The Omicron sub-variant BA.2 has now spread to as many as 57 countries (dellyranks.com, Feb. 4, 2022). It is more contagious than the original Omicron (BA.1). Luckily for people in India, this sub-variant does not cause more severe disease than the orginal variant. According to a study conducted in Denmark, BA.2 transmits the COVID-19 virus to about 39 per cent of susceptible household members, versus 29 per cent for BA.1. In the wake of it, Covid vaccination may seem ineffective against infections, but the vaccines are still quite effective in preventing severe illness, hospitalization, and death, which explains the need to speed up the vaccination to all illegible.
Stealth Omicron: BA.2 is harder to detect
The concerning thing is that BA.2 is harder to detect (IE, Feb. 4, 2022) and vaccinated people can transmit it to susceptible people triggering hospitalizations and even deaths. The original Omicron BA.1 is missing one of three target genes used in the PCR test. If the test reports the missing gene, it is assumed that the variant is BA.1. However, it doesn't have the missing target gene, and is, therefore, difficult to identify, and is often known as 'stealth Omicron.'
Infections with BA.2 can be detected with home testing kits, but cannot indicate which variant is responsible.
BA.2 quickly replacing Delta and BA.1 variants in India
In India, BA.2 is quickly replacing Delta and BA.1 variants. Omicron has four lineages: BA.1 (original Omicron), BA.1.1, BA.2, and BA.3. Although BA.1 and BA.2 are quite similar, BA.2 has about 20 mutations which are not found in BA.1. It is not clear where BA.2 originated but, according to reports, it was first detected in the Philippines in November 2021 (BBC, Feb. 3, 2022). BA.2 accounts for about 50 per cent of infections in Denmark now. BA.2 is also surging in other countries, including the United Kingdom and Germany.
Marco Cavaleri of European Medicines Agency (EMA) says that further studies are needed to ascertain how BA.2 differs from the original Omicron in terms of transmissibility and immune evasion (Financial Express, Feb. 4, 2022).
BA.2 has recently been dubbed a 'variant of concern (VoC)' by the World Health Organisation (WHO) (deadline.com; February 2, 2022).
Why booster shots must be given to susceptible populations?
Vaccines are less effective in preventing infections by Omicron compared to previous variants. But vaccines still work in protecting against severe disease. About 25 weeks after the second dose, vaccines were found to block just 13 per cent of cases; but the rate shot up to about 70 per cent just two weeks after a booster (3rd) shot.
Therefore, as BA.1 and BA.2 surge across the globe, including India, it is urgently imperative that boosters are given to susceptible populations such as healthcare workers, the elderly, and comorbid people.
When will Omicron wave die?
Many epidemiologists opine that the spread of BA.2 means that it could prolong the Omicron wave. That is, BA.2 could make the tail of the third wave trail longer. A potentially slower decline in caseloads could lead to higher hospitalizations and possible deaths in countries or regions or with lower vaccination rates.
Although vaccines may not be effective against infections, they are still quite effective in preventing severe illness, hospitalization, and death; therefore, vaccination must be speeded up to cover all eligible individuals.
Does Omicron changes the risk of Long COVID?
Though we may take solace in the fact that Omicron causes mild disease, the million dollar question is: does Omicron changes the risk of "Long COVID?" We must not take 'long COVID' (also called 'long-haul COVID') lightly as it can take a severe toll on personal, social, and working life. Long COVID refers to a cluster of incapacitating symptoms including fatigue, headache, pain, and breathlessness. It may last for several months after the initial infection. Is Omicron less likely to trigger long-haul COVID, or does the risk remain as high as with other earlier variants?
As the extremely contagious Omicron has infected millions of people across the globe, even if only a tiny fraction of those develop long COVID, millions could be burdened with debilitating symptoms for months, even years (Scientific American, Feb. 3, 2022)!
Dr David Putrino, Mount Sinai Hospital, New York, says that this condition can render victims incapable of working, preparing food, and taking care of children. It has been estimated that about 14-30 per cent of COVID-infected people may be afflicted with long COVID.
Long Covid, fatigue, brain fog, and loss of smell or taste
Even mild cases of the disease can and do lead to long COVID, says Claire Steves, geriatrician, King's College London. Long-term symptoms may also develop even in asymptomatic infections. Although Omicron may cause less lung damage, it can still cause nasty long-haul symptoms including fatigue, brain fog, and loss of smell or taste.
Here too vaccinations can greatly help. Not only they reduce the risk of severe illness but they also reduce the chance of developing long COVID.
As per several preprint studies, fully vaccinated people are 50 per cent less likely to develop long COVID than unvaccinated persons.
Akiko Iwasaki, immunobiologist at Yale University says that it is highly likely that booster shots would reduce the risk of long COVID further, even if no conclusive data exists yet on this issue.
Upinder Singh, infectious disease doctor at Stanford University recommends that medical centers and hospitals must start creating interdisciplinary specialty care clinics for long-haul COVID patients
COVID may stay; efforts must be made to slow the spread
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 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 out to be true.
However, by all indications, the end of COVID is nowhere in sight. Just when we thought that a robust immunity wall has been erected against the coronavirus by prior infections and vaccinations, a new variant emerges breaching the wall. Also, the protection by the vaccine declines in course of time and re-infections become part of the game of hide-and-seek between the wily virus and poor humans. There is a lot of unvaccinated people around the world where the chances of new variants emerging remains high.
Maria Van Kerkhove, WHO scientist, says that our goal must be "not to stop the virus but slow the spread" (The Mint, Jan. 29, 2022). She opined that how long the pandemic stays is up to all of us. Eradicating the virus isn't possible. Of course, COVID-19 will not remain forever. Till the pandemic subsides, we must adhere to masking and other preventive protocols. Slowing the spread of the virus will lighten the load on our healthcare systems.
Earlier, some experts asserted that the emergence of Omicron variant signaled the end of the Covid pandemic. But this prediction seems to be highly unlikely now. Omicron may not be the last coronavirus variant to emerge (HT, Feb. 3, 2022). Many scientists opine that in the long run COVID-19 will become an endemic disease. However, Aris Katzourakis, an eminent virologist says that it would be wrong to treat COVID as harmless "just because it will become endemic." He asserts that the words 'endemic' has become one of the most misused terms during the pandemic.
According to Mark Woolhouse, an epidemiologist at the University of Edinburgh, UK, COVID-19 will become an endemic only when most adults are protected against severe infection because they have been exposed to the virus as children; that will take several decades, and many adults who were not exposed to the coronavirus as children will remain vulnerable for a long time to come.
Current COVID scenario in India
The COVID curve seems to have peaked in some regions. A decline in cases has been seen in Maharashtra, UP, Delhi, Odisha, Haryana, and West Bengal. A high number of cases are still observed in Karnataka, Kerala, Tamil Nadu Gujarat, Andhra Pradesh, and Rajasthan. However, the upcoming Assembly elections in five states may lead to a completely changed scenario in February-end or early-March. We must all remain vigilant, take care of standard protocols, and beware of letting our guards down.
Is the number of children affected by Omicron rising?
A new report claims that in South Africa, the hospital admission rate for children 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.
What Manipur should do?
Death audits, genomic tracking combined with tweaking of treatment protocol (as deaths due to COVID remain high in Manipur, logging an average of 1 or more daily deaths, for the past few weeks of Jan-Feb 2022); we need to ascertain if deaths are due to Delta, Omicron or both; or, is there a need to adapt the COVID treatment procedures; regular genomic surveillance, death audits, and tweaking of hospital admission, treatment and monitoring procedures will be helpful in mitigating deaths.
Ensure arrangements for administering Covid vaccines to children in Manipur and booster shots to high-risk people (elderly, healthcare workers and people with weak immune systems).
Conduct immediate seroprevalence studies to understand what per cent of population in Manipur and in its different districts are still susceptible to the coronavirus.
Aggressive vaccinations with monthly targets to cover all eligible populations 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.
Conduct regular and repeated COVID testing in hotspots and enhance 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 and omicron variants: 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 new wave; a separate taskforce for pediatric COVID is also highly recommended.
Ensure 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 online mode, limiting crowds in public spaces, and minimizing crowds in offline cultural, political, and political events; as far as feasible.
As the Lancet Microbe (Jan. 1, 2021) pointed that vaccines will be instrumental in the control of COVID-19, but their global distribution will be challenging and their effect won't be immediate, we must not let our guards down and 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 continue to voluntarily practice social distancing, wearing of face masks, washing of hands frequently) with soap and avoid crowded places, closed contact settings, and closed spaces.
Meanwhile, the authorities concerned must enhance the pace of vaccinations across India, including Manipur, in a big way.
In Manipur, as on January 4, the total number of people who have been administered the COVID vaccine reached 25,44,110 (first dose: 14,45,016; second dose: 10,62,951; precautionary dose: 36,143). Consequently, the cumulative number of people who have been vaccinated in the state with the first dose is 59.07 per cent and for the second dose is 45.41 per cent.
(The views expressed are personal)
