Post-Omicron Peregrination
Preprint
. Post-Omicron Peregrination .
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. 4 April 2022 ISSN 0003 5998
Indexed in IndMED Email: admin@theantiseptic.in www.theantiseptic.in
. Post-Omicron Peregrination .
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. 4
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ABSTRACT
As of mid-March 2022, at the end of the ‘Omicron-powered wave’, the world is in a state of mental exhaustion, fatigue, helplessness, desperation, depression, intolerance, and a feeling of failure albeit silver-lined with a ray of hope, not knowing whether to continue fighting or to surrender in the war against the Covid, just as is the case of Ukrainians fighting the ‘war’ with Russia at the moment. A few of the enigmatic and debatable issues connected with our Post-Omicron peregrination are highlighted in this article in an informal format for thought provocation.
Key words: Omicron, Delta, Covid-19, SARS-CoV-2 variants, Covid pandemic, Covid endemic
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“To be, or not to be: that is the question.”
-- Hamlet’s soliloquy, Act III, Scene 1
Introduction
The famous quote seems to be appropriate for our situation with Covid now in March 2022. It’s a dilemma for the whole world. “To lift the Covid restrictions, or not to: that is the question.” The characters in the William Shakespeare’s ‘Hamlet’ grapple with issues of mental distress and depression. So are the people on the planet now, more so with the ongoing ‘war’ in Ukraine. Incidentally, on March 8, 2022, Ukraine’s President Volodymyr Zelensky, invoked the ‘Hamlet’ as he delivered the historical, ‘Churchill-like’ and the first-ever virtual speech by a foreign leader at the British Parliament, in the context of the ongoing ‘war’ with Russia. He said: “The question for us now is, to be or not to be; now I can give you a definite answer – it is yes, to be.” Suddenly, the world’s focus has shifted from the “Cold Warwith Covid” to the “Potential Third World War.” There is a compelling commonality between these two. The cardinal concern in these two issues is to save lives and economy as well.
Dilemma: Since the pandemic began more than two years ago, Covid claimed six million lives so far in the world -- 9,60,311 in the US, 6,52,341 in Brazil and 5,15,210 in India. The milestone of ‘six million’ comes as the number of deaths and infections continue to plummet in March 2022 in most of the regions in the world, except in Asia, where Hong Kong is suffering its worst-ever outbreak, and Oceania, where New Zealand has recorded a jump in the cases. Surprisingly, on March 13, 2022, China which has been following strictly its “ZERO-Covid” policy, is reported to be having its worst Covid outbreak in two years. In India, as of March 13, 2022, Covid numbers were the lowest since the initial weeks of the pandemic, nearly two years ago – below 250 deaths in a week; less than 26,400 cases in a week; daily number of the infections has plunged to a mere 3,000 per day. The total tally of the COVID-19 cases in India was 4,29,90,991 as on March 13, 2022. While the first ‘Covid death’ was recorded in India on March 12, 2020, Covid took a toll of more than five lakhs in the country. Over 180 crore vaccine doses were given. But we are not sure whether another ‘vaccine escape’ Delta-like variant is on the horizon. Hence the dilemma of “to be or not to be” is in focus. But, many States in the US, the UK and some other countries have now been rolling back ‘Covid-appropriate restrictions’ including ‘mask mandates’.
Covid info: The ambiguity on various aspects of Covid is the hallmark of this pandemic. To have a peep into these uncertainties, one may look into my 19 articles published over the previous 19 months on various subjects related to Covid in The Antiseptic, a journal of Medicine and Surgery, and in Health, a journal devoted to healthful living.1,8,9,12,13,14,15,16,17,18,19,20,21,22,28,29,38,40,42 Incidentally, the publication (mostly Indexed in IndMED) of the 19 articles in 19 months related to just one subject (COVID) by the same author and by the same publisher is a WORLD RECORD in medical journalism. The number would be 20 if this article is to be included. And a compendium of sorts of events related to the early phase of the Covid pandemic may be found on my blog.11, 23 And some other selected Covid information is available on other media. 2,3,4,5,6,7,10,11,23,24,25,26,27,30,31,32,33,34,35,36,37 The volcanic explosion of information over the past two years, full of confusing and contradictory details, has made the common man (who is fully soaked by media with every ‘Covid detail’ every day) totally unable to differentiate sense from nonsense. Incidentally, an article titled “The Science and Nonsense around COVID” was written by me in The Antiseptic of November 2021.9
Covid curiosity: The curiosity to know about the unknown kept the whole world glued to media persistently for over two years for Covid information. They got information, misinformation, disinformation and fake information. The lay public even had read articles published in medical journals more keenly than the professionals. There is an example from the feedback I got -- millions of lay people read the 19 articles mentioned above, accessed through social media, while even a small fraction of the medical professionals would not have had the time to go through them, including the doctor members among my kith and kin. This is one of the Covid phenomena.
Some of the randomly related aspects of the ‘Post-Omicron Peregrination’ are briefly highlighted below in an informal presentation.
Grave portents
Over two years, we have failed to charter the territory in our battle against the better-equipped virus. “A journey, especially a long or meandering one” is the dictionary meaning of the word ‘peregrination’. In our ‘Covid journey’, we have reached a crucial road junction – one road leading to ‘surrender to the virus’, and the other to ‘struggle further against the virus’. The course of our further meandering journey depends upon the wisdom of our choice. Death is one single factor which pushes everything else into the background. That’s what Covid did. And again, there are two options for the mode of dying – one is succumbing to the virus, and the other is getting crushed by economic collapse. Both are grave portents. Again, the choice is ours. The low fatality rate of Omicron is pushing us on to the road of ‘surrender to the virus’. Notwithstanding accumulation of tremendous loads of information, we are unable to come to valid and robust conclusions on various aspects of the Covid. We are right now in an enigmatic scenario, not knowing how to navigate further from the ‘locked lives’ – with a sense of defeat or victory; out of fatigue or hubris. There is a choice: Struggle / Surrender.
End of the pandemic ?
“To ‘unlock’, or not to, that is the question.” Two years on, the light at the end of the tunnel still seems to be an illusion. Should we travel back in the tunnel to the drawing board or proceed to an indefinite destination ? The roadmap of the voyage is crucial. Controversies, arguments, confusion, suspicion, assumptions, presumptions, conjectures, hopes, disappointments, fear, stress – all seem to be rolled into one ‘CORONA phenomenon’. Notwithstanding the tremendous strides that the science and technology have made, we seem to be still groping in the dark corridors of Covid. Uncertainty, doubt and shifting strategies to control the seemingly invincible scourge have been the hallmark of this pandemic. The pandemic has been filled with hopes and despairs. At the end of the ‘first wave’, ‘second wave’ and now the ‘Omicron-driven wave’ there has been a hope of the pandemic transitioning into an endemic. In the first two instances, some scientific predictions of the transition crashed and the hope ended in despair.
Fourth wave: While we are rejoicing the fag end of the ‘third wave’, a team of researchers from the Indian Institute of Technology (IIT) of Kanpur has predicted that a ‘fourth wave’ will hit India in June 2022 and would last for four months, peaking in September-October 2022. The prediction is based on statistical methodology to study and forecast future waves, using the model that they have developed on data from Zimbabwe. But we are impatient. Protests against the ‘Covid restrictions’ spilled violently on to the streets in several countries, with high decibel tones. Opposition parties stepped up their voice by intense cacaphony. Because of the previous unexpected disasters, scientists are a tad tight-lipped now and delivering statements against lifting curbs all of a sudden.
But the governments are pressurised to ‘unlock’ everything immediately out of economic compulsions and the demands by the exasperated public. Science, perforce, is being bent by extraneous factors. The US had informally called an end to the coronavirus pandemic on February 9, 2022 -- more out of fatigue and surrender than from conquering it. As with most of the matters connected with the pandemic, many other nations just copied the US strategy though the ‘cases’ had been surging and deaths could not be prevented in some countries.
Is it right ?
The British Prime Minister Boris Johnson ended almost all pandemic-related legal restrictions in England in February 2022 under a “Living with Covid” plan at a time when the ‘Omicron wave’ had not yet touched the base line. This venture is naturally followed by many other countries amid scientific unease with the decisions. Matthew Taylor, the Chief Executive of the NHS Confederation said that “the government cannot wave a magic wand and pretend the threat has disappeared entirely.” David Nabarro, the World Health Organization’s (WHO) special envoy for Covid said that the scrapping of the curbs was ‘really very unwise indeed’. The WHO chief Tedros Adhanom Ghebreyesus said that it would be ‘premature for any country to surrender, or to declare victory’. “Omicron will not be the last variant you will hear us speaking about. The next variant of concern will be more fit and what we mean by that is it will be more transmissible because it will have to overtake what is currently circulating. The big question is whether or not future variants will be more or less severe,” said Maria Van Kerkhove, Covid-19 technical lead at the WHO. The WHO also said that the present vaccines may be less effective due to ‘more immune escape’ and that the world may see seasonal patterns for infection surges, as the coronavirus is a respiratory pathogen. The WHO and the Centers for Disease Control and Prevention (CDC) of the US are leery of premature relaxations of Covid-appropriate preventive measures.
In contrast, the WHO’s ‘Europe continent’ director, Hans Kluge expressed on February 11, 2022 of a bright prognosis that here after the pandemic would pass through a “long period of tranquillity and ceasefire.” 42 Anthony Fauci, the ‘Covid medical chief’ of the US, said on February 9, 2022 that the US is past the full-blown pandemic and it is okay for local authorities and individuals to relax restrictions depending on local numbers, and that there will be more people making their own decisions on how they want to deal with the virus.
These warnings and pacifications only make the post-Omicron cruiser chug down the river with hesitancy, fear and uncertainty. 20 There are always two ways of perceiving things – positively or negatively. Even in a dictionary, one can find positive and negative meanings for the same word. An example is the word ‘REPUTED’. It may mean that ‘an institution is very good, despite not really being so’. It may also mean that ‘the institution is well known and capable’ !
Worrying variants
Generally, viruses become “weaker” while mutating. Hence, during the first year of the Covid pandemic, we thought that Covid would just become endemic in a short period of time due to mutations. 1 But, SARS-CoV-2 proved to be an exception, unlike 2002 SARS virus or MERS virus. It has been evident that the novel coronavirus had mutated into more transmissible and more virulent strains while evolving which is a tad against nature. Delta variant was more severe than the Alpha variant which was more severe than its immediate ancestors or the ‘original’ virus.
Fallacy and misconception
That the Omicron variant can’t cause severe disease is a fallacy and misconception. The “less severity” of Omicron as was experienced is not due to its less intrinsic severity but due to the pre-existing immunity either from previous infections by other Covid strains or Covid vaccination. 47 In fact, two studies (reprint in medRxiv on January 12, 2022 and document from Imperial College COVID-19 response team) found that the Omicron variant is as much likely to cause severe disease or death to the extent of 75% of that of the Delta variant, and much more than that of the Alpha variant or the ‘original’ virus.
Intrinsic severity: One characteristic that makes the Covid virus different from others is that its transmission is decoupled from disease – transmission (spread) begins even before symptoms show up. This implies that the natural evolution process selects variants not based on how severely they cause disease but how they can ‘escape’ neutralising antibodies and infect. Omicron has been highly transmissible but could not cause much of a severe disease, but not due to its lack of intrinsic severity. The next variant may be more severe like the Delta variant. It could be a chance occurrence. So, the previous opinion that SARS-CoV-2 would become less and less virulent and fade away soon is no more tenable.
Ominous warnings
Omicron not mild: Dr. Roby P. Bhattacharyya from Massachusetts General Hospital, Boston and Dr. William P. Hanage from Harvard T. H. Chan School of Public Health, Boston wrote in The New England Journal of Medicine that “viruses don’t inevitably evolve toward being less virulent.” According to these two researchers, “Omicron’s ‘milder’ outcomes are likely to be more due to more population immunity compared to the earlier waves of the pandemic rather than the virus’s properties.” 47 The evolution of SARS-CoV-2 isn’t a straightforward one. The main variants didn’t evolve from each other. So far, they are all distinct, becoming ‘fitter’ through sub-variants until replaced by an entirely new variant.
Pandemic not over: Perhaps, this is the reason why Dr. Maria Van Kerkhove, the WHO Technical Lead on Covid-19 cautioned that the pandemic is far from over and new variants will emerge and such variants could be more transmissible than the Omicron B.A.2 variant. To be more dangerous, a new variant should be capable of infecting fully vaccinated people. The lesson is that the hurdles in the post-Omicron journey depend upon how new variants evolve to ‘escape’ the current herd immunity.
Uncertainties galore
Rubik’s cube: We may not find explanations for many things related to the pandemic. People and even the Covid experts are confused with the way in which the pandemic navigated and compelled authorities to revise their technical advisories and programming strategies quite often. The knowledge we gained during the past two years about this virus is diverse and fragmentary, an academic Rubik’s cube with a lot of possibilities. We said “YES” to so many things and later said “NO” and vice versa. Disinfectants were sprayed on people; in banks, staff used ‘ironing boxes’ to get rid of the virus from currency notes; people kept newspapers and vegetables in the sunlight for hours to sterilise them from the virus ! There were numerous study reports in favour of and against as well – not conclusive on almost all matters concerned with this virus. Many of our interventions during the pandemic had gone kaput. Approve it or discredit it, we have to admire the chutzpah of modern medicine for what it is. “It is what it is” in the words of Donald Trump.
Fate of celebrities: Perhaps, this is the reason why the world famous ‘tennis king’ Novak Djokovic preferred not to get ‘Covid vaccinated’ over the chance to win French Open and Wimbledon. We don’t know for sure why the legendary comedian actor Vivek, aged 59, died the next day after getting vaccinated, though officially it was declared that the death was not due to the Covid vaccine. Andhra Pradesh’s minister Goutham Reddy, 50 years, hale and healthy, died of cardiac arrest while getting ready to the gym on February 21, 2022. It’s reported that he recovered recently from Covid-19 and that the “doctors suspected that post-Covid complications might have led to the cardiac arrest.” And it is baffling that the music maestro S. P. Balasubrahmanyam walked into a high-tech hospital almost as a normal person with very mild symptoms of Covid and didn’t come out alive after 52 days of ‘VIP’ treatment.
Blood proteins: In these days of theory and speculation, one may hypothesise that there may be a causal link between their blood proteins /groups and the fatality. A recent study published in the journal PLOS Genetics said that ‘one of the blood proteins (ABO) that was identified as having a causal connection to the risk of developing severe COVID-19 determines blood groups, suggesting that blood proteins / groups play an instrumental role in whether people develop severe forms of the disease’. Some of the blood proteins are protective and some may aggravate Covid-19. 46
Hong Kong enigma: With hospitals overflowing and more than 10,000 patients still awaiting admission, Hong Kong continues to report thousands of new Covid cases and considerable number of deaths. Following a stringent “ZERO-Covid ” policy like that of China, Hong Kong had avoided a major second wave unlike most of the world. Under the circumstances, it is puzzling that the Omicron which didn’t overwhelm hospitals with serious cases elsewhere is causing a serious concern in Hong Kong which is mulling a total lockdown. But the Hong Kong leader Carrie Lam said on March 14, 2022 that the government has to consider the mental health of the citizens before further tightening the already strict curbs. An enigma.
China’s “Zero-Covid” failure: On March 13, 2022, a nationwide surge in Covid cases has seen Chinese authorities close schools in Shanghai and lockdown several northeastern cities, as almost 19 provinces battle clusters of the Omicron and Delta variants. China contends with its gravest outbreak since the start of the pandemic two years ago, driven by “Stealth Omicron” (B.A.2 lineage of the Omicron variant) which spreads faster than the original Omicron. Uncertainty of the outcomes of the “ZERO-Covid” policies !
Inconclusive
Most of the knowledge we have about Covid is patchy and cloudy, right from the origin of the virus to treatment to prevention to emergence of variants to vulnerability of children.18 We may never be able to answer the “why and how” of many things in medicine. For example, more than 40 years ago, in an article in The Antiseptic of April 1979, I wrote: “Our knowledge about the pathogenesis of digital clubbing and hypertrophic pulmonary osteoarthropathy (HPOA) is fragmentary and inconclusive, and the views put forth still belong to the realm of conjecture.” 43 Even today, our knowledge about the pathogenesis of HPOA is the same !
Yellow Nail Syndrome
The nail changes (‘digital clubbing’) I wrote above prompt me to mention about a COVID-19 case I had seen with ‘Yellow Nail Syndrome’ (RT-PCR positive, pleural effusion and yellow nails). The case is yet to be documented. This may be the first COVID-19 case in the world to be associated with ‘Yellow Nail Syndrome’. In this context, I recall the first documented case of ‘Yellow Nail Syndrome’ from India which was reported by me and published more than 40 years ago, in 1980, in an American medical journal (Chest, April 1980, Vol. 77, Issue 4, P. 580; https://journal.chestnet.org/article/S0012-3692(16)40458-7/fulltext ). 49, 48 In the same year, I reported the second case of ‘Yellow Nail Syndrome’ in India which was published in the Journal of Chest Diseases and Allied Sciences (1980, Vol. 22, No. 1, P. 69-72 https://drtramaprasad.blogspot.com/2017/04/yellow-nail-syndrome_28.html ). 48 I wrote in this article: “The pathogenesis of this syndrome is yet to be elucidated, particularly of the enigmatic yellow discolouration of the nails.” Four decades on, the pathogenesis is still an enigma, and many of the happenings occurred in the Covid pandemic period would remain an enigma for ever.
A remorseless killer
A study published in The Lancet (February 2022) said that of the 20 countries studied, India accounted for the highest number of children orphaned by Covid-associated death of at least one of their parents during the initial 20 months from March 2020 till October 2021 spanning the first two waves that devastated many families. 50 During the period, 19 lakh kids lost at least one parent to the Covid. The study done by the CDC of the US, the Imperial College of London, the University of Oxford and the World Bank proposed immediate integration of care for the children into every national Covid-19 response plan. The post-Omicron or post-Covid journey for these unfortunate children should be supported by governments, NGOs and philanthropists.
In a significant gesture, on March 13, 2022, the Tirupur district administration gave as much as Rs. 9.5 crore to as many as 309 ‘Covid-orphaned’ kids, from the State Disaster Response Fund. Even small contributions from individuals would play a great role. On my part, I contribute some of the amount received from my patients at my “PAY WHAT YOU CAN Clinic” where patients may pay whatever amount they wish for the service. To know more about this service, one may go to https://drtramaprasad.blogspot.com/2017/04/what-you-can-clinic_30.html . There are lessons in the link for the medical profession and the society as a whole. The roadmap for the Post-Omicron life for these orphaned children would be a complex and tortuous one. The path may not be without landmines, as the virus has the streak of ‘Putin Determination’ !
Pre-Omicron vaccines
Shortcomings: All the wealthy countries vaccinated their populations reasonably well. Notwithstanding, many of the vaccinated got infected (breakthrough infections) though not affected seriously. Antibodies which prevent infection might have waned, but the cellular immunity might have protected them from serious disease. The protection by the vaccines is not absolute and not for a long period. Reinfections are also not uncommon. Perhaps, the vaccine may have to be taken annually. That’s the shortcoming which is to be taken seriously while navigating the post-Omicron meandering journey.
Can’t eliminate risk: The US Surgeon-General, a fully vaccinated Indian-American, Dr. Vivek Murthy, aged 44, announced on February 18, 2022 that he along with his wife and two children have ‘tested positive’ for COVID-19 despite best efforts to stay safe. Ten of his relatives died of COVID-19. Covid had claimed over nine lakh lives in the US so far. “Our safety measures reduce risk but they can’t eliminate risk. Nothing can,” he said in a tweet.
Ex-POTUS infected: On March 13, 2022, former President of the US, Barack Obama, who was fully vaccinated, confirmed that he was ‘tested positive’ for COVID-19. The Indian Prime Minister Modi wished him quick recovery. Last month, Queen Elizabeth II who was fully vaccinated had a ‘positive test’ for COVID-19.
Short period protection: According to researchers from New York State Department of Health and the University at Albany School of Public Health, the effectiveness of the Pfizer-mRNA vaccine for children of 5 to 11 years fell from 68% to just 12% within one month of being fully vaccinated, though it was still protective against severe disease. The study was posted on the preprint repository MedRxiv in February 2022.
Paradoxical: On one hand, we lament shortage of vaccines at a global level. Here in Mumbai, 1.5 lakh Covid vaccine doses lying with a bunch of the city hospitals are due to expire on March 5, 2022 and thrown out as waste as there are no takers. It is said that if the government is not dragging its feet on the policy of giving boosters for the 45-plus age group, this wastage could have been avoided. But, some experts are of the view that it is superfluous to give boosters to ‘normal people’ and that the exponentially spread Omicron itself acted like ‘booster vaccinations’ shoring up the ‘herd immunity’. 40, 14
Post-Omicron vaccines
As long as there is widespread infection, new variants would keep coming, especially from Africa, as only about 15% were vaccinated there. Since the vaccination drive in January 2021, over 70% of India’s adult population has been vaccinated so far. Globally it is 56%. Unless the entire population across the world is fully vaccinated, new variants will keep cropping up which could be ‘vaccine-resistant’. Omicron B.A.2 seems to have already replaced Omicron B.A.1 as the most common Covid-causing SARS-CoV-2 variant in circulation in India today. 42
Pan-coronavirus vaccine: R. Vinod Scaria of the Delhi-based Institute of Genomics and Integrative Biology said that reinfection is rare and mild which may occur more in the younger and unvaccinated people. It must also be noted that a ‘positive test’ before 120 days could be due to a ‘residue’ of a virus from an earlier infection. The eminent American physician-scientist Dr. Drew Weissman who was conferred the Genome Valley Excellence Award 2022 said that his team is working on a pan-coronavirus vaccine that would be effective against all Covid-19 variants in the coming days. Right now, ‘tweaking’ of the old vaccines to modify them to tackle the existing variants is in progress. There are two shortcomings with the present vaccines. One is that the new variants are ‘escaping’ these vaccines. The second one is about waning of the ‘antibodies’, though ‘cellular immunity’ may protect for a longer period. There have been three coronavirus epidemics in the past 20 years and there may be more in future.
Brainstorm
“A moment in which one is suddenly unable to think clearly or act sensibly” is one of the dictionary meanings of the word ‘brainstorm’. Clearly, Covid gave us many of such moments and made us act senselessly. In the post-Omicron phase of our travel we should be wary of the pitfalls and move with cautious optimism -- no knee-jerk-blanket-countrywide lockdowns and travel bans. The world lost more due to these than due to Covid-19. 13 Lockdown, a blunt instrument, has become the default strategy and an epidemiological fashion, based on mathematical models of a limited theoretical frame. Just a couple of days after the report of the presence of Omicron on November 24, 2021, flights were senselessly 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. 13
Mental illness: This apart, Covid had ‘stormed’ everyone’s brain making them “weak” and vulnerable. It has been well documented that mental illness had grown exponentially during the past two years. The President of the Indian Psychiatric Society said that mental health issues went up by about 30 per cent, even 40 per cent among women, during the pandemic. Aside this, the online education and work had changed the minds so much that going back to normal type of activities is becoming difficult. This is a matter of great concern.
Online storm
Educational handicaps: Despite resumption of full-fledged operations in colleges, officials said that just about 50 per cent of the students were attending classes regularly. It seems that the students find it difficult to be psychologically and physically comfortable to switch over from online education to classroom teaching. Other reasons put forth were that many students took up part time jobs, ‘Open Distance Learning’, ‘School of Open Learning’ and coaching courses to prepare for competitive examinations, during the past two years. The University Grants Commissionapproved 350 online courses for universities. Online education and ‘customising’ the courses is the new avatar of pandemic capitalism. Classroom education is a social process – crucial for mental health. Degree certificates won’t keep the psychiatrist away. The chief of the Block Resource Teacher Educators Association said: “At least 2,000 students dropped out of schools during Covid in Coimbatore alone.”
Corporate hesitancy: Similarly, there has been a psychological dependency to conduct corporate business online. The factor of fear and anxiety about new variants is keeping them on ‘online’ and curtailing business travel and the associated entertainment. 20 This has very adversely affected the travel and hospitality industry, despite lifting all Covid-related ‘restrictions’ in the post-Omicron journey. Covid has upended everything and even made us stupid to accept that bottom is the top !
Aberrant Omicron
It was the time when we were passing through the ‘post-Delta lull’ with gay abandon of Covid-preventive measures. Kith and kin were making merry rounds hugging each other, while Omicron was spreading silently at a lightning speed underneath the calm and placid waters.
For a septuagenarian, a member of a family of many doctors, the “Stay home, Stay safe” shield didn’t protect her. It’s like in a road accident where a good driver may get hurt because of reckless drivers around. She had the main symptom complex of “loss of appetite and absolute aversion to food along with flatulence and mobility problem.” A battalion of specialists attended to the case. Gastritis was suspected and ‘proton pump inhibitors’ were pumped in. No improvement. Low serum sodium level was thought to be the cause and sodium was infused as a panacea. No improvement. A gastroenterologist entered the arena and prescribed a pill. No improvement. An orthopaedist and a physiotherapist tried their skills. No improvement. An underlying psychological factor was suspected and promptly a psychiatrist was on the scene who declared that the clinical features were not related to psychological factors. No improvement. She tested positive for RT-PCR, and expensive antibodies and antivirals were injected. No improvement. Haemoglobin was found to be low. She was discharged from the hospital with an advice to consume plenty of ‘greens’. After reaching home, appetite returned even without ‘greens’ ! All the other members in the family tested ‘positive’ despite being vaccinated. One of them had acute severe diarrhoea which was attributed to the food item ‘Mushroom Biriyani’.
‘Gut storm’: Several studies brought to light that Omicron or any other variant may present aberrant gastro-intestinal symptoms. “The mechanism of COVID-19 diarrhea appears to require the molecular interplay among inflammatory cytokines, the viral receptor, and several apical and basolateral ion transport proteins as well as activation of intracellular Ca2+ signalling,” according to Donowitz and his colleagues. 44 The ACE 2 receptors to which the virus binds are abundant in the gastro-intestinal tract (almost 100-fold of those in the lungs; but lungs are more affected due to their direct exposure to ‘infected’ air). The virus seems to gain direct luminal entry rather than through blood circulation. Around 30% of adults aged over 35 years had diarrhoea during Covid illness. 45 Omicron had even masqueraded as the Delta variant through aberrant S-gene dropout test results. Around 30% of Omicron variant cases read positive for all the three probes, which makes S-gene dropout test unreliable.
The next station
We are on the COVID EXPRESS train, not knowing whether it would take us to our destination city of ‘Endemicity’. At present, as of March 2022, most of the world had bid ‘goodbye’ to the ‘social vaccine (masks, distancing and hand hygiene)’ partly due to intolerance, partly due to the steep fall of the Omicron cases and mostly due to economic compulsions. Hopefully, the next station would be that of the city called ‘ENDEMICITY’. On the way, the train which is running late won’t stop at small stations like ‘DELTACRON’, ‘IHU (B.1.640.2)’, ‘ENGLAND/MILK-2D24AC9/2021’, etc. due to economic constraints – earlier it was stopping at small stations like ‘ALPHA’, ‘BETA’, GAMMA’, etc.
COVID-19 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. 40 But, when many epidemiologists declared endemicity (transition of the epidemic into an endemic) at the end of the ‘first wave’ and the ‘second wave’ in India, Mrs. Corona laughed and sent two of her daughters named Delta and Omicron, one after one. Another daughter may be in the waiting list !
Journey ahead
For a full two years, we didn’t exactly know the direction which was ideal in the Covid travel. The leadership in the pandemic came mostly from the well-developed countries which was not ideal for all the countries and which was not without vulnerabilities and vested interests. The WHO is no exception. Learning from the mistakes and doing the right thing in collaboration with others when no one knows what needs to be done is of paramount importance. It is this wisdom which made Homo sapiens coming out stronger over the better-endowed Neanderthals. And it is this wisdom of collective team efforts cutting across geographies and functions that helped in developing Covid vaccines and rolling them out in the shortest possible time.
To go further forward, the global leadership should develop an analytical approach with a heart filled with empathy and a deep caring for the society. Profit with a humane purpose should be the credo of the pharma industry as it evolves a humane face to lead the new post-Covid world where we have to marry the ‘tech’ with the ‘touch’ in a judicious manner. In a parochial technical way, each one tried to project the imaginary good of a product on a scientific platform, not without selfish motives. This had complicated the pandemic and led to controversial decisions on matters to control it. It would be the unique ability of blending a secret sauce using hardware, software and ‘humanware, that’s going to save us, while getting rid of redundancies and adjusting to the changing paradigms.
Post-Omicron’s way forward
Overreactions and under-reactions took place during the pandemic. To what extent the human interventions contributed to the emergence of variants of concern is unknown. Nature has its own way of countering human stupidity. The “letter written” by Charles Darwin elucidates this facet to some extent (https://drtramaprasad.blogspot.com/2017/04/corona-and-charles-darwin.html ). 27 The text in the link may be an eye-opener for the selfish ‘modern man’. Darwin “wrote” to the ‘modern man’ : “You had 'super-evolved' to manipulate and kill 'Nature' to suit your self-centred materialistic interests. You had altered the course of evolution and invited calamities like droughts, floods, forest fires, earthquakes, tsunamis, formidable diseases, both metabolic and infective, etc. And now you have invited Coronavirus. It will be your permanent guest. Nature has its own ways of controlling ecosystems and maintaining environmental balance. Don't interfere with it too much. Adapt, adapt and adapt.”
So long as the Covid virus adapts to ‘escape’ the immunity conferred by natural infection or the vaccines, it may go on delivering new variants of concern. Let us also adapt, though the course of the pandemic had been and would be dictated more by the virus than human interventions. We need to make a brutally honest introspection on matters pointed out by Darwin in his “letter” if the Homo sapiens is to survive in the long term. 27
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A quote from the article titled “OMICRON – A Paper Tiger” published in The Antisepticjournal of Medicine and Surgery of February 2022 – Vol.119; No.2; Page No.14
