INDIA HAS BEEN recently witnessing a surge in COVID-19 infections, driven by the Omicron variant (maybe, also, supplemented by the Delta strain). India has been reporting 3 lakhs and above single day new COVID-19 cases for the past few days. In states that were hit first by this new wave e.g. Delhi, Maharashtra and Karnataka, it is projected that the third wave would peak soon. But how dangerous is Omicron variant? Is Omicron more dangerous for children?
According to Manindra Agarwal, IIT Kanpur, the third wave may peak in most parts of India on January 23, 2022 (The ET, Jan. 22, 2022). He says the wave has already peaked in Delhi, Mumbai, and Kolkata in the last seven days. Next, the peak would be seen in other regions, including Maharashtra, Karnataka, Uttar Pradesh, Gujarat, and Haryana; and, in Assam, Andhra Pradesh, and Tamil Nadu next week. Agarwal claims that daily caseloads may peak around January 23 and would remain below 4 lakh.
Most experts opine that Omicron causes 'mild disease' and hospitalizations and fatalities would be much less, compared to Delta. However, three groups must stay careful: the unvaccinated, the elderly, and the co-morbid people.
We were earlier forecasting that India's caseloads would be much higher. But the trajectory has changed considerably. As per Dr Agrawal, this may be due to two reasons, there are two groups in the population: one with less immunity against Omicron, and the other with more. The new variant first spread in the former group, causing a sharp rise. Now that the first group is exhausted, the virus is trying to spread through the latter group; hence, the spread is slower.
However, Omicron may still have more tricks up its sleeve; and, we must not let our guards down yet!
Omicron Sub-Variant
A sub-variant of Omicron strain is causing alarm among some scientific circles (Fortune, Jan. 21, 2022). WHO says that Omicron (B.1.1.529) has 3 main sub-strains: BA.1, BA.2, and BA.3. The recent global surge has been largely triggered by BA.1; according to WHO, 99 per cent of the sequenced cases were BA.1. However, the rise of BA.2 sub-variant has been reported in Denmark and elsewhere. Soon, BA.2 may outcompete BA.1!
Denmark is currently reporting over 30,000 new cases per day, 10 times higher than peaks in previous waves. It's almost certain that BA.2 may be even more transmissible than the highly contagious BA.1 (original Omicron strain). It's npt clear, thoguh, if this sub-variant would cause more serious disease than BA.1. Initial data indicates that teher are no significant differences in hospitalizations due to BA.2 compared to BA.1. However, we all must remain very watchful of the developments!
BA.1 has a mutation in the S gene (a deletion) that shows up in certain PCR tests (using a special kit), and it makes it easy to tell if someone is infected with the classic Omicron. However, BA.2 doesn't have this mutation, and will not show up on PCR tests. Hence, BA.2 has been called "the stealth Omicron."
WHO currently levels BA.2 as a 'variant under investigation.' But some scientists are of the view that it's very different from the original Omicron strain. Hence, they claim that it should be termed a VoC and have its own Greek letter to designate it.
New COVID Drugs approved in Australia
Australia has recently approved two new drugs for treating COVID patents (The Conversation, Jan. 21, 2022). These are Lagevrio (Merck Sharpe & Dohme) and paxlovid (Pfizer, discussed in previous columns). The former causes errors in the viral replication process whereas the latter is a combination of two drugs: nirmatrelvir (new drug) and ritonavir (already used for HIV treatment). Nirmatrelvir inhibits the function of a key protein essential for viral replication; ritonavir prevents the body from breaking down nirmatrelvir.
Drugs and many vaccines targeting the SARS-CoV-2 spike protein would become less effective against Omicron. Omicron has over 30 mutations affecting the spike protein. However, these new drugs don't target the spike; and, hence, they are expected to be effective against Omicron!
Can Omicron cause severe effects?
As discussed several times in the columns of this esteemed daily, most experts view the omicron disease to be mild. But it may, nonetheless may cause serious sickness in certain groups of people: the elderly, the co-morbid, and the unvaccinated. Some reports also allege that Omicron may trigger severe disease in children. However, there are also other contradictory findings.
As the jury is still out on this issue, we must not be complacent and must make preparations to protect our kids as well as boost infrastructure for treatment of children.
In addition, it would greatly help if the unvaccinated get the first dose, the partially vaccinated gets fully vaccinated, and the fully vaccinated get the booster doses!
Omicron dangerous for Kids?
A new report claims that Omicron may be more dangerous for kids (Pharmaceutical Technology, Jan. 20, 2022). In South Africa, the hospital admission rate for kids under four was 49 per cent higher during the Omicron wave than Delta. However, a definitive answer cannot be given till further studies are reported.
Third Wave Scenario
According to an IISc-ISI model, the present COVID-19 wave in India may be flattened by March or April (The Mint, Jan. 12, 2022). The peak may witness more than 8 lakh daily cases! Cases may start declining by January or February end, as per this model, but it may vary from state to state. They assumed three scenarios: 30%, 60%, and 100% susceptible population. If more people are susceptible to the new variant, the third wave may linger much longer. If a new and severe variant emerges, there may still be another wave of COVID infections.
As per a report by Dr Manindra Agarwal, IIT Kanpur, the third wave may end by April. He also warned that the election rallies can prove to be super-spreaders (The ET, Jan. 15, 2022). A multi-pronged approach can only prevent or mitigate the third COVID wave in India triggered by Omicron, and compounded by Delta:
1. Enhanced tracking, testing, and isolation measures,
2. Strict surveillance of positive cases, including genomic surveillance,
3. Completing the single dose vaccination of the entire eligible population,
4. Enhancing double vaccination rate from 60 to 70% in next few weeks,
5. Strengthening healthcare infrastructure especially in rural, remote, and peripheral areas e.g. the North East,
6. Limiting crowding in public spaces such as markets, malls, and halls,
7. Conducting election campaigns, at least, partly in the virtual mode; as elections are unlikely to be postponed; and limiting the crowds in meetings, rallies, and campaigns to the minimum possible.
We also need to remember that vaccines and boosters may not protect us against Omicron infections but they will go a long way in protecting us from serious hospitals and possible deaths.
In addition, hospitals including those in Manipur need to stockpile the new anti-COVID drugs such as molnupiravir, paxlovid, and PBI-0451 (experimental drug, a protease inhibitor, made by the firm, Pardes Biosciences), as and when they become available (Al Jazeera, Dec. 28, 2021).
End of COVID
The world waits with bated breath for the end of COVID which has hit the globe for over two years now. According to the Lancet (Jan. 19, 2022), COVID-19 will continue for quite some time. The heartening news is that the prestigious journal reports that the end of the pandemic is near!
It says that after the Omicron wave gets over, COVID-19 will return but the pandemic won't; hope, this report turns true.
What Should Manipur do?
Preparations for administering vaccines to kids in Manipur and booster shots to high-risk people (elderly, healthcare workers and people with weak immune systems).
Conducting immediate seroprevalence studies to understand what per cent of population in Manipur and in its different districts are still susceptible to the coronavirus.
Speeding up vaccinations in a big way; aggressive vaccinations with monthly targets to cover all eligible population with first doses in the next few weeks (4-6 weeks); and targeted vaccinations of all adult population with second doses in the next 2-3 months.
Regular and repeated COVID testing in hotspots.
Enhancing the ratio of RT-PCT to Rapid Antigen Testing (RAT).
Weekly "awareness messaging" about the pandemic to the public by a designated healthcare official.
Genomic sequencing of a subset of positive cases and surveillance of the variants including the delta variant: which COVID strains are there in Manipur, where are they, and where are they moving towards; and whether any new variants are emerging.
Contact tracing and government-monitored isolation of positive cases, wherever feasible.
Boosting healthcare provisions such as medical oxygen plants, tankers and cylinders; steroids, antifungal drugs, oxygen concentrators, ventilators, oximeters, masks, PPEs, sanitizers etc.
Strengthening of healthcare infrastructure such as construction of new COVID hospitals.
Provision of more COVID care centres (CCCs), more Covid beds and ICUs in existing hospitals
Constitution of a special taskforce for the third wave; a separate taskforce for pediatric COVID is also highly recommended.
Special provisions for kids such as pediatric hospitals, wards, and ICUs, pediatric oximeters, concentrators, and ventilators and strengthening of staff such as pediatricians and pediatric nurses and paramedical workers etc.
Conducting, at least, part of the election campaign in the online mode, limiting crowds in public spaces, and minimizing crowds in offline cultural, political, and political events; as far as feasible.
We all owe it to the common people of Manipur to religiously adhere to the standard SOPS to help prevent/mitigate a possible third wave in Manipur; and, help save our people from possible hospitalizations and deaths.
As an editorial in the prestigious medical journal, The Lancet Microbe (Jan. 1, 2021) says, "Vaccines will be instrumental in the control of COVID-19, but their global distribution will be challenging and their effect won't be immediate."
Meanwhile, we must still strictly observe the non-pharmaceutical interventions such as the major SOPs of the use of face masks, physical distancing, and hand hygiene and avoidance of crowded places, close contact settings, and closed spaces (with poor ventilation). We must religiously follow the protocol of 'test, track, and treat' for months to come. If possible, the public health authorities must take steps to prevent large gatherings such as weddings and death ceremonies, music concerts, and large meetings. The 'hoi polloi' must voluntarily practice the 3 Ws -watch your distance, wear your masks, wash your hands frequently) and avoid the 3 Cs: crowded places, closed contact settings, and closed spaces.
(The views expressed are personal)
