Published on the Blog on December 20, 2021
Preprint
. Ominous Omicron of COVID .
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
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A MONTHLY JOURNAL OF MEDICINE AND SURGERYSN
Vol. 119 No. 1 January 2022 ISSN 0003 5998
Indexed in IndMED Email: admin@theantiseptic.in www.theantiseptic.in
. Ominous Omicron of COVID .
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. 1
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“Since Omicron is now everywhere in the world, let's rename it Omnicron.”
-- Nkwachukwu Ogbuagu”
ABSTRACT
Yes, true to this quote, the variant has become omnipresent in no time. Just when the world was getting ready to the idea of learning to live with the known variants of SARS-CoV-2, the news of a reportedly more transmissible and vaccine-resistant variant loaded with a myriad mutations, named OMICRON, has rattled the people across the globe. Not much is known about this devil except its formidably dangerous structure. Certain steps were taken to curb the menace which are arguably debatable. As this variant has been known for only three weeks, as of mid-December 2021, its real world profile is yet to be scripted. It is not yet clear as to whether the preemptive steps taken are reflective of over-reactivity or balanced judgment. A few known aspects of this evolving Omicron are briefly presented in this paper – not a formal account. Let us hope that the world which has been battered continuously for two years would, by a stroke of serendipity, ‘escape’ from this seemingly vicious variant which may ‘escape’ from the currently available Covid vaccines.
Key words: OMICRON, SARS-CoV-2 variants, Booster Covid doses
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Introduction
By nature, viruses mutate into various types leading to hundreds and thousands of variants / lineages. However, only a few differ a lot to cause immense harm like the Delta variant. The new coronavirus, SARS-CoV-2 , is no exception. We don’t yet fully know about the latest three-weeks-old ‘Variant of Concern’, the Omicron’, which is currently terrorising the world. Some information about the variant bugs may be found in my article titled ‘Covid Variants’ which was published in The Antiseptic of May 2021.1
Omicron (B.1.1.529), a variant of SARS-CoV-2, was first reported from South Africa (Gauteng province) to the World Health Organization (WHO) on November 24, 2021.2 Quickly, just two days later, the WHO designated it as a ‘Variant of Concern (VOC)’ on November 26, 2021 and named it after ‘omicron’, the fifteenth letter in the Greek alphabet, skipping ‘Nu’ (to avoid confusion with the word ‘new’) and ‘Xi’ (which happens to be part of the name of the premier of China).3,4 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.
Petrifying news
On November 25, 2021, India was on the way to ‘business as usual’, dancing to the tune of the most unexpected absence of a ‘third COVID-19 (Covid) wave’. Crowded markets, full-to-the-brim restaurants and over-the-top weddings had come back. The next day, on November 26, 2021, the music was silenced by the announcement of suspension of flights from several countries in the wake of detection of some cases infected with Omicron. Blunt and blanket measures that are not evidence-based or effective on their own were introduced by many countries once again. The world was again in a turmoil. The panic reaction of ‘shutting down’ was due to the presence of many mutations in the variant, though no serious illness was reported. And, at ‘viral speed’, the WHO declared it as a ‘Virus of Concern’(VOC). Hectic discussions and debates have been going on about the wisdom of the pre-emptive actions that have been taken and the future course of the pandemic. All the same, Indian people continued to dance albeit without music and masks !
Magnitude
Within three weeks from the date of reporting, Omicron had spread to about 80 countries (as of December 16, 2021) despite travel restrictions. Africa accounts for 46% of reported cases globally, and just 7.5% of over one billion people in Africa have had primary doses of the vaccine. In Africa, on a single day, on December 2, 2021, the number of infections went up exponentially to 11,535, and the number of admissions of children increased dramatically. Another notable feature is that people who were previously afflicted with Covid or completed two-dose vaccination tested positive for Omicron. Even the South Africa’s president who was ‘fully vaccinated’ tested positive. The silver lining is the pleasant and positive finding that almost all the victims had only mild symptoms and needed no hospitalisation – notwithstanding, the sheer numbers could overwhelm unprepared health systems.
As on December 15, 2021, 77 countries have reported the cases though the Omicron may be present in most countries. Omicron is spreading at a rate not seen with any previous variant. Currently available vaccines may not be that effective against Omicron, but they do protect to some extent against severe disease and death. The WHO said that Omicron is more transmissible than the Delta strain and reduces vaccine efficiency, but causes less severe symptoms, and is likely to outpace the Delta variant.
Omicron seems to like the British hospitality ! Amid Omicron spread, the UK reported the highest ever daily Covid cases (78,610) on December 15, 2021. A staggering 11 million people out of a total population of 67 million tested positive for Covid so far in the UK (in India 34 million out of a population of 1,300 million). As the variant is expected to be the dominant strain by mid-December in Britain, the country launched a ‘booster blitz’ by announcing that it would be giving the ‘booster’ doses to people over 30 from December 2021 and to those aged 18 and above from January 2021, and has put the country on the “turbocharged” ‘alert level 4’ on its 5-point scale to contain the ‘tidal wave’ of Omicron which has kindled political opposition over a parliamentary vote (more than 100 lawmakers of the ruling party voted against the measures to contain Omicron on December 14, 2021) on the ‘Omicron restrictions’, reminiscent of a similar ‘Covid political problem’ of an opposite stance in the US last year. There were 1,239 confirmed cases of Omicron on December 12, 2021, and the world’s first ‘Omicron death’ was confirmed in Britain, where people are rushing to get ‘booster’ shots while the swiftly spreading strain is doubling the cases every two or three days (‘doubling time’ much shorter than that of Delta). The variant accounted for 40% of the cases in the British capital, and hospital admissions were rising, as of mid-December. It is expected that Omicron would become the dominant strain within 48 hours with an estimated case load of 200,000 per day through ‘community transmission’.
The US which reached 8,00,000 Covid-related deaths on December 12, 2021 is bracing for a potential surge in infections due to the highly transmissible Omicron. The death toll of eight lakhs exceeds the entire population of North Dakota ! As of December 14, 2021, according to a new modelling by the Centers for Disease Control and Prevention (CDC) of the US, the worst scenario may be of a massive wave peaking in January 2022 with the “Triple Whammy” of Omicron, Delta and influenza.
So far, as of mid-December 2021, India reported only around 50 cases of the variant, but one can’t guess the number of the undetected cases in the country. But, the epidemic graph in countries abroad clearly suggests that the disastrous threat of the Omicron is right on the horizon. The disparity between the countries is puzzling. 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. Perhaps, the scenario would vary from country to country depending upon various factors.
Global deceleration
The news of ranking Omicron as a VOC by the WHO had applied brakes to the just accelerating travel and trade. At the beginning of the Covid pandemic, about two years ago, the WHO was criticised for an alleged delay in declaring Covid as a pandemic (announced on March 11, 2020) by two months. Now, the same WHO is being accused of hastily declaring Omicron as a ‘Variant of Concern’ (VOC) within two days of its ‘identification’ ! The verdict immediately evoked a ‘knee-jerk’ response -- hurriedly spooking the world, suspending many flights and crashing markets. It is well-known that the WHO has been beset with controversies throughout the pandemic period.
Economic impact
The Swiss-based BIS (dubbed as the ‘central bank’ to the world’s central banks) said that Omicron had already caused falls in major stock markets and ramped up uncertainty over the potential human and economic costs of Omicron. Claudio Borio, head of the BIS’ Monetary & Economic Department said: “The emergence of Omicron indicates that we should not lower our business guard, considering that this is the latest reminder that we have to be watchful.” In India, markets nosedived to a bloodbath on Dalal Street as benchmark indices shed significant points over rise in Omicron cases.
Overreaction ?
It all depends upon how one views at the situation. One may accuse the WHO of bypassing the stage of initially designating it as a ‘Variant of Interest (VOI)’ which seems to be a significant departure from the precedence followed for other ‘Variants of Concern’ in the past. Notwithstanding, it may be said that the WHO had technically did the right thing as all the three criteria (increase in transmissibility; a detrimental change in in COVID-19 epidemiology; increase in virulence or change in clinical disease presentation or decrease in effectiveness of public health and social measures including vaccines, therapeutics and diagnostics) were met with to declare it as a VOC. And, the WHO had gone through the praiseworthy studies done about the variant by the South African doctors and virologists during the previous few months before reporting the variant. On the other hand, it may be said that many countries overreacted by suspending flights which was not advised by the WHO. This has generated a humongous chain reaction nosediving markets and global economy.
Origin of Omicron
Equally mysterious is the origin of Omicron as that of the parent virus. Two years on, still heated debates have been going on about the origin of the original ancestral SARS-CoV-2 virus, with abundant political overtones. It is presumed that Omicron originated in an immunocompromised Covid patient somewhere in Botswana and then spread to southern African countries and then on to other countries in the world. Taking the circumstances into consideration, this theory seems to be sound. A research team which included Indian experts in the US and Canada found that 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.
But, a 46-year-old medical doctor in Bengaluru in India, who was one of the first two reported (December 2, 2021) cases of Omicron in India, has no history of travelling abroad or contacting a case of Omicron. Curiously, he tested positive again two weeks later. In addition, it was reported that the Omicron variant was in Europe, Dutch, Belgium and Germany even before South Africa flagged it. This opens the door to the theory of development of the variant independently in various countries, and portends the possibility of community transmission in the coming weeks. Further observations over a period of time only would elucidate on this evolution.
Based on genome comparisons, it is estimated that Omicron diverged in late September or early October 2021.5 Sequencing data suggests that Omicron had become the dominant variant in South Africa by November 2021, the same month when it had been first identified in the country.6,7 Phylogenetic studies show that Omicron emerged recently. Available data from South Africa indicates that Omicron has a pronounced growth advantage in that country, perhaps, due to its immune-escape capability and high transmissibility.
New Omicrons
While this drama is going on, on December 9, 2021, just within a fortnight of the first report of Omicron, a genome sequence data was posted on a public database indicating identification of a sub-lineage -- BA.2 – of Omicron. This means that the Omicron variant has been split into two sub-lineages, namely BA.1 (the original globally-distributed lineage) and BA.2 (the new outlier lineage). As the BA.2 does not have the ‘S-gene dropout mutation’, it can’t be identified by the primers used in the RT-PCR test unlike in the case of BA.1. Added to this, another sub-lineage from a sample from England is discovered which is temporarily named as ‘England/MILK-2D24AC9/2021’. At present, we know almost nothing about the clinical and epidemiological profile of the new strains.
Omicron and booster doses
The jury is still out on how effective 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 vaccine ‘booster’ doses. Britain announced that it would be giving ‘booster’ doses to people over the age of 30 from December 20, 2021 and to those aged 18 and above from the end of January 2021. As some rich nations are giving booster doses to protect people from Omicron, many Indians are demanding a third jab and are even getting it unofficially from private hospitals.
On December 9, 2021, the WHO warned wealthy countries against hoarding Covid vaccines for their booster shots to fight off Omicron, and also recommended boosters only for those with health issues, or those who have received an ‘inactivated shot’ like Covaxin. The concept of booster (additional) dose arrived with the evidence that the vaccine-induced immunity tends to wear off with time and that the currently available Covid vaccines may not be equally effective against variants. In such a scenario, the looming threat of Omicron naturally made everyone wonder if it is time for a booster dose. It made sense to scientists also as can be seen from a bulletin (November 29, 2021) from the India’s top genome sequencing body, Indian SARS-CoV-2 Consortium on Genomics (INSACOG), which is suggestive of recommending booster doses to people of the age of 40 and over with preference for high-risk and high-exposure persons. Subsequently, the Union Health Minister said in the Lok Sabha in the first week of December 2021 that the Central Government was in no hurry to give the green signal for the booster dose and that it would wait for proper scientific analyses – the corpus of evidence at hand for boosters is largely based on waning of antibodies, not of cellular immunity. Following this, the INSACOG issued another bulletin (December 4, 2021) saying that many more scientific experiments are required to assess the impact of boosters, going back on its ‘recommendation’. The National Technical Advisory Group on Immunisation (NTAGI) which met on December 6, 2021, in the context of the emerging Omicron, had deferred “any decision on additional (booster) dose” for anybody in the absence of consensus. Further, on December 10, 2021, the government officials stated that the country’s policy on booster Covid vaccine doses will be in line with WHO recommendations. This is another example of the prevailing uncertainty in Covid matters. That much is about the booster scenario in India which is at the other pole of that in Britain about which I wrote under the subheading “Magnitude” above.
‘Mix & match’ of boosters
A 28-year-old German man, who is a researcher in virology, and who had a booster dose also, has tested positive in Jabalpur of Madhya Pradesh when he came to India to attend a wedding function in the first week of December 2021. There is no clarity yet on the efficacy of booster doses on preventing Omicron or even the other variants. All the same, taking everything into consideration and looking forward, I feel that booster (additional) doses of different platforms (Mix and Match) to produce a smarter ‘hybrid’ immunity would come into vogue in 2022. India may think of the DNA plasmid-based ZyCoV-D vaccine or a protein-subunit vaccine like Novovax 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.
I mentioned about the ‘mixing’ with the second dose itself in my article published in The Antiseptic as long ago as in April 2021.8 In the article titled “Covishield or Covaxin ?”, I wrote, at a time when talking of ‘mixing’ vaccines was anathema, that an inactivated virus vaccine (Covaxin) or mRNA vaccine (Pfizer) be given as a second or third booster dose to those who had an adenovirus vector-based vaccine (Covishield) as the first dose.8 Now we have a wider choice. 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.
Relevance of boosters
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. There is scarce evidence that boosters add value to the main purpose of the immunisation programme which is to reduce severe disease, hospitalisation and death. This purpose is well-served by the present primary schedule of vaccination which means that a booster is superfluous at this stage when global coverage of the primary vaccination is woefully poor. As there is no evidence yet of the value of boosters to tackle Omicron, the focus should be to ensure that every eligible one should receive a primary schedule of vaccination which protects to some extent against all the known strains. Let all have a square meal a day before dreaming of a feast.
Let’s talk about the projected value (or uselessness) of boosters at community level, not at the individual level. The emergence of Omicron makes the case for a global inclusive primary vaccination more compelling than it was. Western nations should part with their booster dose stock for the universal vaccine coverage. It is to their benefit also, as eventually more variants would emerge from the poorly vaccinated countries and later spread to them. That’s the price wealthy countries have to pay for the malicious disparity in vaccination between the rich and the poor due to the poor policy decisions (including about intellectual property rights) on vaccinations of some of the advanced countries. Vaccine equity campaigners have been crying hoarse over this issue. Unvaccinated population is a fertile ground for the virus to mutate and go around the globe. No country is Covid-safe unless all the countries are Covid-safe.
Unfortunately, this subject is the wealthy countries’ elephant in the room. Wait not until another wake-up call comes from another variant to the pandemic-ravaged humanity. Let India too not skirt the elephant; India also is rich, of course – rich in the capacity to manufacture vaccines; India should help less privileged countries with vaccines instead of giving boosters of unknown value or with fragmentary evidence to all who are fully vaccinated 6 to 9 months ago. We may rethink when granular evidence comes forth. For the present, giving boosters to the elderly and the vulnerable would suffice – for this purpose, some of the unused stock (60 lakh Covid vaccine doses) lying with private hospitals in India which has no demand and which is due for expiry shortly may be utilised advantageously. If surplus stock is available, those who had Covaxin (only a small 10.7% of the 135 shots administered in India) may be given a booster nine months after the second dose.
Similarities and differences
The three-weeks-observation (up to mid-December) is too short to draw any conclusions about the behaviour and impact of Omicron, especially for India where the number of cases are in two digits so far. South African experience indicates that it has a high transmissibility quotient and a low fatality rate. Omicron seems to be more potent than other variants to infect even people who had been previously infected and vaccinated. Computational modelling suggests that Omicron might escape cell-mediated immunity. South Africa had seen more younger people and less need for hospitalisations compared to the scenario of previous ‘waves’.
The reported symptoms are a little different from those of the Delta variant which has been dominant – fatigue and body pain, mainly; without loss of smell, taste and cough. It can generally be diagnosed by the existent RT-PCR test. “S gene target failure” can serve as a marker; of course, the sub-lineage -- BA.2 – of Omicron is an exception. Most of the other aspects are as uncertain as that of the other cousins. Corticostreroids and IL6 receptor blockers may be of help in severe forms of the disease. The RNA virus antiviral drug, Paxlovid and the anti-RNA virus drug, Molnupiravir may prove to be efficacious.
Ground realities
The ground realities of the new variant are unknown though the structural profile of the mutations indicates Omicron’s capacity to ‘escape’ from the existing vaccines. It may only be a scientific speculation that it may replace the Delta variant and cause a ‘third wave’ in India. Real world happenings may differ from scientific calculations.
The world’s health and scientific bodies are expressing grave concern about an impending stroke of disaster by Omicron. On December 11, 2021, a modelling released by scientists at the London School of Hygiene and Tropical Medicine suggested that Omicron is likely to cause a large wave of infections by January 2022, and could cause between 25,000 and 75,000 deaths in England in the next five months. The variant, theoretically, has a greater ability than the currently dominant Delta variant to bind to the human ACE 2 receptors by virtue of the large number of new mutations it has acquired, especially in the spike protein. Judging by its structure and the speed with which it is spreading, it is feared that it would outdo the Delta and destabilize the world.
But, the BETA, DELTA PLUS and LAMBDA variants, which are better equipped than the DELTA, couldn't do much harm. Ground realities seem to be different, more so in India. The epidemic course, such as the number of waves, and the vaccines used in other countries are different from those in India. There are only limited studies on a few thousands of people from a few hospitals and frontline workers by the National Institute of Epidemiology of the Indian Council of Medical Research (ICMR). The chance of detecting cases of Omicron varies significantly, especially depending on a country’s sequencing rate.
Natural immunity
Though many Indians don’t care much for the ‘Social Vaccine’ (masks, distancing and hygiene) or the ‘Pharmaceutical Vaccine’, they are well equipped with strong “INDIAN IMMUNITY (acquired genetically through racial/native inheritance of traits and through natural infections, Covid vaccines and the BCG vaccine).”28 And, as and when new variants or viruses emerge, the naturally acquired immunity gets topped up. So, India may sail through the Omicron predicament just as it has been through the ‘scripted third wave’, contrary to the ‘scientific’ predictions.
It may sound extremely contrarian, but the truth is that the important things to end the pandemic are not lockdowns, masks and vaccines. They, including universal Covid vaccination, play a role to some extent for a short period of time. Some of the measures that were taken like ‘national lockdowns’, ‘zero-tolerance Covid policies’ and the Omicron-related flight suspensions are like hitting a fly sitting on a glass plate with a hammer. Contrarian view ? Well, be that as it may, the utility (or futility) of some of the blanket measures enforced and the superiority of naturally gained herd immunity along with need-based and focussed interventions would be talked about in the coming years.
The idea that ‘mask-wearing’ prevented the projected ‘India’s third wave’ which was to see a ‘peak’ of around one lakh cases a day in October 2021 is the most flawed. Who wore proper masks properly ? Not even many doctors ! While mask is beneficial to some extent, it is hyped too much and used too casually – hanging a piece of cloth somewhere on the face or neck to avoid a penalty (like riding a motorcycle with a helmet on the handlebar) ! Expressing her contrarian stance, Prof. Sunetra Gupta, Infectious Diseases Epidemiologist, University of Oxford has recently said: “Several studies have shown that the effects of masks are really negligible, if at all. … Published studies show that natural immunity is longer lived than the vaccine induced. … Lockdowns will cause more harm than anything else might do. … you can’t rely on vaccinations to halt the spread. … the main reason that the pandemic is going to end is that many of us have been naturally infected and have natural immunity which gets topped up again (when re-infected). So, the barrier of herd immunity is an essential tool in combating the virus.” 32
Contrarians and ‘anti-vaxxers’ quote a body of overwhelming evidence to say that naturally acquired immunity is equal to or more robust and superior to that obtained through the existing vaccines, and that Covid infections and severe disease were higher among the vaccinated than among those who recovered from the disease, and that those who previously had Covid and then get vaccinated may be at a higher risk of adverse events due to Covid vaccination. 30,31,32 Well, it’s good news for anti-vaxxers and those who were infected and recovered. And, be that as it may, but how about those who do not recover and die ? Can those departed souls return to have the rejected vaccine ? Frighteningly farcical. Data for and against on any aspect of Covid is abundant.
Responding to a question whether all should get Covid infection to gain natural immunity which may be superior to vaccine-induced immunity, Miss Sharyl Attkisson, Investigative Journalist at New York Times, who authored the paper “Covid-19 natural immunity compared to vaccine-induced immunity : The definitive summary,” said in a sharp critical expression: “You can draw your own conclusion. I’m simply providing study information and data that some are censoring or seem unwilling to acknowledge.” 30 Is this remark pointing to something murky in ‘modern medicine’ ? For an inquisitive reader, there is a small window, to peep into the darker side, in my articles titled “Hydroxychloroquine, Ivermectin, Coronavirus and Research Frauds” and “Modern Medicine – the Good, the Bad and the Ugly.” 25,27
There is half-truth in the studies. For example, masks were found to be effective under ‘laboratory conditions’. In the ground reality, masks are pieces of cloth hung somewhere in front of the face or neck to avoid penalty. Similarly, vaccines which show 90+ efficacy in the ‘study conditions’ may scale down in real world situation, especially when variants like Delta and Omicron arrive. Of course, unfortunately, in this materialistic world, vested interests come into play in a big way to give a scientific colour to nonsense. Some of the artefacts are pointed out in my article titled “The Science and Nonsense around COVID” and published in The Antiseptic of November 2021.9
Predictions
Regarding the ‘third wave’ in India, my prediction, as published in a medical journal (‘The Antiseptic’ of September 2021), that the ‘third wave’ would not be a demarcated wave and may just merge with the ongoing surges at some places has come true.21 Researchers at the Indian Institute of Technology (IIT) at Kanpur and Hyderabad predicted that the ‘third wave’ of India would reach a ‘peak’ in October 2021 with around one lakh cases a day.21 There have been only around ten thousand cases a day, while the US has been recording more than 120 thousand cases a day ! And, now, I am predicting that the Omicron would not impact India much, because of the immunity acquired through the massive ‘Delta wave’ (‘second Covid wave’ in India) infections (acknowledged by serosurveys) and the huge 135 crore Covid vaccine doses (around 50% accessed two doses) that were administered which would keep the country at a safe level.
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 Another redeeming aspect which makes me think that Omicron would be a ripple and not a tsunami 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. There may be more infections but not many problems.
To the contrary, on December 9, 2021, Tedros Adhanom Ghebreyesus, Director-General of the WHO, said that the emergence of the Omicron coronavirus variant highlights the "perilous situation" the world is in, roughly two years after the start of the Covid pandemic. And in Britain, alarm bells are ringing with the announcement of the scary ‘alert level 4’ on a 5-point scale. Some scientists and authorities are predicting that a huge ‘Wave of Omicron’ may hit India in January and February of 2022. In India, as the public participation in preventive measures and the health infrastructure are not praiseworthy, the country would do much better if people take both the ‘social’ and ‘pharmaceutical’ vaccines seriously.
Covid uncertainties
Omicron is a three-weeks-old infant the future behaviour of whom is uncertain. There had been too many uncertainties even about the two-year-old toddler, Covid. We just shrug when somebody asks why we used ‘disinfectant tunnels’, Hydroxychloroquine, Ivermectin, Remdesivir, blind and blunt blanket-lockdowns, etc. Many of the Covid-related studies were not large and robust to enable one to draw valid conclusions. The subjects related to Covid are of patchy knowledge and uncertainty. This can be perceived in all my 16 articles published over the previous 16 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 And some other Covid information may be found on my blog and other media.10,11,23,24,25,26,27
A blessing in disguise
Omicron may act like the Covaxin. 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. Even as I am writing this, news of a new Omicron (BA.2) trickled in.
‘Much ado about nothing’ ?
Even as the whole world is stepping up surveillance and preparation in anticipation of an ominous Omicron surge, news as on December 12, 2021 from the epicentre of the Omicron wave in South Africa makes us wonder whether all this fuss is ‘much ado about nothing’ ! The current ‘Omicron wave’ in South Africa had already ‘peaked’ on December 10, 2021within three weeks, and the case fatality rate was almost zero / just less than 0.5%. The Omicron infections were milder than the ones caused by the Delta variant. The analysis is from the University of Johannesburg, based on the hospital data from the South Africa’s National Institute of Communicable Diseases. Here in India, the Omicron tally on December 12, 2021 stands at a mere 38, while the Union Health Secretary suggested measures like night curfews in districts that are witnessing increased positivity rate. Ultimately, it is not even the kind of virus that matters, it is the viral load which is crucial in the outcome.
The way forward
As mentioned above, Omicron may not cause much harm to India, but caution dictates that we should assume the worst that it may cause severe disease and may be resistant to the currently available vaccines. In view of the fast spread among the unvaccinated African population and the higher prevalence among their young, and the surge in the vaccinated British people, the following steps need to be taken to tackle the epidemiological emergency. (1) Bolstering the sagging interest in ‘social vaccine’ (facemasks, distancing & hygiene). (2) Speeding up and sustaining primary vaccination activity. (3) Administering a ‘booster’ dose selectively to the elderly and the vulnerable, and, if possible, to those who had two doses of ‘inactivated virus vaccine’ like Covaxin nine months ago. (4) Vaccinating children of the age group already recommended by expert panels. (5) Providing beds for isolating and treating children when the need arises. (6) Avoiding non-essential travel and partying.
Finally, hi-tech or godly Nature ?
Of course, as expected, the world’s major hi-tech manufacturers of Covid vaccines are working at hectic viralspeed to roll out variant-specific vaccines. New vaccines will neutralise new variants until yet another new variant arrives ! The modern human being doesn’t prevent fire, but develops top-notch technology to make a more sophisticated fire engine ! The truth is that more than making the human to learn to develop new fire engines, the virus is trying to show that the world has to learn to live together with Nature – in that concord only lies the humanity’s hope. The more and more we tinker with Nature, causing an ecological imbalance, the more and more baffling bugs come out of the forests. If we extend our mind a little beyond, our haphazard therapeutic interventions promoted emergence of newer germs. Did we not give birth to drug-resistant bacteria and ‘superbugs’ ?
“Man is the most insane species. He worships an invisible God and destroys a visible Nature. Unaware that this Nature he’s destroying is the God he’s worshipping.”
-- Hubert Reeves
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.
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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.
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“Omicron is adding fuel to the fire of Delta.”
“It is always better to be safe than sorry.”
*****************
December 17, 2021
Study indicates Omicron spreads faster than Delta but is likely less severe
Bloomberg (12/15, Kay) reports, “The Omicron variant infects around 70 times faster than Delta and the original Covid-19 strain, though the severity of illness is likely to be much lower, according to a University of Hong Kong study that adds weight to the early on-ground observations from South African doctors.” Bloomberg says, “The supercharged speed of Omicron’s spread in the human bronchus was found 24 hours following infection, according to a Wednesday statement from the university.” However, the study also “found that the newest variant of concern replicated less efficiently – more than 10 times lower – in the human lung tissue than the original strain which may signal ‘lower severity of disease.’”
December 18, 2021
UK sees record 93,045 fresh cases amid Omicron surge
The Centre (India) has advised against all non-essential travel amid a global concern over the Omicron variant. It also said quoting WHO that no change in treatment protocol is suggested for infection by the Omicron variant.
December 18, 2021
“Warning that the number of daily Covid-19 cases being reported from the UK and France could translate to 13-14 lakh cases in proportion to India’s population, top government authorities on Friday (December 17, 2021) sought a fresh reset of measures to keep infections under control. During the peak of the Delta wave in early May, India had reported over 4 lakh cases daily.” – The New Indian Express, December 18, 2021.
December 21, 2021
The British Medical Association has warned that almost 50,000 doctors, nurses and other National Health Service staff in England could be off sick with Covid-19 by Christmas day unless additional restrictions are introduced. But, the British prime minister is facing vociferous opposition within his Conservative Party to any such restrictions. Amid controversial opinions and happenings in Covid-related matters over the past two years, many have been questioning whether all this fuss is about science or nonsense (read my article: https://drtramaprasad.blogspot.com/2017/04/science-and-nonsense-about-covid.html ). The WHO chief Tedros said: “There is now consistent evidence that Omicron is spreading significantly faster than the Delta variant and is more likely to infect people who were vaccinated or who had the infection.” American medical chief Fauci said: “Omicron is raging through the world and Americans should have booster doses as there has been a 50% increase in the cases.” Omicron has become the dominant strain in the US accounting for 73% of new infections last week, and the first death due to Omicron in the US occurred on December 20, 2021. Israel, one of the best vaccinated countries, reported the first death due to Omicron on 20th December 2021, and barred its citizens from travelling to the US and Canada, apart from the ban to go to 56 more countries. In a study published on December 20, 2021 in The Lancet, it was found that the protection from severe illness by the AstraZeneca (Covishield) vaccine starts declining about three months after the second dose.
In contrast, India recorded only 164 cases, as on December 21, 2021 !!!
India has recorded only around 500 cases, as on December 25, 2021, but the number may grow exponentially by the end of January 2022 !!! It is very small now. Even if it grows big, it is of no serious concern so long as serious illness doesn’t occur. It may even improve immunity through infection though it doesn’t mean that the infection shouldn’t be prevented. Indian children (15–18 years) would get the vaccine from January 3, 2021, and the high-risk groups (healthcare & frontline workers & those above 60 years with comorbidities) would get “precaution dose” (booster) from January 10, 2021. Israel is ready with the fourth (booster) dose.
. “Omicron or Omega, or whatever -- we have to move on normally, of course, with cautious optimism.” -- T. Rama Prasad
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