Dear Covid Experts, January 26, 2022
Two years ago, you thought of stopping the virus by hiding in your homes for three weeks. Then, followed the extended lockdowns, washing hands, masks, touch-me-not, Alpha, Beta, Delta, native medicines on pavements, modern medicines in black market, ventilators, oxygen and 5-star hospital bills. Then, vaccines, Omicron and boosters. Then, 4th waves and 4th boosters. Then, again, the crippling lockdowns, night curfews, the most irritating ‘Covid-appropriate-precautions’ with N-95masks this time, hiding in homes – all again, for how long ? GOK, Om Shanthi. Om, Om, Om; Om icron, Om icron, Om icron. The sacred ‘Om’ in ‘Om’icron may end the pandemic. But, Omicron felt insulted when you declared it to be incapable of killing. So, it started that job now. Mercifully, Omicron spelled out a solution to the humans to get out of this grave, saying that: “The pandemic would come to an end (in fact, it would not have even started) if the humans switch off the Internet and all the media.”
Now, for a serious thought for India:
1. With the mistakes we had committed and the knowledge we gained during the past two years, we have to restructure our strategies to deal with the pandemic, especially after a good coverage with the Covid vaccines. There have been two major mistakes done all over the world – 1. Irrational health system responses; 2. Insufficient adherence to Covid-appropriate behavior by citizens.
2. Modify the old epidemic strategies of ‘test, trace, isolate or treat’ by reviewing and updating all public health policies and by factoring in the new epidemiological and scientific evidence that is available now.
3. Start managing Covid as an endemic disease.
4. Stop excessive ‘testing’. Avoid unnecessary investigations, isolation, medications and hospitalization. Don’t rush to give booster doses to healthy adults or to vaccinate healthy children. Schools should be the last to close and the first to open, in any future Covid surge.
5. Identify and treat the majority of Covid cases at primary health-care facilities which are closer to people at home. Triage the cases at the peripheral level rationally and make use of the local family doctors and private specialists.
6. Pay the ‘pre-corona’ scale of attention to all the diseases.
7. Stop blanket bans and restrictions of unknown value on daily activities which affect the economy. Don’t convert paranoia into psychosis.
8. Stop feeding people with enormous confusing data (‘Infodemic’) and start giving them only useful information in brief.
9. Last, but the most important one is to improve ventilation at all the places.
-- Dr. T. Rama Prasad, Perundurai, India. January 26, 2022.
Preprint
. Omicron -- a paper tiger ? .
RAMA PRASAD T.
Dr. T. Rama Prasad,
Formerly: Medical Superintendent (Special) of RTS & IRT Perundurai Medical College and Research Centre,
Perundurai, Tamil Nadu, India.
Presently: Director of ‘PAY WHAT YOU CAN’ Clinic, Perundurai, Erode District, TN – 638052. drtramaprasad@gmail.com WhatsApp +91 98427 20393 BLOG https://drtramaprasad.blogspot.com
WEBSITE www.rama-scribbles.in Twitter @DrRamaprasadt Facebook T Rama Prasad
Telegram Dr T Rama Prasad
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A MONTHLY JOURNAL OF MEDICINE AND SURGERYSN
Vol. 119 No. 2 February 2022 ISSN 0003 5998
Indexed in IndMED Email: admin@theantiseptic.in www.theantiseptic.in
. Omicron -- a paper tiger ? .
RAMA PRASAD T.
Dr. T. Rama Prasad,
Formerly: Medical Superintendent (Special) of RTS & IRT Perundurai Medical College and Research Centre,
Perundurai, Tamil Nadu. Presently: Director of ‘PAY WHAT YOU CAN’ Clinic, Perundurai, Erode District, TN – 638052.
Specially Contributed to “The Antiseptic” Vol. 119, No. 2
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“Imperialism and all reactionaries are paper tigers.”
-- Mao’s Little Red Book
ABSTRACT
The phrase ‘paper tiger’ was used in the ‘Mao’s Chinese Communist State’ against their opponents, particularly the US. The issue of origin of SARS-CoV-2 has been a political hot potato between China and the US. It seems that the COVID-19 which originated in China made the US look like a ‘paper tiger’ by killing more than 800,000 Americans. The Omicron variant which was first reported on November 24, 2021 seems to have taken the ‘baton’ from the Delta variant in the ‘virus vs human’ race. The limited data available to date indicates that it is overwhelmingly infecting people, but its ‘killing power’ is at a low mark. But the scare is so humongous that drastic economy-crushing preventive steps are being taken. If it doesn’t cause severe illness despite its huge presence we would regret for the immense global economic loss which this Omicron ‘paper tiger’ might have caused. If it is a ‘real tiger’ we may have to regret for the tremendous loss of life, notwithstanding the preparedness, as happened with the previous variants. As Omicron is only seven weeks old now, by mid-January 2022, it would take some more time to know whether it is a killer ‘real tiger’ or immunity-boosting ‘paper tiger’. It is predicted that the ‘Omicron wave’ may swiftly ascend to ‘peak’ by February 2022 and speedily come down to endemic proportions by April 2022. It would be a stroke of serendipity if it turns out to be a ‘paper tiger’. Some of the information connected to Omicron relevant to the present short slot of time (November 24, 2021 to January 14, 2022) is briefly presented in this paper (a tad informally) with focus on Indian scenario.
Key words: OMICRON, SARS-CoV-2 variants, Booster Covid doses, Paper Tiger
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Introduction
Just when the world was getting ready to the idea of learning to live with the existing variants of SARS-CoV-2, a report on November 24, 2021 of the existence of a superfast variant named as ‘Omicron’ jolted the whole world sans evidence of high virulence of the microbe. And just two days after the report, the World Health Organization (WHO), at a viral speed, designated it as a ‘Variant of Concern (VOC)’ on November 26, 2021 and named it after ‘omicron’, the 15th letter of the Greek alphabet. Immediately, flights were suspended by some wealthy countries. Blunt and blanket measures that are not evidence-based or effective on their own were introduced by many countries once again. The wisdom behind these measures is arguably debatable. My article titled “Is the ‘Lockdown Medicine’ too toxic ?” and published more than one year ago in The Antiseptic of October 2020 contains some information on the ‘ineffectiveness of lockdowns’.13 The WHO’s Chief Scientist, Soumya Swaminathan, recently, on January 8, 2022, said lockdowns are not needed now since there is a better understanding of the novel coronavirus that causes COVID-19.33, 32 The world is again in a turmoil with lockdowns, and the citizens are fatigued with the unflattering stereotypical reaction of the authorities. As it is a nascent variant, we don’t clearly know about its transmissibility, ‘kill power’, ability to ‘escape’ infection-induced or vaccine-induced immunity, etc. If the looming Omicron finally turns out to be a ‘paper tiger’, we shall have a lot to regret about the derailment of economy and loss of livelihood.
Myriad mutations: The panic reaction of ‘shutting down’, even before the speedy spread of Omicron across the world was evident, is due to the presence of the formidably dangerous structure of myriad mutations in the variant which enable the variant to infect people very fast, even those who were already vaccinated (breakthrough infections). Naturally, Omicron terrified populations through its speedy infective capacity, if not of serious illness or death. But, mathematical projections like: "In a very short period of time, 80 lakh cases may be reported in India with 1% mortality which would mean 80,000 deaths" rattled everyone. And, based on the current scenario in the UK, scientists are predicting a huge 14 lakhs of cases a day in India shortly.
‘Omicron wave’: In its latest weekly pandemic report (January11, 2022), the WHO said there were about 15 million new COVID-19 cases last week globally (a 55% jump over the previous week) and more than 43,000 deaths, although the number of deaths remained stable. It also said Omicron was ‘evading immunity’ and was crowding out the previously dominant Delta variant. Scientists in the UK and the US said there are early signs of speedy ‘peaking’ of the ‘Omicron-powered third wave’. Let’s call it a ‘Omicron wave’ which may ‘peak’ in February 2022 and transform into an endemic by April 2022, in India. The absence of the ‘second wave’s accompanying devastation would be a silver lining.
Hullabaloo: By nature, viruses mutate into various types leading to hundreds and thousands of variants / lineages. However, only a few differ a lot to cause concern like Omicron. The Omicron may just be a ‘paper tiger’, scaring us, infecting a lot without causing much of a serious illness or death, and it may even be benefitting us byimproving our ‘herd immunity’ through its infection which may cause only mild symptoms or no symptoms.24 It may even turn out to be just an endemic like flu which doesn’t require this much of hullabaloo of tracing, tracking, isolating, restricting, locking down, etc. As it affects upper respiratory track more than the lungs, it may not produce serious illness. Much ado about nothing ? Or, it may be a ‘killer tiger’, like the Delta. None knows for sure at present. Some experts feel that a sudden huge surge of infections, though of a low fatality rate, may overwhelm hospitals with a sudden demand for intensive care. This is the reason why governments have built up facilities to deal with a probable ‘tsunami’. Hectic discussions and debates have been going on about the wisdom of the pre-emptive actions that have been taken, especially of the restrictions, lockdowns and flight cancellations, and the future course of the pandemic. A little about the problem is written here (a tad informally) with special reference to India. More comment on Omicron may be found in my earlier article titled “Ominous Omicron of COVID” published in The Antiseptic of January 2022.38 So also, some information on the earlier ‘tigers’ of the Covid had been documented in my 17 articles published over the previous 17 months on subjects related to Covid in The Antiseptic, a journal of Medicine and Surgery, and in Health, a journal devoted to healthful living.1,8,9,12,13,14,15,16,17,18,19,20,21,22,28,29,38 And some other Covid information may be found on my blog and other media.10,11,23,24,25,26,27
Why is this haste ?
The following is the basis for the haste. Firstly, this variant has a very large number of mutations (a total of 60; 32 in the spike protein – more than double the number of the dangerous Delta variant’s spike protein; a whopping 15 in ‘receptor-binding domain’) which theoretically might make it highly transmissible, capable of evading immune systems and resistant to vaccines. Omicron’s 32 spike protein mutations include E484A, K417N and N440K which may aid the virus to ‘escape’ detection from antibodies. Another mutation called N501Y may boost transmission. Secondly, it is the blindingly fast pace with which it moved in South Africa and moved out of that country that caused the alarm.
Once bitten, twice shy
The WHO was severely criticised about two years ago for alleged delay in declaring the COVID-19 as a pandemic. The Indian government was also accused for alleged lapses in preventing the ‘second Covid wave’. So, the WHO and several countries acted with urgency as a measure of abundant precaution, if not in a haste, especially as the behaviour of the SARS-CoV-2 and its variants had been aberrant and unpredictable. Some scientists felt that certain actions taken which tumbled the economy were not warranted for lack of scientific evidence, while appreciating the speedy and praiseworthy work done by the South African researchers and doctors who brought Omicron to light. To put it in context, it may be recalled that Dr. Angelique Coetzee, the Chairwoman of the South African Medical Associationsaid: “We do not know why so much hype is being driven. To ban flights from South Africa is premature as there is not much information on how dangerous it is.”
Lessons from Omicron
From the half journey made by the Omicron so far, we learnt at least four important lessons: (1) Avoid blanket lockdowns and quarantines, and maintain economic activities to minimise damage to livelihood of common people, by adopting a pre-emptive and proactive approach. (2) When mild symptoms are present, don’t rush out for Covid tests; instead, consult a local family doctor. (3) The behaviour of Omicron has also changed the scientific thinking about the need for Covid tests as it spread at an almost four-fold speed (compared to the Delta) with a large majority of the infected being asymptomatic. It is impossible and futile to test everybody for its infection. Asymptomatic individuals in community setting and contacts of confirmed cases of COVID-19 (unless identified as high risk) need not be tested. This is what is according to an ‘Advisory on Purposive Testing Strategy for COVID-19 in India’ of the Indian Council of Medical Research (Version VII; https://bit.Iy/31UtJ7F). (4) Improve ventilation and avoid nonessential travel.
“If there is ‘good ventilation’ and ‘no travel’, there is no Covid.” -- T. Rama Prasad
Drowned in nationalism
As a knee-jerk reaction, wealthy nations swiftly and thoughtlessly barred flights from some African countries which are already disadvantaged health-wise and economy-wise. Promotion of nationalism seems to be scripted in the ‘RNA’ of the ‘novel virus’ and passed on to the humans ! Eminent personalities are also swayed by it. Amusing remarks by the ex-American President Donald Trump on many matters – dime a dozen -- related to Covid are legendary (Covid origin, hydroxychloroquine, injecting disinfectants, etc.).23 Back at home, the written “directive” of the Director General of the Indian Council of Medical Research, Dr. Balram Bhargava, to make Covaxin the world’s first vaccine by August 15, 2020 (Independence Day) even when the completion of the clinical trials was not in sight drew flak and impacted on the credibility of ‘Indian vaccines’.23 More recently, the Chief Justice of India, N.V. Ramana said: “Many criticised Covaxin because it is made in India. Some even complained to WHO against it. While MNCs like Pfizer worked against the India vaccine …” Some wondered as to whether it is proper for persons in such eminent positions to react like that, and whether it was appropriate to authorise a vaccine before completion of clinical trials and recognition by the WHO. Now, Covaxin is authorised in India for children also, though the WHO has not yet recognised its use in children.
Debatable issues
Covid is notorious for upending our assumptions and priorities. The emergence of the Omicron variant has further complicated the matters. For example, it has brought the matter of ‘booster doses’ and vaccination for children to the fore, and even to ‘compel’ authorisation for them in India. The scientific data is not robust and incontestable as the experience with the virus is short. ‘Mix and match’ of vaccines either for primary or booster vaccination is not authorised by Indian authorities though evidence to prefer mixing of vaccines is very considerable, especially in view of the ‘vaccine-escape’ capability of the Omicron. India has fixed a nine-month gap after the second dose, citing scientific data from certain studies. But, a UK Health Security Agency study shows that a third shot has 88% protection from hospitalisation against the Omicron variant while the protection of ‘primary vaccination’ drops to 52% for those who got their second jab over six months ago. This is just one example; there are many debatable matters about the Omicron variant and the actions taken to control it. As it is only just about eight weeks old (November 24, 2021 to January 14, 2022) at the time of writing this, hardly anyone knows conclusively about its virulence though it has demonstrated its lightning speed in infecting.
Boosters
Indian advantage: In India, except for the Omicron, boosters (‘precautionary doses’) and vaccination for children would not have come so soon. And, uncertainty prevails over their effectiveness against Omicron. Presumably, in a way, India is in an advantageous position. At least half of the Indian population got infected during the ‘first’ and ‘second’ waves (which means that they had already gained some kind of immunity through the infection) before being vaccinated mostly. This means that the vaccination would have boosted up the already present infection-induced immunity to such an extent that it (‘hybrid immunity’) would be much more than what could have been achieved with vaccine alone. Also, the infection-induced immunity may last longer by virtue of the ‘T-cell component’ in contrast to the ‘antibodies component’ (a more noticeable result of vaccination) which may wane in course of a short time.32 This is not to say: “Get infected instead of getting vaccinated.” But, do remember that vaccination is not a panacea for protection. About 92% of the adult population in India got the first dose of the vaccination, mostly after the episode of the ‘second wave’. In Israel (where a fourth booster is authorised) and some other countries, Delta struck after the bulk of their population was vaccinated which means that the immunity gained there may not be as strong as that in India. This raises the pertinent question: “Is it necessary to give a booster dose to all Indians who had the second dose 6 to 9 months ago while a big chunk of the population is yet to complete the primary vaccination ?” A UK Health Security Agency study shows that a third shot has 88% protection from hospitalisation against the Omicron variant while the protection of the ‘primary vaccination’ drops to 52% for those who got their second jab over six months ago. Even while arguments around booster doses to tackle the existing Covid are growing louder, the arrival of Omicron has ensured that the clamour for booster shots has reached a fever pitch. The jury is still out on how effective the current vaccines, including ‘booster doses’, are against Omicron. The emergence of the Delta variant with ability to cause ‘breakthrough’ infections even in fully vaccinated people had completely changed the calculus. Amid such scare, Omicron has opened the floodgates for a demand for Covid ‘booster’ doses.
WHO for better vaccines: Even as the WHO opined recently that a better vaccine is to be developed (tweaked / reworked) to be effective against Omicron and the future variants that may emerge, AstraZeneca company declared on January 13, 2022 that a third dose of its vaccine (Covishield) would be effective against Omicron. Of course, manufacturers vie with each other to make newer vaccines. As expected, the world’s major hi-tech manufacturers of Covid vaccines are working at hectic viral speed to roll out ‘variant-specific’ vaccines. New vaccines will neutralise new variants until yet another new variant arrives ! Subjects related to the viruses, immunity and vaccines are quite complex.29, 30, 31, 32, 34, 38, 14
Mix and match: Taking the ground realities into consideration, India seems to have made the right decision to limit the boosters (‘precautionary dose’) to some priority groups — health care and frontline workers and those aged over 60 years with comorbidities. According to the Centre’s directions, the third dose will be of the same vaccine as the first two jabs and will be given to those who were vaccinated nine months ago. ‘Mix and match’ of vaccines either for primary or booster vaccination is not authorised by Indian authorities though evidence to prefer mixing of vaccines is very considerable.14 While no vaccine is a silver bullet, taking into consideration some studies like those from the Asian Institute of Gastroenterology and the UK’s COV-BOOST, it may be said that ‘mixing’ doses of ‘different platforms’ may be more desirable. In fact, many in India and abroad had ‘mixed’ vaccines ‘unofficially’ where it’s not authorised.
Nasal vaccine, Covaxin and Omicron: Once the ‘nasal Covid vaccine’ of Bharat Biotech comes into the market, Covid vaccine would become a household vaccine ! There is evidence to say that the ‘intranasal’ vaccine is highly efficacious conferring a very high level of protection against infection. Some experts opined that the nasal vaccine may prevent Omicron better as Omicron is largely present in nose and upper respiratory tract more than the lungs. With the currently available evidence, it may be said that the indigenous Covaxin is likely to be more effective against Omicron by virtue of its ‘whole-virion inactivated virus platform’ compared to the ‘Spike Protein–based’ vaccines like ‘mRNA’ vaccines (Pfizer / Moderna) and ‘adenovirus-vector-based’ vaccines (Astra-Zeneca / Covishield / Sputnik).
Omicron may be a ‘booster’: India may think of the DNA plasmid-based ZyCoV-D vaccine or a protein-subunit (recombinant nanoparticle) vaccine like Novovax (Covovax) (Corbevax) as a booster dose, though any of the wide range of the vaccines of different platforms (heterogeneous) or of even the same platform (homogenous) would be fine. The brands Covovax and Corbevax are likely to be available in the Indian market shortly. Generally, mild infections by any of the Covid viruses and doses of any of the available Covid vaccines do protect us to some extent by inducing some immunity. Even the widespread mild infections by Omicron are a blessing in disguise as they act like vaccine doses, even like ‘boosters’ – it sounds ironical though. In the manufacture of ‘live attenuated vaccines’ like Covaxin, the cultured virus undergoes through repeated passages in the laboratory and loses its virulence but retains its potency to produce immunity. In the same way, the ‘Covid virus’ might have undergone prolonged and repeated replications in some immunocompromised human beings and transformed into the ‘Omicron’ which may be equivalent to an attenuated virus incapable of producing serious disease mostly but may have a vaccine-like beneficial effect in boosting immunity. In course of time, such of these variants may increase and behave like the existing common cold or influenza viruses, leading to perpetual endemicity. If it doesn’t cause much of a serious illness, Omicron may be considered as a beneficial ‘paper tiger’. Perhaps, more Covid variants would evolve in future making it a need for annual doses just as is being done for the mutating influenza viruses.
‘Paper tiger’ in India ?
During the first fortnight after it was reported to the WHO, Omicron didn’t cause much alarm in India though forebodings of a disaster were very much palpable in the UK and some other countries. As on December 5, 2021 only five cases of Omicron were identified in India. Curiously, about two years ago we had only five cases of the original strain of the coronavirus. What happened later is a tragic history.12
In the 15 days since the surge began in India on December 28, 2021, the daily Covid-19 cases had risen from around 10,000 to around 250,000 at a scorching speed, after the emergence of the Omicron variant. But the daily deaths remained around 300. The recorded number of cases of Omicron were around 6,000 only which means that genomic testing was done for a very small number of cases, as Omicron appears to be the only factor responsible for the surge of the cases. Though the Delta is still having considerable presence, it is believed that the exponential surge is due to fuelling by the fast-spreading Omicron. But the real quantum of contribution by the Omicron is not known as genomic testing for Omicron has been dismally low. Unlike the Delta variant which killed a lot during the ‘second wave’ in India, Omicron may turn out to be very much less lethal, with the overwhelming majority of the infected not requiring hospitalisation, so far.
More cases, less serious: Reports show that there were around 6,000 Omicron cases in India as of mid-January 2022. There must be a huge number of undetected cases, as 85% of the cases in clusters have the S-gene dropout, a proxy indicator for Omicron. Serious illness and deaths due to Omicron seem to be scanty. It looks that Omicron is more like a ‘paper tiger’ in India, with low figures of serious illness and fatality. Even as the daily Covid-19 cases continue to surge rapidly (2.5 lakh), the Indian government said only five to 10 per cent of the active Covid cases needed hospitalisation so far during this wave while it was 20-23 per cent during the ‘second wave’. Omicron is a milder version of Covid mostly with the symptoms of sore throat and nasal discharge. There may not be much of cough, fever, low blood oxygen, or lung involvement. As Omicron uses fusion of virus envelope with the endoscopes within the cytoplasm, it does not mostly cause serious disease, confining itself to upper respiratory tract. And as it has a propensity for evading neutralising antibodies, the existing monoclonal antibodies may not be very effective against Omicron.
A loud warning: But, a doubling time of less than three days and a R-naught soaring to more than three are a loud warning that things can go out of control soon. Experts warned that the number may be low in terms of percentage, but with quick increase in cases, admissions in terms of absolute numbers may go up overwhelming the healthcare system. At this stage, getting misled by the mild nature of the disease and throwing caution to the wind will be a dangerous gamble. The WHO has recently flagged that Omicron should not necessarily be categorised as mild. “Just like previous variants omicron is hospitalising people, and it’s killing people. In fact, the tsunami of cases is so huge and quick that it is overwhelming health systems around the world,” the WHO Director-General Tedros Adhanom Ghebreyesussaid.
Crucial next fortnight: The second half of January 2022 is crucial to know about the trend, and would be a test for this premise. It is most unlikely to be a repetition of the 'Disastrous Second Wave of India'.12 However, the entire health care machinery seems to be equipped to meet the possible ‘tsunami’ situation arising due to the continued Omicron surge in India. In Tamil Nadu State alone, as many as 120, 000 hospital beds, 17,960 oxygen concentrators, 217 oxygen generators and 1,500 oxygen tanks have been readied, as on January 9, 2022. Private hospitals in the State are warned not to admit asymptomatic Covid cases to prevent crowding at health care facilities unnecessarily. In a situation like this of uncontrolled spread, the metrics that matter most are the numbers of hospitalisation, hospital caseload and deaths. Nationally, only around 7% per cent of the active Covid cases needed hospitalisation so far during this wave while it was more than 20 per cent during the ‘second wave’. In Tamil Nadu, 15% of the active cases have been admitted accounting for a bed occupancy of 7% . Bed occupancy has been very low in most of the districts. Most of the beds in many Covid Care Centres are vacant as of mid-January, 2022. The ‘preparedness’ may prove to be a good ‘mock drill’ exercise to handle efficiently any future ‘real tigers’. Or, will they be overflowing after a couple of weeks ? We don’t know, but unlikely.
Time lag: “While Omicron is now known to be much milder in causing serious illness than Delta, it is also known to be much more transmissible and more capable of ‘immune-escape’. Experience in the UK suggests that these opposing forces play out, after a lag of time, to generate some noteworthy increases in hospitalisation of those in older age groups. While the young—by far the larger majority in India—should be able to recover readily, those who are immune-compromised are likely to be more severely affected,” it is observed.34 The time lag between infection and hospitalisation is another reason why it is too early to pronounce any verdict on the virulence of Omicron in India. However, it can be predicted that the Omicron’s scenario in many countries would be similar to that in South Africa – fast and huge rise followed immediately by a sharp fall, without causing much serious illness or death.
Prediction: On the basis of the ‘Sutra’ mathematical model of the Indian Institute of Technology, Kanpur, the ‘third wave (Omicron wave)’ will manifest in India in January 2022, may ‘peak’ in February 2022 with 1.8 lakh daily cases, and would end in April 2022.35 After that the Covid would become an ordinary endemic. It is predicted that 1 in 10 will need hospitalisation and that two lakh beds may be needed by the middle of March 2022.35 The professor behind the ‘Sutra’ model, Mahindra Agrawal warned that election rallies can prove to be super-spreaders of the virus.35 Curiously, the Election Commission was said to be informed by the Health Secretary that there was no cause for alarm or concern in the five poll-bound States. However, the situation is dynamic and may change rapidly, said the Health Secretary Rajesh Bhushan in a letter to States and Union territories. The post-mortem findings of the ‘second wave of India’ are still fresh in our memory. The pity is that the stakeholders in the events that pave the way for a surge are more ‘powerful’ than scientists !
Undue scare: Appointments for patients from other States have been suspended in all the hospitals in Vellore which has the pioneer Christian Medical College hospital of national repute, following 220 persons, including doctors, in the hospital campus tested positive for the virus. To continue to be on duty, even some doctors with negligible symptoms are not getting ‘tested’ as they think that ‘it would be positive, warranting isolation but not specific treatment’.
Not disastrous: I wrote in my previous article titled “Ominous Omicron of COVID” and published in The Antiseptic of January 2022 that “Omicron would not impact India much, …Omicron could be highly contagious but not dangerous. There may be more infections but not many problems.” So far, in about the six weeks after the announcement of the first couple of Omicron cases on December 2, 2021 in India, no significant number of Omicron-related serious afflictions or fatalities are reported though there has been an exponential increase in the number of cases. If the same trend continues for another six weeks, despite our unpraiseworthy public participation and health infrastructure, we can heave a euphoric sigh of relief looking at the ‘paper tiger’ fearlessly. If not, India would have to go through a bad patch mauled by a vicious ‘real tiger’. Even in Europe, there have not been many deaths due to Omicron. The WHO’s European regional director Hans Kluge said that despite the unprecedented scale of transmission (seven million Omicron cases across Europe in the first week of January, 2022) the mortality rates have not increased.
The ‘tiger’ abroad
Omicron had wreaked havoc globally and had hurriedly spooked the world, crashed the markets and suddenly suspended flights. Its pattern is not uniform across the world. The impact is varied and unexpected. A lamentable limitation in realistic assessment is the paucity of quality in the collection of data at the grass root level in many countries, including India. There was a huge surge in the vaccinated British and American people. The Omicron-fuelled surge in the UK resulted in 150,000 cases and 300 deaths on January 8, 2022. The WHO said on January 10, 2022 that more than half of the people in Europe are on track to contract the Omicron variant in the next two months. In the first week of January 2022, there were more than seven million cases of the Omicron variant across Europe though there was no increase of deaths. There was a fast spread among the unvaccinated African population and a higher prevalence among their young. It ‘peaked’ and ‘dipped’ very fast in that country.36 Data from Gauteng Province (the epicentre of Omicron where the first cases of Omicron were seen) in South Africa show that Omicron had lower rates of prevalence, hospitalisations and deaths compared to those seen in previous Covid waves -- (1) daily infections rapidly declined 50 days after Omicron became dominant; (2) Omicron cases peaked at a lower level ( 9,651) than the Delta variant (11,647) (3) daily hospitalisations at the peak for Omicron (3,567) are significantly lower than those of the Delta (9,208); (3) average daily deaths due to Omicron were 18, significantly lower than those of the Delta (150).
Not a ‘paper tiger’: On the other hand, a data scientist, William Ku, said that the US has set a new record of 1,38,073 Covid hospitalisations on January 8, 2022 with an ICU occupancy of 22,394 -- twice the level of just 7 weeks ago, and that deaths were rising in States like New York. “Are these the signs of a ‘mild’ infection?" he asked. As on January 7, 2022, the US reported a seven-day average of more than 600,000 new cases daily. The University of Washington’s researchers are projecting that the US will crest at 1.2 million by January 19, 2022 and will then fall sharply simply because everybody who could be infected would have got infected by that time and the virus runs out of vulnerable people. China is struggling with a rise in the numbers while the 2022 Beijing Winter Olympics is just a few weeks away. Singapore’s Health Minister Ong Ye Kung said in the Parliament on January 10, 2022 that the nation can expect an infection wave due to Omicron several times larger than the one caused by Delta. He also stated that fully vaccinated (most of them with non-mRNA vaccines) individuals accounted for 30 per cent of Singapore’s total Covid-related deaths last year. Singapore’s scenario is the most surprising one as the very small and very affluent country has an advanced world-class health care system and a supreme social order. Another matter of consternation is the observation by the minister about the apparent ‘inefficiency’ of ‘non-mRNA’ vaccines.
Overreaction
Though we had many pandemics before, the Covid pandemic is distinctly different. It spread fast and killed many in the highly-empowered wealthy countries (death toll of eight lakhs in the US exceeds the entire population of North Dakota !) which brought it into focus and played up by media. Otherwise, the ‘rich man’s pandemic’ could have just been another flu, albeit with more kill-power. But the fear had driven many countries, rich and poor, into miscalculated and random blanket 'lockdowns' associated with humongous economic disasters, as is again happening with Omicron. Sensational publication of news misled societies and governments into making inappropriate decisions. We need not ape the West. For example, the ‘Zero-COVID Policy’ may be fine for an affluent country, but it could be an economic stupidity for the ‘low income’ countries, taking into consideration the human value also.
And, there is the Brazilian President who scared people saying that Covid vaccines would turn them into crocodiles.24,11 When social media spread this news, the ‘vaccine-hesitant’ people turned into ‘anti-vaxxers’, to avoid turning into crocodiles ! 'Social Media Distancing' may be a preventive measure against overreaction ! Recommended by VIPs, hydroxychloroquine, ‘appalam’, ‘gangajalam’ (Ganges river water), ‘gomoothram’ (cow’s urine), milk of ass, and a host of other things entered Indian homes through social media. 48% of 24,000 messages on social media were found to be ‘fake’ by ‘TimesVerified’. The toxic waves of fake news about ‘Omicron wave’ that have been lashing social media groups must be stopped.
Pandemics
In 1855, 'Bubonic Plague' pandemic swept the world and rapidly killed 10 million people in British India. The epicentre of the outbreak was also in China -- a place called Yunnan. Later in 1918, the ‘Spanish Flu’ swept the world from Kansas to China ... perhaps, it didn't start in Spain though its name indicates so -- it might have started in the US Army / Navy, and, perhaps, the news was played down in those days of war, jingoism, censorship and denial. The ‘Spanish Flu’ killed as many as two crore Indians. Pandemics such as flu, plague and cholera exhibited sharp rise and fall. Even without vaccination and ventilators, ‘Spanish Flu’ vanished after killing many. There were three ‘Spanish Flu’ waves, very much resembling the Covid waves. Compare them with calmness – the past is not a prediction !
Use, misuse and exploitation
Humongous use, misuse and exploitation with “experimental” / “emergency” / “empirical” medicines and hospitalisations occurred during the ‘India’s second wave’.25, 23 Some of them might have saved lives and a lot of money, and some of them were misused and also used to exploit the desperate. Australian professor Thomas Borody batted for the combination of ivermectin, doxycycline, zinc and vitamin D3 as a cure / prevention for COVID-19.25 Though Australian authorities denied approval, the drug regimen was extensively used in India, and, perhaps, prevented and cured COVID-19 at a very affordable cost. But, there is no proof. Very expensive drugs like remdesivir, tocilizumaband the like (which found their way into the black market) were also used extensively to an unjustifiable extent both with the intention to save lives and also, in some cases, to profiteer. They also might have cured COVID-19 patients. But, there is no incontrovertible proof. And anecdotal references like “my doctor cousin in California uses this; my doctor friend in Florida uses that” had immense influence on the prescriber and the patient as well. Due to lack of knowledge and wrong projections, many drugs were used needlessly, hazardously and haphazardly. ‘Convalescent plasma’ therapy was touted as a gift from the heaven and subsequently was proved to be useless.25 Numerous people in India lost their loved ones and their livelihood after borrowing and spending ten lakhs of rupees on an average on each patient on the ‘repurposed’ expensive drugs of little value.11, 25 And, a host of brands of medicines of various systems of medicine of unproven value and a myriad of “corona-specific” vitamins, and nutritional supplements made their heyday.
One should be on guard, about these, as there would be a repetition of this ‘drama’ in case Omicron takes a turn to strike terror through widespread serious illness and alarming number of deaths. In some countries, medicines can be bought ‘unofficially’ without a prescription. Recently, one wealthy lady proudly bragged about the ‘self-administered’ course of Molnupiravir she took for “a little cold and cough to be on the safe side of Covid !” Let’s pray she won’t give birth to a child with genetic disorders ! Molnupiravir along with its expensive friend ‘Antibody Cocktail’ is becoming a fad amongst the ‘rich’ hospitals and the rich patients who are suspected to be affected by Omicron !25,23 And, who is not suspected to be so when Omicron is sweeping !
Shifting and confusing evidence and protocols made everybody rudderless. Though the cheap and life-saving steroids didn’t go into the black market, their improper use did kill voluminously, albeit indirectly, through Mucormycosis.17 With half-knowledge, we made many mistakes, fuelled by vested interests, during the past two years of the pandemic. 25, 11 Orchestrated by ‘big pharma’ and ‘small research’, unethical promotion of ‘experimental’ medicines, even in children, and vested interests in treatment protocols, and Covid-related fraudulent research and publication have become almost a commonplace of ‘Covid business’.25, 27 The ‘so-called evidence-based’ bugle blown by rich countries has become the marching tune for the poorer countries.27 How much money was wasted on needless investigations, and drugs of unproven efficacy during the past two years of the pandemic !27 The All India Institute of Medical Sciences (AIIMS) and Health Ministry, belatedly, on September 2, 2020, advised not to usefavipiravir, pirfenidone, methylene blue, itolizumab, tocilizumab, etc in the protocols of Covid treatment. too enthusiastically as sufficient evidence is lacking to support their use. Again in January 2022, further restrictions on the use of Remdesivir were imposed, and the much awaited and much touted ‘game changer’ Molnupiravir couldn’t find a place in the official protocols because of safety concerns, even as it was approved by another authority in India – read my article “The Science and Nonsense around COVID.” 9 People emptied the shelves of many drugs.25 ‘Plasma therapy’ dived into the ‘useless therapy’ zone. We have to still learn on the go ! Omicron would create a very fertile field for needless use of useless drugs and exploitation if it turns out to be a ‘real tiger’ !
‘New tigers’
Omicron may have evolved, from a co-infected Covid patient after the virus changed its genetic template, through insertion mutation (ins214EPE) and exchanges between a common cold virus like HCoV-229E and the SARS-CoV-2, which is a new phenomenon. The future roadmap depends upon the future variants and their sub-lineages. Many are not aware that the ‘Omicron tiger’ has siblings of unknown pace and ferocity. Already, a sibling of the original Omicron variant, along with the existing Omicron, is rapidly replacing the Delta variant in India, especially in Maharashtra. This sibling, BA.2, is one of the three sub-lineages (subsets, not different variants) of the Omicron – BA.1, BA.2 and BA.3. Quite unlike BA.1 and BA.3, the BA.2 can’t be picked up by using the RT-PCR-SGTF kits as it does not have the ‘69-70 deletion’ in the spike protein to show ‘S-gene drop’. As such, ‘S-gene dropout’-based screening may give high false negative reports. However, the standard RT-PCR test can detect all the three sub-lineages. In most of the countries reporting an Omicron-fuelled surge, the BA.1 / BA.2 sub-lineage of Omicron accounted for 99% of the sequencing runs. The BA.2 / BA.1 sibling of Omicron, which seems to be the main force in the current surge of cases across India, may be a better ‘paper tiger’ for us as it is more transmissible and less virulent.
As though this tragedy is not sufficient, a few more ‘tigers’ have stepped in when the world is reeling from a savaging infliction by the Omicron. Professor Leondios Kostrikis of University of Cyprus christened a strain that has a combination of Delta and Omicron characters as ‘Deltacron’. The new strain which was found in 25 patients has Omicron-like genetic signatures within the Delta genomes. And, IHU (B.1.640.2) is a new variant identified in Southern France by researchers at ‘IHU Mediterranee Infection’ institute, which has not been detected in India so far. A preprint posted on December 29, 2021 revealed that IHU has 46 mutations and 37 deletions resulting in 30 amino acid substitutions. Added to this, another sub-lineage from a sample from England is discovered which is temporarily named as ‘England/MILK-2D24AC9/2021’.
Children and Omicron
The subject of ‘Children and Omicron’ came into focus because of the observed increase in the prevalence of Omicron infection in children of South Africa. But the Indian children may have a different immunological profile. Though children ‘stayed at home’ for over a year, serosurveys show that they are well off in immunity which means that they were infected ‘while at home’. I wrote that they were needlessly deprived of education, in my article titled “Covid, Children and Schools” published in The Antiseptic of October 2021.22 Indian children may not be affected as much as those abroad. Anyway, a lot of ‘paediatric beds’ are kept ready for immediate occupation in the country.
Another redeeming aspect which makes me think that Omicron would be a ripple and not a tsunami of deaths is the ‘native Indian immunity’ and the possible loss of virulence of the virus through repeated replications. Omicron could be highly contagious but not dangerous. The infections may rise at an exponential rate but the number of cases of serious illness and death may not be anywhere near the figures of the ‘second wave’.
The way forward
Omicron or Omega or whatever -- we have to move on normally, of course, with cautious optimism. Omicron is of no serious concern so long as it doesn’t cause serious illness and death. It may even improve ‘herd immunity’ through its natural infection. Omicron seems to be unable to break the barrier of 'NATIVE INDIAN IMMUNITY' and kill a lot of Indians, so far. And, it's time to think of other bigger health problems which were neglected during the past two years.10 One reader wondered about the Omicron: “It is like declaring ordinary cold and cough as pandemic.”37 If we look at it from another angle, the Omicron may just not be a variant of the SARS-CoV-2, but may be the cause of a new pandemic which may be named "COVID-21" as it has overcome high population immunity consistent with the characteristics of a 'deviant' with 'antigenic shift', rather than a 'drift' and of substantial genetic differences.
The “no way” forward ?
“If there is ‘good ventilation’ and ‘no travel’, there is no Covid.”
-- T. Rama Prasad
‘Good ventilation’, which is more important to prevent an air-borne infection than ‘face masks’, is seldom emphasised, perhaps, because of its impracticability in the ‘modern living’ set up. There are three reasons for poor ventilation. (1) High density of population leading to crowded living – this is the main reason for the high prevalence of Covid in urban areas. (2) Due to mosquito menace and dust problem, windows and doors are mostly shut in Indian homes. (3) The extensive use of air-conditioners perforce shut out natural circulation of air.
‘No travel’ is emphasised, but it is absolutely impracticable even for short periods in the modern world.
So, there’s no way !
Disease of the cities
Covid has been dominantly present in the cities, especially in the Indian cities, for four reasons: (1) Lack of good ventilation in the crowded cities. (2) Excessive travel inside and out of the cities. (3) Stupendous stupidity among many of the urban educated in flouting preventive mandates. Even abroad, did we not see Americans and the like, including doctors, going around in gay abandon and even protesting against safety regulations ? Incorrigible recklessness. Fighting for a right is right, but paranoia isn't. In contrast, the naive Indian rural folk adhere to advisories mostly, though not explained to them. (4) The dominant bad lifestyle in cities, with a high presence of stress, ‘screens’, sedentariness, sleeplessness and junk food, may be a contributory factor. Dr. Nicole Saphier of New York’s Memorial Sloan Kettering Cancer Center stated that America’s junk food diet makes one vulnerable to the novel coronavirus ( https://nypost.com/2020/04/18/americas-junk-food-diet-makes-us-more-vulnerable-to-coronavirus/ ).39 This brings the home truth to the surface.
‘Tigers’ from the forests ?
Perhaps, many viruses started their global journey from African rain forests, striking terror across the world. Some originated in China. We have interfered too much with 'Nature', intruding into the forests and causing 'tropical biosphere devastation' leading to ecological imbalance which may be the cause for the emergence of new dangerous (Biosafety Level 4) microbes. International travel promotes the spread of infections wide and fast. It is high time that we sit up and act to preserve ecology, biodiversity, environment and climate. COVID-19 would have served its purpose if we learnt the importance of NATURE. We claim to follow the writ of ancient India, but follow the modern materialistic philosophy. The ancient values and the contemporary political will have been replaced by GREED.
Adieu to humans
The mistake we committed (destroying NATURE) over a long period of time can’t be rectified soon. And, there are no de-addiction centres to wean us away from bad lifestyle and materialism. If interested to know more about it, go to the link https://drtramaprasad.blogspot.com/2017/04/corona-and-charles-darwin.html and listen to what Charles Darwin has to say.26 And, reading in between the lines of his letter may give a glimpse of the root cause for all our myriad maladies.26
“And I hate to write a book titled ‘The Extinction of Humankind’. Long live Homo sapiens !”26
-- Charles Darwin
REFERENCES
1. Rama Prasad, T. Covid Variants. The Antiseptic. 2021 May; Vol.118; No.5; P: 11-14; Indexed in IndMED -- www.theantiseptic.in
2. "Classification of Omicron (B.1.1.529): SARS-CoV-2 Variant of Concern". World Health Organization. 26 November 2021. Archivedfrom the original on 26 November 2021. Retrieved 26 November 2021.
3. Meyer, David (26 November 2021). "What's Omicron? Here's what we know and don't know about the new COVID variant that's roiling markets and air travel". Fortune. Archived from the original on 26 November 2021. Retrieved 26 November 2021.
4. Torjesen, Ingrid (29 November 2021). "Covid-19: Omicron may be more transmissible than other variants and partly resistant to existing vaccines, scientists fear". BMJ. 375: n2943. doi:10.1136/bmj.n2943. ISSN 1756-1833. PMID 34845008. S2CID 244715303. Archived from the original on 2 December 2021. Retrieved 2 December 2021.
5. "Omicron coronavirus variant partly evades Pfizer vaccine's protection, study shows". CNN. 7 December 2021. Archived from the original on 8 December 2021. Retrieved 7 December 2021.
6. "Pfizer And BioNTech Provide Update On Omicron Variant" (Press release). New York City and Mainz: Pfizer. 8 December 2021. Retrieved 8 December 2021.
7. Sandra Ciesek (2021). "Reduced Neutralization of SARS-CoV-2 Omicron Variant by Vaccine Sera and monoclonal antibodies" (PDF). doi:10.1101/2021.12.07.21267432. S2CID 244950946. Retrieved 9 December 2021.
8. Rama Prasad, T. Covishield or Covaxin ? The Antiseptic. 2021 April; Vol. 118; No. 4; P: 12-16; Indexed in IndMED – www.theantiseptic.in
9. Rama Prasad, T. The Science and Nonsense around COVID. The Antiseptic, 2021 November; Vol. 118; No. 11; P: 8-14; Indexed in IndMED -- www.antiseptic.in
10. https://drtramaprasad.blogspot.com/2017/04/tuberculosis-in-india_29.html
11. https://drtramaprasad.blogspot.com/2020/06/coronavirus-covid-19-sars-cov-2_43.html
12. Rama Prasad, T. Disastrous Second Covid Wave in India. The Antiseptic. 2021 June; Vol.118; No.6; P: 20-27; Indexed in IndMED – www.antiseptic.in
13. Rama Prasad, T. Is the “Lockdown Medicine” too toxic ? The Antiseptic. 2020 October; Vol. 117; No. 10; P: 13-15; Indexed in IndMED – www.theantiseptic.in
14. Rama Prasad, T., Versha Rajeev. The Conundrum of COVID-19 Vaccines. The Antiseptic. 2021 January; Vol.118; No.1; P: 10-17; Indexed in IndMED – www.theantiseptic.in
15. Rama Prasad, T., Versha Rajeev. Antiseptics, Disinfectants and COVID-19. The Antiseptic. 2020 November; Vol.117; No.11; P: 26-28; Indexed in IndMED – www.antiseptic.in
16. Rama Prasad, T. 40+15 Hypoxia Test in COVID-19. The Antiseptic. 2020 December; Vol. 117; No. 12; P: 13-17; Indexed in IndMED – www.antiseptic.in
17. Rama Prasad, T. Mucormycosis and COVID-19 in India. The Antiseptic. 2021 July; Vol.118; No.7; P: 21-26; Indexed in IndMED -- www.antiseptic.in
18. Rama Prasad, T. Vagaries of India’s Covid Vaccination Policy. The Antiseptic. 2021 August; Vol.118; No.8; P: 10-16; Indexed in IndMED – www.antiseptic.in
19. Rama Prasad, T., Versha Rajeev. Tea and Covid. Health. 2020 October; Vol.98; No.10; P: 4-6.
20. Versha Rajeev., Rama Prasad, T. Fear and Covid. Health. 2020 November; Vol.98; No.11; P:31-32
21. Rama Prasad, T. India’s Third Covid Wave. The Antiseptic. 2021 September; Vol.118; No.9; P: 14-20; Indexed in IndMED – www.antiseptic.in
22. Rama Prasad, T. Covid, Children and Schools. The Antiseptic. 2021 October; Vol.118; No.10; P: 08-18; Indexed in IndMED -- www.antiseptic.in
23. https://drtramaprasad.blogspot.com/2020/
24. Rama Prasad, T., Versha Rajeev. https://drtramaprasad.blogspot.com/2017/04/covid-crocodiles.html
25. https://drtramaprasad.blogspot.com/2017/04/hydroxychloroquine-hcq-and-coronavirus_29.html
26. https://drtramaprasad.blogspot.com/2017/04/corona-and-charles-darwin.html
27. https://drtramaprasad.blogspot.com/2017/04/modern-medicine-good-bad-and-ugly_30.html
28. Rama Prasad, T., COVID and Tuberculosis. The Antiseptic, 2021 December; Vol. 118; No.12; P: 11-17; Indexed in IndMED -- www.antiseptic.in
36. @jsphctrl, @mroliverbarnes: https://ft.com/content/0ee745ce-ac55-46a9-9766-0b419821a79d
38. Rama Prasad, T., Ominous Omicron of COVID. The Antiseptic, 2022 January; Vol. 119; No. 1; P:25 – 29; Indexed in IndMED – www.antiseptic.in
39. https://nypost.com/2020/04/18/americas-junk-food-diet-makes-us-more-vulnerable-to-coronavirus/
“Omicron is adding fuel to the fire of Delta;
It is always better to be safe than sorry.”
*****************
Happenings after writing the above article on January 14, 2022:
January 18, 2022
Prof Julian Hiscox of University of Liverpool echoed what’s written in the above article, saying that Omicron infection will lead to a scenario of endemicity ending the pandemic by 2022. But, Dr. Anthony Fauci, chief medical advisor to the US said that it is too early to say that Omicron will mark the end of the epidemic.
66% of the ‘non-Covid’ patients in Mumbai’s ICUs tested positive, on routine testing for Covid, with no Covid symptoms.
January 22, 2022
“Again, with around 3.5 lakh infections and around 400 deaths recorded on January 21, 2022, fear is on the top of the mind of a repetition of the ‘second wave’ in India. In all probability, the infections may continue to increase but the deaths won’t increase proportionally (whatever the low number of deaths that occur are likely to be mostly in the unvaccinated and those with co-morbid diseases). India’s total number of infections is around four crores and the deaths around five lakhs, now. Having been stumped so often during the past two years by the coronavirus, experts now are a bit tight-lipped about predictions. In 2021, many experts said that India entered into an endemic (ordinary infection) stage for six months from June 2021, before Omicron hit in December 2021. Now, it is being projected by some that India would be in an endemic phase after April 2022. Most likely, it would continue to be like that for a number of years unless a more formidable variant emerges. The scenario is so uncertain with the emerging “vaccine-resistant” variants that we may have to depend on the “social vaccine (masks, distancing & hygiene)” for a long time to come.” -- T. Rama Prasad.
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