RESURGENCE THE OMICRON WAY

December 11, 2021 0 By Gopakumar

As the efficacy of existing vaccines has been proven to be inadequate against Omicron, our only hope from the jab is to reduce the severity of the disease, highlighting the importance of adhering to covid appropriate behaviour

CH Unnikrishnan

When the first headlines started appearing about the outbreak of a ‘novel coronavirus’ in the Chinese city of Wuhan two years ago, what was happening appeared a world away to Indians and Indian policymakers.

A year later, a similar crisis caught us by surprise when the Delta variant took shape somewhere in the country and spread all over completely under the radar of our scientific monitoring systems, resulting in the second wave.

Now, the third chance is upon us. 

Unlike the first time, we no longer are under any illusions about what an uncontrolled spread can do to us, nor are we — like the second time — lacking in advance warning. 

But the prognosis for India this time is hardly better. 

Despite knowing fully well what is in store for us — thanks to two years of extensive medical and empirical data — and armed with better tools than ever before, we today find ourselves in a greater confusion than at any time since this pandemic started.

On the one hand, the experience of the second wave has taught us that letting the virus run free leads to massive casualties and bodies floating down rivers, but bitter experience has also taught us that we simply do not have the economic stamina to undergo another round of lockdowns.

So, what should India do, as Omicron, the latest avatar of a virus that has brought the world to its knees, shows up at our gates uninvited?

THE IMPOSSIBILITY OF LOCKDOWNS

Experts believe that the strategy of trying to contain and exterminate the virus has failed, and now advocate a policy of trying to manage its spread rather than arrest it completely.

The economy is in tatters, unemployment is rife, crores of people have been pushed into pover over the last two years and any new lockdown is more than likely to result in massive social unrest.

“Even though we have proved that lockdowns are effective in reducing the virus spread and keeping the infection rates low, the fact remains that enforcement of a lockdown without socio-economic support is not sustainable. However, the real challenge in our country is that religious festivities and political extravagances are issues of sentiments and priorities,” says a senior epidemiologist associated with a premier scientific institution, who doesn’t want to be identified.    

LIMITS OF VACCINATION

The second strategy, that of vaccination, too is unlikely to be of much use in preventing the third wave, though it may help in reducing the fatalities.

Since most of the current vaccines are developed targeting the spike protein of coronavirus, they are unlikely to be of much use against the new variant. 

“They are not very good at stopping infection or transmission because they do not provide lasting mucosal immunity,” says  Dr Rajeev Jayadevan, Vice Chairman, Research Cell, at Indian Medical Association.  

“For example, in a Texas prison outbreak a few months ago, 73% of fully vaccinated people picked up infection. Besides, their viral loads were the same as unvaccinated people. In other words, the total fatalities is more a function of the total number of infected people in a country, rather than the total vaccination coverage,” he points out.

The fact that Omicron is sweeping almost unimpeded in the Gauteng district of South Africa 3-4 months after the area saw a large Delta outbreak indicates that the immunity conferred by previous infection too is of limited use, though there is evidence that it may help in reducing fatalities. 

Still experts believe that the presence of a large number of vaccinated and previously exposed individuals could cushion the impact of the third wave, at least in terms of casualties.

Dr Rajeev Jayadevan too agrees that vaccination does have a role to play in countering the third wave. 

He points out that the existing vaccines are systemic in nature, geared at preventing organ damage. “As one looks around the world, it is clear that there is no difference between a country which has maximum vaccine coverage and a country that is poorly vaccinated as far as the pandemic wave pattern is concerned. However, the change we have been able to make is that when the next wave happens, there will be a difference in the outcome in a vaccinated country as compared to an unvaccinated country. 

“This means, the percentage of people falling seriously ill or dying of the infection will be smaller in countries with high vaccination coverage. A vaccinated person is about 90 percent less likely to develop severe disease than an unvaccinated person of the same age group. This aspect of immunity does not wane with time.”

BACK TO MASKS & SOCIAL DISTANCING?

Caught between these two impossibilities, the only option for India is to reintroduce covid appropriate behavior and make it mandatory to minimise the impact and to enable a controlled transmission that does not overwhelm the health infrastructure.

Experts, therefore, say it is time for India to bring back COVID protocol with more stringent measures, given that a full lockdown is next to impossible.

They point out that the Omicron variant is five times more contagious than the Delta variant, which took away over 4,00,000 lives in the second wave.   

If India fails to act in an emergency, taking cues from the experience of Europe, the US and Souht Africa, and brings back compulsory face masks, zero public crowding and banning indoor gatherings, we will find ourselves in a situation worse than the April-May Delta outbreak, warn epidemiologists, medical experts and virologists alike.  

“The confirmation of Omicron Variant of Concern today by India, the first two cases in WHO South-East Asia Region, was not unexpected in view of the interconnected world that we live in. However,  this emphasizes on the urgent need for all countries to step up surveillance, to be on alert and rapidly detect any importation and take measures to curtail further spread of the virus,” cautioned Dr Poonam Khetrapal, Head of WHO South East Asia region.. 

Dr Rajeev points out that most nations have overlooked the basics in their quest to get people vaccinated. 

“They failed to give due attention to the other equally important measures such as wearing masks, avoiding indoor gatherings and improving room ventilation etc to control the spread of infection. 

“It is like treating cholera with more and more antibiotics, which is bound to fail. Cholera was controlled by chlorination of water, not by antibiotics. This virus spreads rapidly through air, and that occurs predominantly indoors. Unless we address that, we will not be able to gain control on its spreading ability,” Dr Jayadeven added.