By Dr. Gyan Pathak
Though COVID-19 is almost under control in India, the emergence of Omicron variant should be considered as early warning for the challenges ahead. Gearing up for the Omicron challenge must also include scaling up of health infrastructure for making the country fully prepared for any eventuality.
Individuals and the government need to remain alert and must guard against the threat because the scale and magnitude of the rise in cases and most importantly the severity of disease that will be caused by Omicron are still not clear as the Union Ministry of Health has said in a clarification on frequently asked questions. More importantly, Omicron has entered India, and is most likely to spread.
Given the vaccination of large number of people and their high exposure to the Delta variant as evidenced by high seropositivity, the severity of the disease is anticipated to be low, but it should be noted that we don’t have sufficient data at this moment to substantiate this expectation.
Union Ministry of Health has said that there is no evidence to suggest that existing vaccines do not work on Omicron, and said that vaccines are expected to still offer protection against severe disease. However, the ministry’s clarification itself contains a contradiction when it said, “some of the mutations reported on spike gene may decrease the efficacy of existing vaccines.” Moreover, there is a fear that the 32 mutations on its spike protein the Omicron uses to unlock human body’s cells may render antibodies from previous infections or vaccinations too weak, though how much, we do not know at present, and also its interaction with other aspects of the immune system, which is presently under investigation.
Detection of Omicron variant is also problematic “as the S gene is heavily mutated, and some of the primers may lead to results indicating the absence of the S gene, called as S gene drop out”, the Union Ministry of Health has said. This particular S gene drop out along with the detection of other viral genes “could be used as a diagnostic feature of Omicron, however, for final confirmation of the omicron variant genomic sequencing is required.”
Individuals therefore must reduce their risk of exposure to COVID-19, and take measures including proven public health and social measures such as wearing well-fitting masks, hand hygiene, physical distancing, improving ventilation of indoor spaces, avoiding crowded spaces, and getting vaccinated.
The government has also no option but to gear up for the threat by enhancing surveillance and sequencing efforts, perform field investigations and laboratory assessments to improve understanding of the potential impacts of its epidemiology, severity, effectiveness of public health and social measures, diagnostic methods, immune responses, antibody neutralization, or other relevant characteristics, as rightly suggested by the World Health Organisation (WHO).
Omicron has now been reported to enter India and two cases have been detected in Karnataka, as per the latest data released by the Union Ministry of Health. We must not ignore it because, in the beginning only one case of COVID-19 was detected in Kerala on January 30, 2020, and now everybody knows what a heavy price we had to pay in terms of lives and economy. The cases rose to over 3.46 crore and 4.7 lakh people died, and all for our negligence, unpreparedness, and lack of health infrastructure. We must not repeat our mistake this time, though the active case in the country has dropped below one lakh. We must note that daily recorded death case on December 3, 2021 was still 415 and daily new cases of infection 8,603.
One of the reported cases in Karnataka was of a 46 year old person who has no history of foreign travel. It has already given rise to the suspicion that there might be many undetected cases in India. The CSIR’s Centre for Cellular and Molecular Biology (CCMB) chief has even said that “It’s wake up call. Omicron already here, it’s not coming from abroad.”
We have now revised the guidelines and new travel rules as the Centre and states are gearing up for the Omicron challenge. Curbs and advisories have been issued both by the Union and the state governments. However, there are several operational problems as has been reported in the form of escape of travelers from abroad without check, and even getting negative RT-PCR certificates even when infected with the virus. For example, in Karnataka, where the government has to order a probe into how a South African national obtained a negated RT-PCR report from a Bengaluru lab enabling him to leave the country despite his swab results testing positive for Omicron variant. The escape of the foreign passenger to unknown destinations in India is a strong evidence that everything is not well at our ports, both the air and sea. Our surveillance is still too weak to defend ourselves, the same mistake is being repeated that we have committed last year. The latest report coming from Maharashtra suggests that over two dozen people are suspected to be infected with Omicron. Twelve suspected cases have also been found in Delhi. We need strengthening tracing and testing for those coming from abroad.
The noted virologist Dr Gagandeep Kang has also said that Omicron variant might have been around in the country as India detected the Karnataka patient who had no foreign travel history. Her advice is to scale up the vaccination and new testing strategy. She categorically says that lockdowns and travel bans make no sense at this time. We need strong vigilance and alertness, she says.
WHO has said that Omicron is more transmissible and could overwhelm the healthcare system, though advised not to panic. In this scenario, ramping up the health infrastructure and facilities of the country seems to be the only way to face the threat. (IPA Service)