Omicron And Future Of Covid Variants

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.

ALSO READ: Omicron, The Crafty Virus

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

Omicron, The Crafty Virus

It would appear as if there is a central committee of viruses that meet, learn from their experience and adapt with new strategies. That is of course a metaphoric statement. Viruses are not meant to have brains nor a sense of social community, let alone a strategy team. But what has happened and has happened in the past with dangerous viruses, is not far from this myth.

The Omicron variant of the SARS-Cov-2 Virus is far less potent than its predecessors but more infectious, spreading like wildfire once it takes hold in a population. According to three studies quoted in the British Medical Journal, the infection rate is faster but hospitalisations rate is about 15-80% less than its first predecessor and even the Delta variant. It also lasts shorter, between two and seven days. Some people have almost no symptoms but found to have the Omicron virus on testing.

The studies were done in England, Wales and South Africa. The number of people needing intensive care and oxygenation is even lower. Deaths are far fewer than the first Covid wave.

However that is no reason to let the virus rip through society. India is beginning to see an exponential increase in Omicron cases. That is the pattern with this virus. It starts with a few cases, but then within weeks, there is a steep curve of number of people infected.

The three studies so far have different populations. The South African study is based against a background that over 70% of South Africans have contracted Covid-19 last year and then subsequently the Delta variant. They have developed a natural immunity as the number of vaccinated people are less than countries like UK or India.

Cheryl Cohen, the South African doctor from the National Institute for Communicable Diseases who did the study even declared that their study suggests a positive story with reduced severity.

The England and Wales studies were against a background of over 80% people having been vaccinated twice. The percentage of people with the third, booster vaccine dose, was lower when the study was conducted. The study shows that people with booster dose are least likely to have any serious illness from Omicron. Those with two doses are at slightly higher risk. But most people needing hospitalisation have been those who were not vaccinated. Britain has escalated its booster dose programme and has even declared that it will reach its target before the end of the year. Vaccinators were working during the holidays too.

The studies have implications for India. The number of triple jabbed people is not high. India’s hospital infrastructure needs a lot of investment and is no where near that of developed western countries.

ALSO READ: More Covid Questions Than Answers

As Omicron starts to spread, the number of people relative to number of hospital beds and doctors is again going to be highly unfavourable. Even if a mere 0.5% people become seriously ill in India, that is over a 5 million patients. Where is the infrastructure to deal with that?

Consequently, India needs to take precautions urgently. Many European countries who have only just finished second vaccination, have gone into full or partial lockdowns. Some countries require quarantine for visitors. These measures have not started in India. There is a general belief among people that the virus is less virulent and therefore will require less stringent measures. There have been demonstrations against Government lockdowns as a result.

The Coronavirus story is typical. A new strain of virus can be extremely virulent as it is with the original SARS-Cov-19. However after a few mutations, it either becomes extinct or finds a form that causes minimal reaction within the human body but also enables the virus to do what it wants. The virus simply needs a host, replicate and die.

It is the reaction by the human body that causes health problems with Coronavirus. Macrophages (cells of defence and clean up) react, cells die and the toxins produced overwhelm the body’s ability to get rid of them. Consequently the SARS-Cov-19 virus now has found a mutation that can slip by through most human defences, cause less disruption and cell death and therefore less toxin production.

Eventually it might end up being treated as another cold. That is beneficial to both the virus and human beings. It seems surrealistic to paint a picture of nature engaged as a silent mediator between a virulent virus and a determined anti-virus human race and finds a settlement that appears to be in sight. The virus becomes less dangerous and humans start tolerating it. However this is in fact mythology or fiction.

When a new strain of virus comes into human race, sometimes it can cause havoc. This was the case with Bird flu, the Spanish Flu (of 1918), Ebola and Zika virus and now the Coronavirus.

Some viruses in history are thought to have become extinct. While others have become so benign that they don’t pose any problem.

What actually happens is that the genetic code is not static. As it replicates, it continues to develop mistakes, changes, mutations etc. Some times the mutation can be deadly for the host, such as humans or an animal. Sometimes the mutations can be self destructive and the virus goes into extinction. Sometimes mutations can become benign and cause fewer symptoms.

Benign viruses can also suddenly develop a mutation that becomes deadly. The Omicron Coronavirus may be less dangerous now but as its genetic code, the RNA in the case of Coronavirus, continues to develop faults, changes and mutations, a future mutation from the Omicron could be fatal.

It will be best if the Virus disappears altogether. However that is unlikely. Coronavirus has already had hundreds of mutations. Some have caught the headlines because they were virulent. Many have disappeared. Others may be lingering in benign form in animals or even humans without symptoms. Any of these could mutate into dangerous ones.

The spread of viruses depends on several factors but mainly transmissibility. Some, like HIV, can only be got through direct sexual contact or fluid exchange. Others like Covid seem to be airborne too and can jump easily from one person to another. Some viruses transmit when the host is fully infected while others jump when the host is still asymptomatic.

Consequently, it will be silly not to take Omicron Virus seriously. There have been quite few other small epidemics and pandemics in the last 20 years. It will be equally silly not to be vigilant for new variants. The vaccines give us hope. Equally Government need to put in place rapid reaction response strategies in case a dangerous mutation evolves. In the war between viruses and humans, indeed between viruses and all species, there are no winners. It is a perpetual war that will carry on as long as life exists on earth.

3rd Wave Covid

‘3rd Wave Is Upon Us; Of All Gatherings, Election Rallies Are Worst’

Dr Mridul Sharma, 24, from Amritsar, says our leaders lecture others on Covid-appropriate behaviour but fall short of following the protocols themselves

No matter where the Covid-19 has come from, it is certain that it will go very far in destroying the health of millions. And we doctors and other frontline healthcare professionals are the first line of defence when the virus attacks. The Delta variant has shown just how devastating the effects of the mutated virus can be and I am pretty sure the Omicron variant is going to cause as much, if not more, damage. The third wave is a certainty and we should brace ourselves for it.

People have no idea how much pressure healthcare workers come under, when the cases surge and peak. Not only are we ill equipped to fight the virus, as it is mutating faster than we can understand it, we are also overwhelmed with the volume of cases.

Conducting a political rally when the third wave is imminent, isn’t a good idea. In fact any gathering is not a good idea, be it a marriage or funeral, but political rallies are the worst. A big rally is scheduled for January 5 in Punjab and in my opinion by January 15, there are chances of the third wave striking in force. I wish people understood the situation.

I myself contracted the virus twice, once in August 2020 and the second time during the second wave. And since I live alone, it gets difficult to manage the infection on one’s own. My oxygen saturation levels went dangerously low while I was infected. On Covid duty during the second wave, I had to take up rented accommodation near the hospital, so that I didn’t have to commute much and there were lesser chances of me infecting someone else.

Sharma lost his grandfather to post-Covid complications but had little time to grieve his death

Most other people can cope with the slow recovery but a healthcare professional, especially a doctor, has to get back on one’s feet immediately. I lost my grandfather aged 86 to post-Covid complications in April. He was full of life and someone with a healthy lifestyle and yet it was difficult for him to fight the long Covid complications. As healthcare professionals we don’t even get time to grieve our loved ones. When people conduct election rallies they must understand that human lives at stake.

ALSO READ: Health Workers Are Anxious About Omicron

My sister is a dentist and during the second wave, healthcare professionals from other streams were also asked to pitch in to enhance resources. My parents get anxious to see both their children stand in the frontline. I wish governments understood that individual families get impacted when prevention isn’t done well and each story ends up differently.

Tamam umr sarkarein yahi bhool karti rahi, dhool chehre pe thi aur aaina saaf karti rahi. (Governments commit this mistake all the time: find fault in others’ behaviour, forget to check their own record). Political leaders should lead by example so that the public knows how to behave and follow Covid protocols. As the virus mutates, the complications are also getting severe: the Guillane-Barre syndrome, body paralysis, long Covid etc. And people with co-morbidities have it tougher.

India has better immunity than most countries because of our food habits, but we also have enormous numbers. We are bracing ourselves to report on Covid duty once again. Even if we report on duty for one day, we have to quarantine ourselves for a fortnight. It isn’t easy to be confined for that long every few days. And when we are called on duty, the workload is beyond overwhelming. We all need to take the right decisions every step of the way to fight the virus.

Weekly Update: Could Covid Horrors Return to Haunt India; Hatred Rears Ugly Head, Again

In a late night address to the nation on Saturday, December 25, Prime Minister Narendra Modi announced that India would be administering third shots of vaccination (booster jabs) for those above 60 with co-morbidities as well as for frontline healthcare workers. He also announced that children aged 15-18 would also be eligible for COVID vaccines. These are timely decisions given that COVID’s latest mutant, Omicron, could spread rapidly in India. The challenge of vaccinating a population as large as India’s is daunting but the good news is that, at least according to official reckoning, 75% of adults have received the second dose of the vaccine.

That’s the good news. The not so good news is that if you take the entire population of the country, then just a little over 41% are fully vaccinated.  Also, it may be a fact that the renewed surge of the virus may be inevitable. According to official estimates, at the time of writing, there have been around 422 reported cases of people infected by COVID. The actual figures in a country as large and as divided by inequality, accessibility, and lack of testing facilities could be way higher. The earlier waves of COVID’s spread were marked by a pattern: initial detection rates were slow, leading to complacency; and then, like a sudden horrific storm, the country was gasping for oxygen and hospital beds.

From most reports based on, albeit limited, research into the Omicron virus it seems that the latest mutant of the pernicious pandemic virus is milder, particularly when it affects fully or partially vaccinated people. However, these are not conclusive findings because the Omicron variant was detected very recently. What is known and is of concern is that this variant is more contagious and spreads much faster than earlier variants.

The other area of worry is the experience of other countries where Omicron is spreading. In Europe, UK, and the US, it is seen that the virus is affecting younger people (aged below 30) more than it is the older population. While there is little research yet to establish reasons behind this phenomenon, the fact is that India’s youth (18-20 year olds) account for more than 20% or more than 260 million people (that is more than half of the total population of the EU region of 447. million). Also, a large proportion of the Indian youth is not vaccinated yet. In that context, Prime Minister Modi’s announcement of vaccination for 15-18 year olds is in the right direction.

There is, however, another area of concern. Many countries in Europe have already slammed the emergency brakes in the form of new restrictions on public events, commuting, entertainment venues, and so on. Many states in India have also taken similar action. But when it comes to compliance by the Indian public, it is a different matter. The correct use of masks is nowhere near universal in India’s densely populated cities; and bans on congregations and public events are still flouted routinely. These can have alarming consequences.

When the second wave hit India, the anguish that millions suffered was heart-wrenching. A total of 48,000 people are estimated to have died as a result of COVID in India. Many more have suffered or are still suffering long-term consequences of the virus. Public memory is short but this is a virus that we need to be prepared to grapple with for a long time. And, while the authorities can attempt to do their bit by ensuring vaccination for all and stipulation of restrictions, much of the onus is on us, the ordinary citizens of the country, to be sensible in the face of adversity.

Hatred Rears Its Ugly Head… Again

The perceptible change in Indian society–no matter which socio-economic echelon you look at–is the increasing insecurity, anxiety and existential angst that minority communities in India have been experiencing over the past decade. It is probably not a coincidence that such feelings have intensified after the Hindustva-espousing BJP-led government came to power at the Centre in 2014. This has manifested in several events: a spate of violence involving alleged cow slaughter; pre- and post-election rioting; and targeted discrimination against certain minority communities.

In mid-December, at a three-day convention of Hindu hardliners in the ancient city and religious pilgrimage destination of Haridwar, several speakers made speeches that were inflammatory and could spark or incite violence against minority communities. In some instances, what was said was in innuendoes. But in a few, there were undisguised call for violence and even genocide.

In a country where secularism and equality for all are principles enshrined in the Constitution, instances such as these coming nearly 75 years after Independence are abhorrent. More importantly, it is the response of the authorities that is of concern. Although there were many protests against the speeches and FIRs were filed, no one had been arrested at the time of writing, more than a week after the convention was held.

What is also of concern is the silence of those in power. Prime Minister Narendra Modi has yet to comment on or condemn the speeches. His colleague, home minister Amit Shah has also not responded. Hindus make up 79.8% of India’s population and Muslims account for 14.2%; Christians, Sikhs, Buddhists and Jains account for most of the remaining 6%. A surge of majoritarianism and hatred of the kind that is demonstrated by the Haridwar gathering is an ugly development in a democracy that prides itself on tolerance and equality. If, in the hour of need, people at the highest level of power choose to remain silent, does it not legitimise the hate?

AFSPA No Longer Relevant In North-East

A day after the Indian armed forces ambushed and killed 17 coal miners in Nagaland’s Mon district on December 4 in what was stated to be a case of mistaken identity during a counter-insurgency operation, a friend sent me this link to a song by a Manipuri band called Imphal Talkies and the Howlers. If you listen to the song, the words are:

“AFSPA, why don’t you go fuck yourself?
Don’t you have brothers?
Don’t you have commanders?
Don’t you have captains?
Why don’t you go fuck them all?
Why don’t you go Kill them all?
Tidim Road is still bloody
And the air smells of gunpowder
And from my windows I can see only widows
And mama don’t want me to sing such songs.
So please please leave
AFSPA, why don’t you go fuck yourself?”

The song dates back to 2016 but the sentiment expressed in it is still strongly alive and widespread through the north-eastern region of India: Manipur, Nagaland, Arunachal Pradesh and parts of Assam. AFSPA or the Armed Forces (Special Powers) Act is hated almost universally in the region. But what exactly is AFSPA?

The origins of AFSPA (like hundreds of Indian laws) date back to the days of the British Raj. In 1942, in an attempt to quell the spread of the Quit India movement, the British colonial government that ruled India promulgated the Armed Forces Special Powers Ordinance. Later, in 1948, to stem the rioting and violence that erupted because of the Partition of India, four ordinances, modeled on the one from 1942, were promulgated to cover four regions, Assam, West Bengal, East Bengal, and the United Provinces. These areas were declared as disturbed and the armed forces were empowered specially to operate there.

After the mid-1950s when the Naga rebellion gathered momentum and a parallel Naga nation was declared, another law was passed. The Naga rebellion (or, as it is officially called, insurgency) was quelled but the act remains in force, validated by regular extensions. This is the AFSPA that (after several amendments) still exists in the area.

To put it in perspective, region-specific special powers were also granted to armed forces in Punjab and Chandigarh in 1983 to combat the rising separatist movement there but the act was repealed after 14 years in 1997. In 1990, a similar act was promulgated in the Jammu and Kashmir region after the spate of unrest and terrorism began growing in the region. AFSPA is still in force in J&K. As it is in the North-East.

In the North-East, almost universally, AFSPA is considered an excessively harsh and severe law that is prone to abuse by security and armed forces. It gives the armed forces the authority to use force or even open fire after warning a person found to be in contravention of the law. In the case of the unarmed Naga miners who were gunned down, interviews with survivors reveal otherwise. The Indian Express published interviews where survivors said they were not signaled to stop nor warned before the forces opened fire.

AFSPA in the North-East has faced criticism for a while. The latest incident brings the issue back into the spotlight. AFSPA has militarized parts of India close to the borders–both in the east or in the west. This has already had adverse effects on civil life, living conditions and the economy in many of these areas. In the North-East where insurgency has been on a steady decline, many believe it is non-aggressive interventions that hold the key to normalizing the tension.

India’s north-east has its own share of problems. Many north-easterners face discrimination in other parts of India; industries have not been investing in the region; and social and cultural differences are often not acknowledged or appreciated by the rest of India. The public mood and opinion the region have suffered another setback with the recent horrific killings, which even the local police authorities have described as being “murders”. It is time now to review the provisions of AFSPA, at least in the North-East

How dangerous is Omicron?

Ever since a new variant of COVID-19 surfaced in South Africa, giving yet another never-ending twist to the ongoing pandemic, questions have arisen about how bad this new mutated version, named Omicron, could be. To be sure, there are no clear answers. At least, not yet. But there are some indicators of what the variant can do.

First, Omicron may be more easily spreadable. If the surge of cases in South Africa is indicative of anything it shows that Omicron could be more easily spread. As on December 9, in South Africa, records showed that the virus increased 255% in just a week. Although deep research into a very recent variant such as Omicron has not been done yet, epidemiologists believe that it can infect people with low immunity levels more than earlier variants of COVID-19 do.

Second, it has already been noticed that vaccinated people or those who have already been infected before by COVID can contract the variant more easily than the earlier mutations of the virus. 

Third, and there is a small nugget of hope here, is that the conditions that accompany infection by the virus may not be that severe. Although it may be too early to pass judgment about it, many patients infected by Omicron have shown milder symptoms than what happened with earlier variants.

While research continues into COVID and its several variants, the bottomline is that there is no substitute for abundant precautions against the spread of the virus: masks, social distancing, and vaccination. These may not offer 100% protection but till the elusive COVID-free world returns, these (often irritating) measures have to be prudently adopted.