Dr Arista Lahiri, Author at Lokmarg

Nearly half a year ago, I wrote an article stating that the Covid-19 virus wasn’t going away anytime soon. And here I am again, discussing a different variant of the virus this time: Omicron. Here too, I shall repeat once again: the virus is here to stay. While the Omicron variant is peaking, it does not necessarily imply that the Delta variant is weakening down or is losing its potential to cause serious harm. In fact, we are now having mixed infections at the community level.

The third wave is raging, at least in the state of Maharashtra, Delhi, and to a great extent in Kolkata, though like the past waves there is no synchronised peaking all over the country. Meanwhile, globally, there are different co-infections emerging like the “Delmicron” (co-infection of Delta and Omicron) or the “Flurona” (Flu with COVID-19). But yes, rarity is an issue with these new combinations as of now.

The Delta variant was severe but its ability to spread was comparatively lower than the Omicron variant. There is an important distinction here. The Omicron variant is merely ‘less severe’ than Delta, but that doesn’t mean in itself that it is ‘mild’ as is being reporting in sections of the media. People cannot be slipshod about it. There have also been reports that say that the Omicron variant will act as a natural vaccine since it is less severe, does not require hospitalisation and its higher-spread potential means herd immunity can be achieved.

These are dangerous, sweeping statements to make. No, Omicron variant isn’t a natural vaccine. There is so much that we don’t know about the nature of the virus and its recurring mutations and the strains that develop from those mutations, yet. There are various permutations and combinations by way of which a particular strain may affect a particular person and we should avoid making blanket statements like these. Such assertions merely encourage people to go about with business as usual and deliberately expose themselves to the contagion; this would amount to playing with fire.

As the medical situation stands in India currently, the Delta virus is still the dominant infection even as Omicron cases are on the rise. There is a difference in disease manifestations and severity! For instance, a person who hasn’t been exposed to the virus at all during the previous two waves will show a different set of symptoms and response, when infected with Omicron, than somebody who is fully vaccinated and has already been infected during one the first two waves.

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Throw in co-morbidities, age and immunity factors into the mix and the symptoms get even more complex. Some people develop immunity because of their natural body milieu and vaccine while some remain dependent on vaccine-induced immunity alone.

Omicron is not a natural vaccine
The virus will continue to mutate
‘One Health’ approach best remedy
Human, animal, climate are linked
Covid-appropriate behaviour must

A person who has been infected after vaccination is called to have a ‘vaccine breakthrough infection’. The Omicron variant has huge mutations in the spike protein of the virus which often helps it dodge the immunity. It may so happen that the newer variants will slowly drive out the older variants, e.g. the Omicron variant may push out Delta with time. But no one can say for sure whether future variants will be less or more severe, or if at all this will happen.

So, Where Does The Solution Lie?

If we are to beat the virus at all or at least have a semblance of control over it, we need to focus on the concept of ‘One Health’. When we discuss about health putting together people, animals, and environment they make the One Health Triad. One Health is in fact a rational unification of local, national, and global practices for optimal health in the interaction between human, animals, and their environment.

In simple language: One health means the health of humans doesn’t exist in vacuum and is deeply connected to that of animals and our shared environment. Zoonotic diseases (diseases that can easily be passed on from animals to humans) like coronavirus will be on the rise if we do not consider humans, animals and other components of nature as ‘one collective unit’. We need to move in tandem with nature.

As we have seen, the emergence of the newer virus strains is also connected to the socio-economic condition of a country. Both the Delta and Omicron variant have emerged (read detected) from developing nations. Even the original novel coronavirus emerged from Wuhan, whose socio-economic condition is not as good compared to other parts of China. So, it is developing nations that will have to take the lead in working with the concept of ‘One Health’ and implement what is known as ‘Systems Thinking’ in public health.

‘Systems thinking’ approach is a holistic one that analyses the intricacies in complex systems – it can be any system. Through this, in Public Health we can try to understand how different societies or its different strata act to achieve collective health goals, and also how and where the external influencers have an impact.

The ‘third wave’ may become the end of waves in which huge number of people get infected at once and the pressure on healthcare system is staggering, but it is not necessarily the end of the coronavirus. With the passage of time it might turn ‘endemic’, meaning we might learn to live with it. A disease becomes endemic when it stops becoming a major problem, although one cannot say that those infected will have it mild or it will just wash away like the common cold or viral fever. A lot of it then boils down to our individual approach to our health. As of now, the World Health Organisation has warned against declaring the pandemic as an endemic (which Spain already has) because the transmission rates globally are still very high and might spiral anytime, we still need cooperation of global proportions in fighting the virus.

All of us are in this together. The virus still has a vice-like grip on people, especially among the poor, the unprivileged who cannot afford to isolate for long because their livelihood depends on going out. Thus to make everyone’s lives easier, the community as a whole needs to practise Covid-appropriate behaviour: wearing masks, maintaining social distancing, frequent hand-wash, and avoiding public gatherings like political rallies, religious congregations, marriages, social parties etc. as much as we can. Taking our vaccines, taking care of other aspects of our health, especially mental health, and pursuing a holistic approach to our lives is what will usher us into a ‘One Health’ era.

The writer is an Epidemiologist and Health Researcher, posted as Assistant Professor (Community Medicine) in Dr B C Roy Multi-Speciality Medical Research Centre, IIT Kharagpur

Coronavirus has turned our lives upside down in more ways than one and even after a year of the pandemic being officially announced, the world is not in the green. As a community medicine practitioner in Epidemiology, I have been studying the behaviour of the novel Coronavirus and its host, us, the humans. Yet, no matter how much I study things in detail, I always come to the same conclusion about the Coronavirus: This virus can change forms (mutate) and come up with new strains faster than we can figure out its cure or vaccine. So, our best bet right now is to avoid the virus! The prevention is easy; the cure may not be.

Our best preventive tools – masks, hand-wash and sanitisers are now easily available. What is not easily available is the will in most people to co-operate and use these tools both for individual safety as well as public health. Even as the number of infected cases and resultant fatalities rise, there is a certain nonchalance in public behaviour regarding the risks. On March 27, more than 62,000 new cases were registered across the country, with over 300 deaths. The first time that the number of people infected in a single day went above 50,000 was July 27, 2020. The last time that the number of new cases went above 50,000 was November 6, 2020.

Even though the number of new infected cases is going up, the ratio of the number of people losing their lives to the infection, is so far less in 2021, than it was in 2020. However, those suffering with manifestations are showing somewhat severe symptoms than before. Though panic is never a way forward, but we should not definitely let our guards down yet as well.

We are seeing a renewed, fresh wave of the virus because the virus has mutated (changed its basic genetic structure and developed newer, more dangerous strains) to survive in its human hosts. We have learnt some strategies to cope with them and the virus too has gained new skills to dodge the human immune system! The influenza virus mutates almost every year and develops new strains. We will have to see which way the wind blows for the novel coronavirus. It definitely has mutated within a year.

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With newer mutations coming up globally we are faced with the threat of the new strains, the UK strain, the South African strain, and the Brazilian strain. It is the antigens that are responsible for stimulating the production of antibodies by the immune system. Even minor mutations depending on the area of the virus they have occurred in, can play in a big way with our immune systems, and are known as ‘variants of concern’. These new variants are identified using a process known as genome sequencing, which reads and then interprets the genetic information found in the RNA- Ribonucleic acid (in this case) of the virus. We need to study the virus to be able to fight it better.

India, through genome sequencing has also detected what is known as a new “double mutant” COVID-19 variant. This means that two important changes are coming together in the same virus. The mutations are basically affecting key areas in the spike protein (the crown-like area which helps the virus to latch on to human cells) of the coronavirus and thus helping them skip or escape the resistance offered by our immune system. This is mostly affecting states like Maharashtra and Delhi the most. Other states closer to these two are also reporting increased number of cases. This is probably because these two states have the maximum international travel (both inward and outward) and thus the maximum exposure to the virus, both by way of the original strain (from Wuhan, China) and the 3 newer strains. At least 18 states and Union Territories in India now have different strains of coronavirus running amok: the UK strain, the South African strain and the Indian strain, so to speak. The threat of infection is high.

What all this means is we are taking one step forward and two steps back in terms of handling the pan-world health crisis. We were all thinking that with the vaccine we would now be saved, but the virus is changing in ways that render the vaccines weak. We cannot say that a person who has been infected once and has received the vaccine as well, won’t be re-infected, though it depends upon an individual’s immune strength as to how his/her body will react and to what level they would be affected.

However, the scientists suggest that the severity of the disease will be bit lesser among the vaccinated individuals – a ray of hope, but still the battle against spread of infection, is on. During the first wave of coronavirus in March 2020 what saved us was the lockdown; it helped in more ways than one to trace and isolate and further treat infected people. However, for all purposes, a second nationwide lockdown doesn’t look feasible, because it affects the people financially when they are not able to earn their livelihood.

What we need right now to handle the second wave is a really strong execution of the plan we already have in place. Public health awareness was already achieved during the first wave; almost the whole population is aware of the crisis as well as the solution, but what is missing is a respect for solutions and the motivation to enact those simple behaviours.

We need strong public health advocacy. Everyday we need to educate, organize and mobilise to change the reluctant and seemingly over-confident attitude among the mass as a whole. We need people at the grassroots level to reinforce for good the safety measures. So many people have let their guards down after one year of the pandemic. The various state elections, the many political rallies, the many religious festivals (we have the upcoming Kumbh Mela) have all contributed to the pandemic still holding fort really strong. We need strong community level leadership at every possible level. Anyone with a voice that is heard and respected should advocate for the use of masks, regular handwashing and social distancing. I wish some religious leaders across faiths weren’t so dismissive of the severity of the pandemic; since many people listen to them.

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We need to reach out to these leaders so that they can influence their followers. Faith must meet science if we want to overcome the pandemic. Political leaders at centre and state levels need to reach out to every kind of leaders possible, to bring about behaviour changes among the people to eliminate the virus from amidst us. To use a sociological concept, we need to the diffuse ideas of public well-being and precautions so that they become culturally acceptable and thus practiced among large parts of the population. The media plays an important role here.

The onus this second time around is truly on the public. We will keep losing the race to the virus until we follow the basic measures stringently. Lockdowns can only stop inter-cluster exchange or two areas with infection from interacting with each other and thus ceasing a larger spillage, but it may not stop intra-location infections. Nowadays, we have a huge number of people living in societies and apartments. Even if they go out only to buy essential items, but don’t follow basic precautionary measures like masks etc. they can still infect or be infected.

All of us depend on each of us this time. It’s kind of “One for all, all for one” idea! As a Community Medicine expert, I once again want to emphasise that it is the community spirit which will keep us safe and alive. Each one for another! The virus alone is not the real enemy, but our relaxed approach to the virus certainly is! We can weaken it in some time if we strictly follow the rules. The so called herd immunity has not shown promising results in this case, so individual immunity is all we have to turn our communities healthy. If we don’t want another lockdown, let’s bring out masks, sanitisers and the will to keep fighting the contagion – by respecting the social distancing norms. Let us put all efforts to develop a “behavioural herd immunity” this time.

The writer is an epidemiologist at College of Medicine & Sagor Dutta Hospital in Kolkata)

Author: Dr Arista Lahiri

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