Within three days of publication of genomic sequence of a new variant, the World Health Organization declared it as a variant of concern. The Greek alphabet assigned to it has become a household name across the world. Scientific information is being shared and analyzed at breakneck speed to unravel the critical issues concerning Omicron so as to inform governments and public on the steps to take to contain the fallout of its spread. It has become clearly evident that it is more infectious than Delta variant. The ongoing debate is by how much. Preprint research publication from South Africa has convincing evidence that it evades immunity acquired after natural infection.

Everyone has kept their fingers crossed as to its virulence (ability to cause more serious illness, hospitalizations and deaths). Initial reports that the cases are generally mild may be giving a false hope as Covid illness generally worsens during second to third week after the onset of infection, as the immune system becomes hyperactive in response to the multiplying virus. Secondly, dominantly younger African population with stronger innate immunity may not develop severe illness. We have to closely watch its behavior in the elderly and in population with other comorbidities.

Most of the vaccines have, in general, demonstrated their effectiveness against new variants including Delta in preventing hospitalizations and deaths. However, their effectiveness seems to be waning rapidly over time (6 to 9 months after the second dose), necessitating booster doses to those at high risk and to all adults if sufficient vaccine supplies are available. Whether Omicron evades immunity from existing vaccines is yet to be ascertained as the percentage of people who have been fully vaccinated is still low in Africa. A hint from Moderna (that makes mRNA-based vaccines) CEO that they may need to develop a new vaccine to tackle Omicron is a pointer that it may evade immunity from vaccines as well. However, we have to await data on breakthrough infections in fully vaccinated people. 

Parents are the most worried as schools and colleges have just begun to open after nearly two years of studying from home. Government is awaiting expert committee recommendations on vaccinating children and booster doses to adults. We were fortunate that the earlier variants did not impact children and young people as they did the elderly. It is still not clear if Omicron behaves in the same way or differently. Until new evidence comes out, it is prudent to keep children at home and follow Covid appropriate behavior.

Given the above scenario, the country has to respond in a balanced way. India did the right thing by not shutting down its borders but taking standard measures of screening, testing, quarantine, and isolation of incoming people. The government has ramped up its vaccination drive as reluctant people become more than willing to get vaccinated given the scare of new wave. Face mask and vaccination certificate mandates have been reintroduced to domestic travelers across state borders. Hospitals across the country are better prepared now in terms of oxygen surplus capacity and ventilator beds. People and businesses have learnt to reinstate Covid appropriate behavior at short notice.

Regulatory bodies may fast-track emergency use authorization of two oral drugs (from Merck and Pfizer) that have demonstrated effectiveness against Covid virus. Fortunately, many Indian pharma companies have been licensed to manufacture and distribute Molnupiravir of Merck. Many others may be in talks with Pfizer for licensing its drug. These drugs are expected be effective against Omicron variant as well as their site of action is not likely influenced by the numerous mutations seen over the spike protein. However, monoclonal antibodies developed against spike antigens may be less effective in view of the mutations.

Face masks continue to be the best protection against any variant. However, correct use of these have to be repeatedly emphasized through public awareness campaigns. To be effective, these masks have to be properly fitting over nostrils to prevent virus entry into the body. Double masks (cloth masks covered with surgical mask) are the most cost-effective protection and are almost comparable to N95 masks which may be expensive for many. Airlines may stop serving or allowing eatables in planes until things become clearer. Eateries may reintroduce social distancing as people have to remove their masks during eating. Social protection (free rations, direct benefit transfers, unemployment benefits etc.,) be extended until the situation settles. Governments should address the growing inequity due to Covid.

India should lead the way in tailoring its response to help other nations in accessing affordable drugs, personal protective equipment, diagnostics, and vaccines by incentivizing industry to ramp up production to meet both domestic and international needs. It should help other nations in improving their own capacity to manufacture. It should enable the movement of people and goods across nations, while taking all standard pandemic control measures. It should not relax its vaccination drive as the world continues to face new variants and till large populations in the underdeveloped world remain unprotected and continue to harbor the virus.

In conclusion, we should prepare ourselves using a balanced approach guided by rapidly growing scientific evidence. We should not yield to panic and misinformation. We are better prepared now to face the Omicron wave than we were against variants of the past. Vaccines, face masks, and proven drugs will protect us.

Dr Krishna Reddy Nallamalla
President, InOrder
South Asia Regional Director, ACCESS Health International

Photo Credit: Fit Ztudio

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