Case surge may not be as bad as during India's 2nd wave but lot depends on govt interventions, citizen behaviour, say experts
The omicron variant of SARS-CoV-2 that causes COVID-19 evades natural as well as vaccine immunity and is highly transmissible, recent evidence has established. The World Health Organization (WHO) has officially warned of a rise in reinfections.
Clinically speaking — now that the susceptible population is once again the same as early 2020 — will it be fair to say we are back to square one of the pandemic?
A month since its classification as a variant of concern, omicron has already been detected in over 100 countries. WHO has alerted that it may be present in many more — its mild or asymptomatic infection making it harder to detect.
Satyajit Rath, an immunologist and visiting faculty at the Indian Institute of Science Education and Research in Pune, argued that even though everyone is now susceptible to an omicron infection, we are not in the same position as we were when the pandemic started.
This is because of the knowledge, experience and availability of responses to the infection gained over the past two years, he said. Masks, vaccines, higher testing capacity and oral treatments to COVID-19 as tools we didn’t have in early 2020, the expert added.
But he also underlined a caveat:
We have made no policy provisions for manufacture and affordable distribution of high-efficiency masks so far. We have not provided a basic level of vaccine coverage to all our people so far even in India and, of course, in large swathes of the global south. We have made no effective policy provisions for easy, on-demand, free, locally available testing even now. We have made no policy provisions for actual large-scale deployment of drugs such as Molnupiravir from Merck and 'Paxlovid' from Pfizer.
Several experts are of the view that evidence on reduced vaccine efficacy against omicron is not yet conclusive. They continue to remain our best way forward.
At present, 48 per cent of the global population has received two doses of vaccines against COVID-19. Every continent has doubly vaccinated at least half its entire population, but Africa has done so for barely 8.8 per cent.
As the vaccination drive completes one year, a huge population is yet to be inoculated with even a single dose. The current situation, even without the threat of omicron, is bad enough, Dr Chandramouli Bhattacharya, an infectious diseases expert with Peerless Hospital in Kolkata, told Down to Earth.
There are still so many susceptible people worldwide who are not vaccinated and that’s the basic problem, he added. “COVID-19 is an RNA virus and it will continue to mutate when it gets the chance.”
While global cases are set to triple in the coming few months, omicron’s virulence remains questionable.
“I don’t think omicron can undo the gains made till now but it does have the potential to land us in a situation similar to the second wave in India,” Dr Bhattacharya warned. Even if we do assume that it’s not as virulent as delta, given its infectious nature the absolute figures for hospitalisation could be much greater, he added.
Experts concur that we are not back to square one of the pandemic. Dr Chandrakant Lahariya, a public health analyst and epidemiologist, argues that we are at a much more advantageous stage in terms of severe disease today.
“Vaccines were not built to protect us from a COVID-19 infection. Their role has never been to curb spread but to avoid hospitalisations and deaths,” he said.
Had omicron emerged in March 2020, our situation would have been far worse. But today, it is unlikely to cause severe damage, Lahariya added. “The surge this time around is not likely to be as bad as the second wave but a lot still depends on government intervention and citizen behaviour.
The global population is once again equally susceptible to an infection by omicron. But that is where the similarity of the situation with early 2020 ends, according to health experts.
Due to vaccination or natural infection, our immune system now has a memory of the disease and can therefore muster a response, reduced antibodies notwithstanding, and protect us against severe disease.
Ram Vishwakarma, immunologist and former chairman of India’s Covid Strategy Group, Council of Scientific and Industrial Research, said:
All studies published till now on waning immunity just calculate antibodies. It says nothing about our memory B and memory T cells. Scientifically speaking, less number of people will progress to severe disease. But it’s the young population I'm worried about. Pediatric population has little to no protection unless they have been infected.
Several countries have now started inoculating children against COVID-19; India will start the process for those between the ages of 15 and 18 in January next year. However, it remains unclear which vaccine they will be receiving. At present, out of the vaccines being administered in India, only Bharat Biotech’s Covaxin has received emergency use authorisation for children.
Early 2020 is also closely remembered for varying degrees of lockdown it induced. India was among those that had the most stringent restrictions. The delta outbreak earlier this year triggered a similar response. What should we expect with omicron?
Rajib Dasgupta, chairperson of the Centre of Social Medicine and Community Health at Jawaharlal Nehru University, believes that the mild clinical features of this infection possibly is an indicator that it won't be back to square one as far as severe restrictions are concerned. “Given its force of transmission, physical restrictions are likely to have less impact, notwithstanding the lack of appetite for restrictions among governments and businesses.”
Cautious conjectures are being made about the severity of disease caused by omicron and what that means for the biological evolution of the virus. With five variants of concern and countless other mutations, the SARS-CoV-2 virus has been mutating rapidly since it infected humans. And it is likely to mutate again. As long as the virus doesn’t transmit easily or cause prolonged illness, its new forms will have a higher transmissibility but lower virulence, according to health experts.
“That is the logic of evolutionary biology that guides the virus. We should create such evolutionary pressure through our behaviours,” K Srinath Reddy, president of the Public Health Foundation of India, told DTE.
If we can establish a stable equilibrium with a virus of low virulence living with us in an endemic form, we will see the pandemic end in a year, according to Reddy. “Till then we will see peaks and troughs distributed across the world in different months.”
Dr Subhrajyoti Bhowmick of Peerless Hospital, Kolkata made similar arguments, underlining that we are in the downhill part of a pandemic’s life. The SARS-CoV-2’s killing power has come down, he said. “The virus’ survival depends on the host’s survival, the former cannot exist without the latter.”
Dasgupta, however, disagrees. Arguing that it's difficult to predict whether omicron means we're closer to the start of the pandemic than the end of it, he said. “Cholera, for example, had seven pandemics, beginning in 1817 and resulting in millions of deaths. It continues to cause new outbreaks but has evolved to be a much milder disease resulting only in occasional deaths.”
History of public health has taught us that it is not wise to judge a pandemic caused by a virus as virulent as these in months; it'd be a matter of years if not decades and centuries, the expert added.
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