The new variant of concern: Omicron has assumed the status of The Global ‘Scariant’ of Concern, because it has sown global chaos, informs Dr. Kishore P. Madhwani

We need to tackle Omicron with speed and science. This variant reported on November 24th from South Africa and designated as Variant of Concern by the WHO - its Technical Advisory Group on Virus Evolution on November 26th probably existed earlier in Europe and possibly in India, too. It is a matter of time before it is detected, as stated by Dr Samiran Panda, who heads the epidemiology cell of Indian Council of Medical Research (ICMR).  

Data gathered in the next two to four weeks will help to fully understand this variant’s epidemiology and its global impact. Currently, the Omicron Variant has been detected in more than 57 nations in the six WHO regions across the globe. In India, till date, 23 cases have been detected. 

A few facts will help you understand the current situation, allay myths, as well as uncertainties, reduce your anxiety. Here’s sharing some simple tips to ensure optimal protection against all the variants. 

What is Omicron? 

It is the new super mutant variant strain of COVID-19. 

How many mutations are seen in Omicron? 

All-inclusive there are 50, with 32 in spike protein at the Receptor Binding Domain (which is unusually high, as Alpha has 3, Beta has 5, Delta has 10 mutations). 

How has it affected patients in South Africa?

It has affected a majority of unvaccinated individuals, more in young males around 35 years and children two years. The daily case numbers in South Africa were fairly low but then rose rapidly from 273 on November 16 to more than 1200 by November 25, more than 80% of which were in the northern province of Gauteng, where the first cases were detected. 

As variants are now gradually emerging, for any new variant of concern, what are important factors that decide their overall impact?

For any new variant, we need to be concerned about 3 factors: I) Does it spread more easier(more transmissible) than earlier ones, 2) Does it cause more severe disease (more virulent), 3) Will our current vaccines/medication/tests  be effective or will boosters, new vaccines, new medication or new innovative testing be required. 

Hence let us address these issues: 

How much more transmissible is Omicron? For any new variant of concern; what are important factors deciding its impact?

According to WHO; it is highly transmissible: 500% more transmissible than Delta, which was 70% more transmissible than alpha. To simplify further: it is approximately 6 times more infectious than the delta strain, which is why it has become a cause for concern. However, time will confirm this initial observation. 

How much more virulent is Omicron? 

Mainly mild symptoms have been experienced by a small group of patients studied in Gauteng province of South Africa. However updates in the next two to four weeks will confirm whether it is less virulent than the Delta variant, because hospitalisations have also increased in South Africa for ages between 18 to 44 years. 

An assessment by Dr R.  K. Dhiman, Director Sanjay Gandhi Postgraduate Institute Lucknow suggests that although transmission rate of virus is high, it is not as dangerous as its predecessors. He further said that mortality rate might also be less than Delta variant, but more time is required to confirm this. Allaying fears regarding the new Omicron variant that has the world on tenterhooks, US scientist Anthony Fauci has said that early indicators suggest Omicron is not worse than the previous strains of the virus, and possibly milder. However, he has admitted that it will still take weeks before the severity of the new COVID-19 variant Omicron can be judged. Till date no death has been reported due to omicron. 

What are the symptoms and are they different? 

Symptoms observed in South African patients are extreme tiredness, mild muscle aches, sore throat, dry cough and slightly high fever. However symptoms need to be monitored and if the worsening of symptoms occur -for example breathlessness or if there is drop in oxygen saturation below 94% or a 3% drop in a 6 minute walk test, one should immediately consult the doctor for further investigations/hospitalization and or treatment. 

Experience from South African patients, as reported by Dr Angelique Coetzee, reveals that usually patients recover completely, without the need to get hospitalized. However, the group of patients studied by her is very small in number. 

Can reinfection occur in those already infected with COVID-19 earlier? 

Yes, as the virus has approximately 52 mutations, of which 30 are in spike protein, there are definitely going to be re-infections if COVID Appropriate Behavior (COB) is not strictly followed. Hence, we all need to be very vigilant. Reason: many infected individuals may be asymptomatic, as observed in South Africa. 

Will the RT PCR testing work? 

Yes, it will work as per central health ministry’s information on India Today TV and Dr Ashish Jha, Dean of Brown University’s Statement on CNN. However, Dr Sanjay Gupta from CNN and Microbiologist Professor Akiko Iwasaki from Yale University suggests rapid antigen testing at home should be encouraged because rapid antigen testing is based on nucleocapsid testing and not the S gene, as used in RTPCR for fast testing. 

As the virus is contagious, many asymptomatic carriers could spread the disease further. Hence, the strategy should be to control the spread by rigorous rapid detection and religiously following the Test, Track and Treat early protocol. This should be the strategy in all progressive corporate organizations and local communities. 

Will the current vaccines work and how well can they protect us?

The update from Dr Sanjay Gupta on CNN, in accordance with the vaccine cushioning effect, the vaccines will hopefully work, though with probably slightly reduced efficacy. A majority of the patients infected in South Africa were unvaccinated. Hence, everyone in India including children should get vaccinated as soon as possible. 

Dr Fauci from the U.S. advises that the variant specific vaccine booster is the best bet. But it may take prolonged time for production and distribution in the near future. Hence today, all should take the currently available vaccine as the 3rd booster shot, when permitted officially because the protection conferred by the third dose, results in multifold antibody protection and the avoidance of severe disease or death from COVID-19. 

Will any new vaccines be manufactured? 

Dr Anthony Fauci has said a new variant specific vaccine booster covering all variants is a likely possibility in 2022. Meanwhile Johnson & Johnson has announced plans to make a new vaccine for Omicron in South Africa in collaborative projects with local vaccine manufacturers. 

When will the booster shots of vaccines and child vaccinations be announced in India? 

The good news is that probably this month, the WHO & INSACOG expert committee will decide and announce booster shot eligibility (six months after the second jab) for Indian citizens above 40 years - subsequently, announcements of child vaccinations are expected as well. 

What are the treatment guidelines?

The earlier launched Antibody Cocktail and the new Merck pill Molnupiravir (the new ace up our sleeve) may probably become our best bets to combat the virus.  Merck is optimistic that their anti-COVID pill will work against Omicron. According to Dr Sanjay Gupta, CNN, if Merck gets emergency use approval for Molnupiravir; patients can be prescribed the drug for home use. Hopefully the antibody cocktail (Casirivimab and Imdevimab; taken by the former US President Donald Trump), which reduces hospitalization by 7o%, may still be effective - if given within three to five days of the disease.  

Will travel ban across countries stop the spread? 

We have to obtain prior travel history, increase testing, trace primary and secondary contacts and treat affected patients. Various countries, including India, have outlined strict quarantine measures. 

What are Health Authorities doing to control the spread?

The Union Health Secretary Rajesh Bhushan said in a letter to all states and Union Territories that all new patients affected with this variant will have to be treated in designated COVID facilities with separate isolation area. 

There have been 23 cases of Omicron detected in India till date. It has to be ensured that no cross infection takes place and adequate precautions are taken by healthcare workers in the facilities to prevent transmission among other patients and healthcare workers. He also advised the need to regularly review the situation and ensure that samples of positive cases of international travelers and their contacts, as well as from emerging hot spots, are promptly submitted to genome sequencing laboratories: as per national protocol. Further to contain spread, it is imperative that states and UTs follow a mission mode and focused approach of quickly tracking primary and secondary contacts of positive cases and facilitate testing for them. 

Maharashtra Chief Minister Uddhav Thackeray, on Wednesday 8th December, ordered "speedy vaccination" against coronavirus as the state cabinet expressed worry over the rapid spread of the Omicron variant across the world. The statement noted that the number of Omicron-infected patients across the world has gone up by 45 per cent in the last 12 hours; hence Thackeray stressed the need for taking precautions and strictly following health-related rules, enforced by the state. 

 

As Omicron cases rise across the world and in India, is it safe to send kids to school & switch back to offline studies?  

Children in India are currently among the unvaccinated population and thus at risk of getting infected with Omicron. Dr. Krishan Chugh, Director Pediatrics, Fortis Memorial Research Institute, Gurugram mentions; “We are definitely wiser now than in March 2020, because we have learnt that, had we not closed schools then, it would have acquired totally unmanageable dimensions”. 

Today, apart from getting teachers and staff fully vaccinated, schools need to ensure safe ventilation in the classrooms (monitor real time Air Carbon Dioxide levels

Similarly, we can’t be sure that disease will be mild in all the cases, hence children should be vaccinated at the earliest to protect them from COVID-19 and its complications like multi inflammatory syndrome (MIS). We also need to bear in mind that “when children contract infection in the school, there is an increased risk of their carrying it back to home and infecting their grandparents who may be living with them. And the disease can be devastating in older people .As far as exams are concerned, children should give online examinations, as of now. In most parts of our country final exams are held in the months of March and April and the pandemic situation will hopefully improve by then for schools to fully reopen and conduct offlines exams for all ages.It is natural for parents to reconsider their decision of sending kids to school in such a situation & doctors agree with their concern," concluded Dr Chugh. 

What is the best way forward? 

It is extremely straightforward: Follow Strictly COVID appropriate behavior and become a Wellness Ambassador in order to encourage your colleagues, friends, neighbors and also the local community to immanent this religiously. A collective effort is essential. The virus is more contagious than Delta but whether it will be more virulent to cause a serious disease, more hospitalizations, whether it will have a vaccine escape - though less likely, we hope to know more in next two weeks. 

How can we maintain Caution, Control & Contain the spread?

We should be cautioned not to show any complacency and let our guard down now. According to the WHO we all must act now to address important factors like: Sanitization of self  (with 60% alcohol based sanitizer/rubbing hands for 20 seconds with soap and thoroughly washing with water) and surfaces (with 1% hypochlorite/disinfectants). Hypochlorite solution can be purchased online or alternatively it can be prepared at home by mixing 10 grams of bleaching powder in one liter of water. This can be used for disinfecting surfaces, walls and soaking vegetables and other foods for a contact time of 10 minutes. 

• Maintain effective Social Distancing by downloading 1.5-meter app (UNTIL) on android phone and keep your Bluetooth on. 
• Shield yourself with a Mask (Double Mask preferably). Don a mask. Recommended: reusable highly efficient air purifier Hepa filter masks. 
• Practice Meditation to allay your anxiety and boost your mind for positive thinking. 
• Vaccinate with COVID-19 vaccines all adults [with two doses, followed six months later by booster (when advocated) and all children. 
• Vigilant. Be vigil by following the test, track and treat protocol. This should be the strategy in local communities, currently. 
• Ventilation. For controlling the spread of the highly infectious Omicron, it is ventilation during traveling, during work, during shopping - in short any activity involving interactions/gathering of a group of people that will play a crucial role in containing the spread. Hence, when stepping out of home, carry your sanitizer, don your mask, avoid elevator use, if feasible and self-drive your vehicle. If the car is being chauffeured, sit behind the car driver, exactly diagonal to the driver. Request the driver to shut off the car air conditioner and keep the window on his right entirely shut. As you will be sitting behind and diagonally opposite, the window to your left will be entirely shut. The remaining windows can be open. If >2 people are traveling in the car, please keep all windows down by 4 inches. 

When entering the public or office place, kindly ensure that you: 

• Avoid closed conversations > 5 minutes 
• Avoid being in closed, confined spaces (with poor ventilation) for a long duration and 
• Avoid close gatherings of >50 people 

To sum it up easily; The Protection Mantra for OVERCOMING OMICRON is:

Sanitisation, Social Distancing, Double Masking, Meditation, Vaccination, Vigilance & Ventilation in order to AVOID 3Cs’ - closed conversations, close confined spaces and close gatherings.