When the Director of Health announces that the number of Omicron cases have reached 127, a string of figures were also made available. Such as out of 187 international passengers, nine have been confirmed as COVID positive. He also indicated that the detected cases included 8 BA.1 variant and 115 BA.2 variant. Omicron now had 4 sub-lineages, BA.1, BA.1.1, BA.2 and BA.3. He also mentioned about the number of samples sent for Whole Genome Sequencing (WGS) and the results, besides the number of death during the third wave. BA.2 is reported to be more transmissible than BA.1 but fortunately it is not more virulent. In some European countries, it is now the dominant variant. It may be recalled that the first case of Omicron was reported on 27th December, 2021 in the state. By yesterday (7th Feb), the number of Omicron cases has risen to 141.
In January 2022, the number of death is 44, of which 9 (20.45%) were vaccinated with the first dose, 16 with both doses (36.36%) and 19 were unvaccinated (43.18%); in other words, the death is more among the vaccinated either first or both dose (56.81%). However, if one analysis the data, among the death, 40 has co-morbidities; or 90.91% is suffering from other diseases which have a bearing on the prognosis. However, in the public domain, the type of co-morbidities is not available and it is therefore necessary for the department to conduct an analysis of the data which is generated, especially during the month of January. It is hoped that the primary data is still available and this should be made available to public health experts who can do the analysis. It would be worthwhile to also conduct an analysis on the age of those who were hospitalised and those who succumbed to the disease. Further, how many of the deaths are due to BA.1 or BA.2 variant also need to be worked out and put up on the public domain. Rather than saying the there must be more cases of omicron, it would be prudent to determine the number of omicron cases during the month of January against the number of samples sent for WGS during the month. From this, the percentage of various variant can be assessed and identify the main driver of the third wave. Omicron is less virulent and it is more difficult are known facts and therefore many who are carrying the virus will not be known or detected with possibility of transmitting to the about 3% of the population who can’t be vaccinated due to co-morbidities leading to mortality.
Manipur still rely more on RAT, which was found to be less effective in detecting omicron cases as during in January, of the total 66,706 samples analysed, 34,300 (51.42%) was done by RAT. This percentage though was much better than in the past. Out of the 31,537 samples analysed through RT-PCR, 4,494 positive cases were detected (14.15%), while of the 869 samples analysed through CBNAAT, etc only 52 positive cases were detected (5.98%). For RAT out of 34,300 samples, 2922 returned positive (8.52%). The Positivity Rate overall stood at 11.20% during the month. There is always a inkling behind one’s mind that if all the samples were analysed through RT-PCR, the number of positive may see an increase; or as a corollary quite a few who carry the virus may had escaped detection and may have spread the disease in the community.
Studies have shown that those vaccinated can be infected with omicron without any symptoms and can pass on the virus to others. With more cases of BA.2 detected in the state, as it is more difficult to detect, the chances of many who are infected but do not show symptoms will not get tested and will be spreaders in the community. The weak links are those who have co-morbidities, whether vaccinated or not. A detailed analysis of the data available needs to be conducted to find out the main variant driving the third wave and what co-morbidities are more liable to fatality. A good academic paper can be brought out; besides not only providing clue on how the disease is spreading and what suitable measures can be applied.
On the other hand, elsewhere research is going on to determine ways to understand the disease to not only prevent but to manage it. In a paper published in “Signal Transduction and Targeted Therapy Journal” it was reported that not only the immune system but dysfunctional endothelium can lead to infection and impact the prognosis. The blood vessels were lined with endothelial cells forming a barrier between the blood and the surrounding tissues. COVID infection causes activation of the immune system and the endothelial cells in the lungs, which resulted in release of various soluble plasma proteins. In severe cases, the endothelial barriers between the alveoli are broken and the recovery may be linked to regeneration of the endothelial barrier. It was also found that severe COVID cases on ICU have increased level of spike and nucleocapsid-specific antibodies. Further study is in progress to determine which elements of the immune system lead to the activation and damage of the endothelial barrier and whether strong activation of the immune system also lead to development of virus-specific T-lymphocytes that recognises and destroys infected cells. The outcome of the study can help in better treatment of cases based on their plasma protein profile. Scientific study is also going on to understand the disease and slowly but stealthily progress is made but it will still take some time to fully comprehend the complexity of this disease. The long COVID may be related to the regeneration of the endothelial barrier.
Another study in Australia indicated that inhalation of heparin, an anti clotting agent, help in treatment of serious cases. Still further, in a review paper published in Nature Immunology, it came to the conclusion that despite advances in basic and translational science in the past 2 years, SARS-CoV-2 and COVID-19 continues to pose an important health threat. The essential first line of defence against the virus is the innate immune cells including Innate Lymhpoid Cells (ILC) that reside in the mucosal epithelia. Preliminary clinical studies suggest that worsened disease severity and increased risk of hospitalisation are associated with reduction of ILC and that expansion of ILC2 population is linked to recovery. The innate immune system uses an array of sensors and effector molecules to directly and indirectly sense the virus or viral component, though the virus counteracts by encoding proteins and mechanisms. Hyperactivation of the host immune system is often associated with cell death, cytokine storm, severe disease and mortality. One advantage of targeting innate immunity by modulating the response is that this approach should be less vulnerable to viral evolution.
Another good news is the claim by scientists at Kazi Nazrul University, Asansol and Indian Institute of Science Education and research, Bhubaneswar that a peptide vaccine have been developed which could protect from all variants including future ones. Journal of Molecular Liquids have accepted their paper and in their study immunoinformatic approaches was made to design AbhiSCoVac; a multi-epitope multi-target chimeric peptide, which would be able to generate protective immunity against all six virulent members of the family hCoV-229E, including SARS-CoV, MERS-CoV. SARS-CoV-2, etc. This is a first of its kind and if the vaccine is produced in sufficient quantity and tested for its efficacy, including human trials, it would be a boon as the region of the proteins identified are highly immunogenic and these have been shown to have high binding strengths with TLR-4, a protein responsible for detecting SARS-CoC-2 in the body and can be used as a vaccine for all the six viruses.
The Governor, coming to the fore to rope in the support of religious leaders for increased vaccination is laudable. Besides interacting with them, his visit to some of the vaccination centres does create a sense of purpose to the frontline workers. The 50 vaccination teams formed need to be sent to the interior where the vaccination is low due to lack of manpower. In those areas, where there is vaccination resistance, efforts must be made to overcome the resistance by sending teams to talk to them, understand their concern and redress them so that vaccination is increased. From the information available, vaccination helps in combating the disease though those with co-morbidities have a lower chance of successfully combating the disease.
Christian organisations rather than focussing on vaccination are more concerned with the election date falling on a Sunday. USA had election on Tuesday, UK on Thursday, Australia and New Zealand on Saturday while most of the Christian countries like those in Middle and Latin America, and Europe has it mostly on a Sunday. Be it Spain, Portugal, France, Germany, Scandinavian countries all have it on Sunday. Our Christians seem more religious than their counterparts elsewhere. Or is it lop-sided priorities?
(The views expressed is personal)
