Omicron variant: How should India deal with a fresh surge in COVID-19 cases?

India reported 1,700 omicron cases as of January 3

By Taran Deol
Published: Monday 03 January 2022

The World Health Organization (WHO) has warned of a tsunami of the novel coronavirus disease (COVID-19) cases triggered by the delta and omicron variants of SARS-CoV-2. The statement comes in the backdrop of a record number of daily cases being reported from the United States and several European countries. 

However, John Bell — a professor of medicine at Oxford University — has stated that this is “not the same disease we saw last year” and that fewer people may be hospitalised this time.

With all this information, should there be a difference in India’s approach to handle a case surge, most likely caused by omicron?

A paper published in medRxiv December 2021 has found that our immune system’s T cell response — which is responsible for killing infected cells in the body, therefore protecting us against severe disease and death — remains robust against an omicron infection.

England and the United States, despite a surge in cases, have not implemented fresh curbs while South Africa has retained its Level 1 restrictions. 

India reported 1,700 omicron cases as of January 3, according to the Union health ministry.

Satyajit Rath, an immunologist and visiting faculty at the Indian Institute of Science Education and Research in Pune, told Down To Earth that our response has always been one of law and order. He said: 

We have been looking at our responses from a top-down approach the past two years. At no point does the fact that the government and communities need to work together come up. Social distancing and other such COVID-19-appropriate behaviour should have become a cultural norm by now and that is simply not happening, not even in the middle class and upper-middle class areas.

The trajectory of SARS-CoV-2 variants is to successively become more transmissible. “In two years, we have not been able to provide proper N95 masks, and this did not even require new scientific technology, he pointed out. “Omicron’s transmissibility was predictable and mask efficiency doesn’t change based on every variant.”

Several Indian cities and states have put in place night curfews and 50 per cent capacity restrictions in public transport and offices. These are unlikely to have any real impact in curbing the spread of the virus, according to experts.

“Night curfew only sends a symbolic message that it is time to worry,” argued Rath. Capacity restrictions are a semi-reasonable effort to reduce crowding and maintain physical distance, he said. 

However, Ram Vishwakarma, immunologist and former chairman of India’s Covid Strategy Group, Council of Scientific and Industrial Research, argued otherwise. “Localised lockdown in hotspot localities will help in controlling the community spread of COVID-19,” he said. 

Implementing 50 per cent capacity is a good idea to decrease crowding in public transport and offices, the expert added.

However, both believed that the best means to tackle omicron is to follow COVID-19-appropriate behaviour by following a strict mask mandate and ramping up vaccination. 

India’s focus should be to enhance vaccinations, including booster dosing, Vishwakarma said. “Door-to-door vaccination drives are required in semi-urban and rural areas.” 

Omicron’s emergence coincided with the concept of waning immunity of the vaccinated population. The medRxiv paper, however, noted: Despite omicron’s extensive mutations and reduced susceptibility to neutralising antibodies, the majority of T-cell response, induced by vaccination or natural infection, cross-recognises the variant.

The study on 138 participants was done by researchers from 21 institutes in South Africa, the US and Britain. These include the National Institute for Communicable Diseases, Center for the AIDS Programme of Research, South African Medical Research Council, Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology and the Department of Infectious Diseases, Imperial College London, United Kingdom.

India’s vaccination drive should not be an either-or situation. At present, India has fully vaccinated just 43 per cent of its total population. Booster dose administration will begin January 10 for healthcare workers and those above 60 years of age with comorbidities. 

India started vaccinating children aged 15 and above on January 3, 2021. Covaxin and Covishield — the country’s first two vaccine candidates — received emergency-use authorisation 11 months ago, Rath said. “Why couldn’t we start testing these vaccines for children sooner?”

We are far from meeting our year-end COVID-19 immunisation target, the expert noted.

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