[Editorial] Implications of Omicron Variant for India

What is the Omicron variant?

Why is it concerning?

  • The emergence of a more transmissible new variant of the SARS CoV 2 has been a key source of concern for epidemiologists.
  • However, what is more worrying is that this variant has caused such a sharp spike in cases that it may outpace the Delta variant with regards to infectivity.
  • Viruses mutate all the time but this variant has a large number of mutations, including some that may enable the virus to evade immunity developed via past infection or vaccination.
  • This large accumulation of mutation is possibly a consequence of COVID infection of an immune-compromised patient. This is because, the virus multiplies and mutates unhindered in a human body with weak immune system.
  • Evidence suggests that this variant may be responsible for the spike in COVID cases in Gauteng province, South Africa. Some 90% of the samples tested from this region have been of the Omicron variant for the past few weeks.
  • The WHO recently labelled it as a ‘variant of concern’.
  • Several countries have blocked the entry of travellers from South Africa but this measure will only provide a temporary relief. Cases may have already crossed several borders as seen from the detection of a case in Hong Kong 4 days into a mandatory quarantine and had led to infection of another individual within this period. Similarly, Israel reported several cases, including the mild infection of a 32-year-old woman who had taken 3 doses of the Pfizer vaccine.
  • Vaccines remain out of reach for many in lower and middle-income countries, due to inequity in dose distribution. More than 60 countries, including South Africa, have vaccinated less than a quarter of their population.
  • These under-vaccinated regions could become the breeding ground for newer and more dangerous variants.
  • Rich countries continue to administer booster shots to even the less vulnerable among their populations. This is at the cost of the rest of the world.

How is India holding up?

  • The consistent decline in COVID-19 cases, even following the festive season, has emboldened the government to ease restrictions. The public behaviour too is returning to normalcy.
  • This is in contrast to the case in many European countries, where the cases are surging.
  • The reason for this trend in India:
    1. A large section of the population has been exposed to the virus at some stage already. This is providing a measure of protection from re-infections.
    2. India’s massive immunization campaign has gathered steam. 44% of adults have received both the doses while 82% have taken atleast one shot.
    3. In addition, it is possible that vaccination, following prior infection, will have a larger protective effect for a person compared to simply receiving 2 doses alone.

How can we address the situation?

  • The WHO has called for studies to develop better understanding of the Omicron variant- especially its ability to evade the immune system. The result from these studies hold relevance for India as a huge proportion of the population already has some degree of immunity.
  • If the studies reveal that the virus is capable of greater levels of immune escape, then there is a need to reformulate treatments like monoclonal antibodies and vaccines.
  • RT-PCR tests are capable of detecting this variant. Hence, this technology should be put to good use.
  • While questions around the new variant’s transmissibility, ability to evade the immune system and infectivity remain unanswered at the moment, its emergence is a cause for concern and calls for alertness.
  • The possibility of new variant evolving exist as long as the virus circulates. In this case, the best way forward is reducing the number of cases. Here, vaccination serves as a powerful tool.
  • Even a single dose of vaccine reduces the risk of hospitalization and death.
  • The protection against symptomatic COVID derived from vaccination decays with time. However, breakthrough infections in vaccinated individuals are of low intensity and of shorter duration compared to cases in unvaccinated individuals.
  • Since weak immune systems are favourable for further viral mutations, future additional vaccine doses should be prioritized towards the elderly and the immune-compromised.
  • Equitable distribution of vaccine is an urgent public health need, globally. It is also the morally and ethically right thing to do.
  • Countries, including India, can learn from the South African experience- exhibiting transparency and making real time data available to the world for scientific study.

Conclusion:

Though we don’t know much about this new variant, adequate preparation is necessary for facing an uncertain future.

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