Omicron: New Coronavirus Variant
A new coronavirus variant has been detected in South Africa. The virus has also been found in Europe and Asia. WHO has classified it as a variant of concern (VOC) on Nov. 26 and countries across the globe are now worried whether the new variant would spread faster or cause more severe disease or evade antibodies from prior infections of vaccinations (The Mint, Nov. 27, 2021).
Why We Need to be Worried?
Early data indicate that the Omicron variant could possibly be more transmissible than the highly infectious Delta variant, and currently used vaccines may be less effective against it. This lineage has been named B.1.1.529 and code-named Omicron by WHO. WHO skipped two Greek letters Nu and Xi as the organisation thought that Nu might be confused with the English word "new" and Xi might be mistaken for the name of the Chinese president. WHO also said that the new variant may spread more quickly than other forms of coronavirus. But it's still not clear if Omicron will be able to displace Delta.
Changes in Spike Protein
The variant contains over 30 changes in the spike protein, the part of the coronavirus that's the target of the body's immune responses. Many of the changes are also found in Alpha and Delta, and are linked to increased infectivity and the capacity for evading infection-blocking antibodies (Nature, Nov. 25, 2021). This variant was first identified in Botswana and later found in South Africa. The sudden surge in cases in Gauteng province in South Africa could be linked to the new variant. Omicron has later turned up in a person arriving in Hong Kong from South Africa.
The UK has now reported two cases of Omicron infections (The Mint, Nov. 27, 2021).
Scenario in India
Indian authorities have been put on alert as two South African nationals tested positive at Bangalore International Airport (India News, Nov. 27, 2021). Efforts are on to ascertain if these two persons are infected with Omicron. Our PM has already convened a high-level meeting to monitor COVID preparedness in view of the Omicron which emerged recently in South Africa. India has now added several countries from where travelers would need to follow additional measures upon arrival in India. These countries include South Africa, Brazil, Bangladesh, Botswana, China, Mauritius, New Zealand, Zimbabwe, Singapore, Israel. Hong Kong and European countries including the UK.
What We Still Don't Know
We are still not sure about how contagious the new variant is, and how far it has already spread. The biggest puzzle is if the currently-used vaccines would work against Omicron or whether people infected earlier with Covid-19 would be immune from the new variant.
Experts also do not yet know if the new variant will cause more or less severe disease compared to other coronavirus strains.
Waht Does WHO Say?
The WHO has instructed countries to do the following:
- Increase surveillance and sequencing efforts to track circulating COVID variants.
- Submit complete genome sequences to publicly available databases such as GISAID.
- Report initial cases/clusters associated with VOC infections to WHO.
- Perform field investigations and Lab assessments to improve understanding of the potential impacts of the VOC on COVID-19 epidemiology and other healthcare parameters.
Vaccines and Omicron
Dr Samiran Panda, ICMR expert says that mRNA vaccines may not be effective against Omicron (HT, Nov. 27, 2021). These vaccines are directed towards the spike protein and its interaction with the receptor on the human cell. He further says that CoviShield and Covaxin trigger immunity through a different mechanism, hinting at the possibility that these India-made vaccines may be, at least, partly effective against the new variant. However, more studies are needed to ascertain this.
Booster Shots and Children's Vaccines
A heartening news is that of the authorities' plan to start vaccinating children with co-morbidities in January 2022 (NDTV, Nov. 22, 2021). By March, all other categories of children are likely to become eligible for vaccination. NTAGI may also come up with a strategy for giving booster shots to adults in India in the next two weeks.
Meanwhile, Zydus Cadila is likely to launch its ZyCoV-D vaccine in December 2021. This is the world's first plasmid DNA-based vaccine. The launch may also usher vaccinations for adolescents (older children) as Zydus' vaccine has been approved for use in people of age 12 and older.
Increased testing, tracing, genomic surveillance, vaccinations; administering booster doses, inoculating children; strict adherence to standard SOPs by common people as well as leaders of all categories are the only means by which we can thwart the possible rise of a third wave or, at least, mitigate its impacts, in case a third wave cannot be avoided!
Possible Third Wave
It's not yet clear if a new wave of COVID-19 will emerge or not. In India, many experts opine that COVID-19 has already become an endemic and no new wave of pandemic will occur in the country. However, there is a complex interplay of new variants, vaccination rate, waning immunity and booster doses, provision of children's vaccines and easing/enforcement of restrictions and winter crowding etc. that will determine the trajectory of COVID-19 infections. We cannot afford to be complacent yet!
With COVID surging in Europe and other parts of the world, a new wave may be around the corner in India. Kerala may witness a fresh COVID wave in Jan-Feb 2022. The onset of winter, large pockets of unvaccinated people, breakthrough infections, age and other factors are some of the factors that may trigger a third wave in India (IE, Nov. 18, 2021).
New COVID Drugs
The new COVID drug, molnupiravir has now been approved in the UK. Thus, UK has become the first country in the world to approve this new pill. Some COVID treatments including some manufactured antibody drugs could become ineffective due to the new mutations present in Omicron, according to Dr David Ho of Columbia University.
However, experimental antiviral pills such as Paxlovid (Pfizer Inc.) and molnupiravir (Merck & Co) target parts of the coronavirus that are not changed in Omicron. These new drugs could become game-changers in the new scenario.
We can only hope that India soon arrives molnupiravir and paxlovid and these anti-COVID oral pills arrive in Manipur and help prevent a third wave, or blunt the impacts, in case a third wave emerges!
Possible Measures for Manipur
We need to assume that there may be a third wave in Manipur too. Even if that may turn out to be a wrong anticipation, it's better to err on the side of caution. Accordingly, we must initiate measures to squarely face a possible third wave in our state. These may include:
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Preparations for administering vaccines to kids in Manipur & booster shots to high-risk people (elderly, healthcare workers and people with weak immune systems).
Conducting immediate seroprevalence studies to understand what percent of population in Manipur and in its different districts are still susceptible to the coronavirus.
Speeding up vaccinations in a big way; aggressive vaccinations with monthly targets to cover all eligible population with first doses in the next few weeks (4-6 weeks); and targeted vaccinations of all adult population with second doses in the next 2-3 months.
Regular & repeated COVID testing in hotspots.
Enhancing the ratio of RT-PCT to Rapid Antigen Testing (RAT).
Weekly "awareness messaging" about the pandemic to the public by a designated healthcare official.
Genomic sequencing of a subset of positive cases and surveillance of the variants including the delta variant: which COVID strains are there in Manipur, where are they, and where are they moving towards; and whether any new variants are emerging.
Contact tracing and government-monitored isolation of positive cases, wherever feasible.
Boosting up healthcare provisions such as medical oxygen plants, tankers and cylinders; steroids, antifungal drugs, oxygen concentrators, ventilators, oximeters, masks, PPEs, sanitizers etc.
Strengthening of healthcare infrastructure such as construction of new COVID hospitals.
Provision of more COVID care centres (CCCs), more Covid beds and ICUs in existing hospitals
Constitution of a special taskforce for the third wave; a separate taskforce for pediatric COVID is also highly recommended.
Special provisions for kids such as pediatric hospitals, wards, and ICUs, pediatric oximeters, concentrators, and ventilators and strengthening of staff such as pediatricians and pediatric nurses and paramedical workers etc.
(The views expressed are personal)
