in India 2021’. Doctors say that if even half this number were to be infected with severe Covid, it would be difficult for the country’s current healthcare infrastructure to manage. Additionally, the most effective treatment right now, the antibody cocktail, is priced at Rs 60,000 and remains out of reach for a majority of Indians. “Vulnerable people should be given a booster on priority. The elderly should get priority for two or three doses right away,” says Dr Kang.

Is Omicron a sign of Covid becoming endemic?

Experts say the manner in which it is mutating is an early sign that the SARS-CoV-2 virus is adapting itself to new conditions—that of vaccine-induced or naturally gained immunity and of people wearing masks. “Covid is finding it difficult to spread in the way it had before as we have new tools for both prevention and treatment. So, in a manner, it is learning to live with us, by becoming more contagious to ensure its continued existence,” says Dr K. Srinath Reddy, president, Public Health Foundation of India (PHFI).

Interestingly, a pre-print study by nFerence, a firm that analyses biomedical information, has found that Omicron has picked up a genetic material from the common cold virus. There is speculation that this marker could be a reason for the new strain’s increased virulence. “A more infectious strain will eventually replace older strains, which aren’t able to survive due to our new preventive techniques,” says Dr Mishra. Thus, the best-case scenario, say experts, is that Omicron might be signalling a shift towards a new Covid—one that is more infectious but no more harmful than a common cold. People will still get the disease but it will not be lethal. However, the new strain is yet to infect a variety of different populations and doctors say it is too early to be sure whether Omicron does or does not cause severe disease. Till enough data is gathered and analysed, staying prepared and taking commonsense precautions is the best possible plan.



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