Stop confusing public on Omicron, not much known about new variant; let's not lower guard, say virologists

Almost two years into Covid-19 induced pandemic and many variants later, fear and fragmented reactions have gripped policy makers in India with the latest news of the spread of Omicron variant of the coronavirus. This variant was first reported to the World Health Organisation from South Africa on November 24, 2021. And even then much remains unknown about the Omicron variant.

Indian authorities have stated that the new variant of Coronavirus spreading across the globe Omicron is not in the country, however virologists in India have stated that Indian authorities can’t be sure unless the virus DNA is traced, isolated and sent for gene sequencing.

There has been news of a man in Chandigarh who returned from South Africa and tested positive for Covid-19. His family members and domestic help have also tested positive for the virus. The Chandigarh administration stated that the samples of the positive cases would be sent to National Centre for Disease Control in Delhi for genome sequencing.

The World Health Organisation has stated that it is not yet clear whether infection with Omicron causes more severe disease compared to infections with other variants, including Delta. Preliminary data suggest that there are increasing rates of hospitalisation in South Africa. The country is sequencing 0.8 per cent of its virus samples.

“Preliminary evidence suggests an increased risk of re-infection with this variant, as compared to other Variants of Concern. The number of cases of this variant appears to be increasing in almost all provinces in South Africa,” stated WHO in its advisory on Omicron.

In addition to South Africa, the strain has been found in United Kingdom, Australia, Hong Kong, Botswana, Israel, Germany, Belguim, Italy, Czech Republic, Canada, Netherlands, Denmark, Portugal, Spain and Austria.

“From a public health and virology perspective, a new variant is not at all unexpected. This happens when along with an ongoing transmission, there is a large group of people who are unvaccinated. Then, a breakout mutation is likely to occur where your vulnerable population is. It is because surveillance systems were robust enough to pick it up, we have found it before major surges have happened around the world,” said Dr Oommen John, senior research fellow at the George Institute. Of the 1.2 billion people in Africa, only 6% have been vaccinated.

Our second wave was due to the Delta variant of Coronavirus, pointed out John, but at that moment no one was willing to acknowledge it as the Delta variant. India marked Delta as a variant of concern only in June of this year. “Now, in case of Omicron, we have picked it up as a variant of concern before systems broke down and the health systems crippled,” pointed out John.

Now that there is awareness of the new variant of concern, one has to be careful in determining how are people affected, what age groups, clusters of infection, or anything unique about this variant. “This knowledge will be important to keep the variant under control. As of now, we have no proven data, only anecdotal information that people with the new variant don’t have classical symptoms, but only tiredness and after tiredness, there is rapid deterioration,” explained John.

According to anecdotal information, Omicron patients have relatively mild symptoms, and none of the loss of taste and smell typically associated with Covid-19. Instead, they have had reported unusual symptoms, such as intense fatigue and a high pulse rate.

This was reiterated by virologist Dr V Ravi, who is on Karnataka’s Covid-19 advisory board. “We know very little about Omicron. WHO has listed countries where it has been confirmed. No one has the answer to if it is more lethal or not. Data drives conclusions and at this point, there is no data. I do not know for certain, if it is infectious. It appears to be as it has spread quickly within Africa. It is replacing existing variants quite fast, but to confirm it we have to isolate the virus and compare it with earlier strains,” asserted Ravi.

It is best to assume that Omicron variant is spreading fast, underscored Ravi; and it is better to assume that this variant may produce a different type of disease as this virus has been mutating. “We also have to assume, because of the mutations, that it can escape immunity induced by vaccines partially. Had it been a virus which was extremely virulent, the number of deaths in South Africa would have gone up. Every other person who got it should have died, but that did not happen. There is infection, but not deaths. This is based on a few 100 sequenced patients. So, we have to wait until more data is available,” explained Ravi, who has recently taken over as the head of R&D at of Tata Medical and Diagnostics.

The key message for India is to be on guard, said John, and to use proper documentation of the clinical procedure so that any early signs of clusters of infection can be picked up. Virologists have asserted that there is a need to continue to trace, identify and isolate the patients.

“Until data is available, we have to assume here is a virus which is challenging Delta variant. To be careful, all you need is to protect yourself by wearing masks, social distancing and personal hygiene. This needs to repeated, but people are tired of it. Here is a new variant warning us,” asserted Ravi.

“The only good thing for India, at the moment, is the fact that we have a very high rate of sero-conversion. We have a large population that has antibodies against Delta, so we need some monitoring to see if people who have prior antibodies are getting infected this time or not. We will know that only if have kept a good record of those who got infected and those who participated in the survey,” pointed out John.

Virologist Shahid Jameel, in an interview, underscored that Delhi showed 97% with antibodies, Mumbai around 85-90% and so on. This meant that a very large fraction of Indians would be protected from severe disease caused by Omicron or any other variant. Jameel is the former head of the advisory group to the Indian SARS-COV-2 Genomics Consortia (INASACOG).

Hospitals and labs were required to update Indian Council of Medical Research on all those who took the RT-PCR tests. So, now there is a need to use the data that is available to see if people who are now showing symptoms or are getting tested have had a prior test before. Unless close tabs are kept on the data, it is extremely difficult to understand the nuances of the variant.

At the moment, it is not known if those who have been vaccinated or those have had Covid-19 before will get infected with the new strain, said virologists. “Most often, everyone is shooting in the dark. No one knows on what basis people are claiming that Omicron is ‘five-times more virulent’. We need data to show that one infected person will infect six others as compared to the transmission rates of the earlier variants,” added John.

The government should be clear in its messaging. Currently, most clinicians have the impression that a person is unlikely to be infected by this variant unless there is a history of South Africa or overseas travel.

“Doctors will not apply a clinical mind to get a test. When public health workers treat any patient, they need to look at it as a variant of concern and treat it likewise. What we did not do during the first two waves was use the clinical information that was collated by different organisations to quickly tell patients and health workers what to take care of. If there was a way to inform everybody else what infection would be like, it would help us work against the pandemic quicker. That’s what we need to do instead of jumping on TV and confusing the public,” quipped John.

Since India has gone through a lethal Covid-19 phase 2, lessons must be learnt from it. “We should quickly be able to put down guidelines, but that alone is not enough. We do not know if this virus is in circulation in India. We need to sensitise our clinicians and public health workers to ensure they not only do a test, but also sequence it,” pointed out John.

Shutting of borders is not the answer either, maintained Ravi, while adding that he is not the right person to comment on it. “Viruses will come through, but vigilance, quarantine, tracking, testing and isolation are mechanisms to be put in place at ports of entry. It will delay the spread in the country,” said Ravi.

There is a need to vaccinate all the citizens in the country as only 42% of the country has been fully vaccinated. “About 90% of doses in India are Covishield, and this has limited use as a booster. For that we will need RNA, DNA or protein vaccines. For the moment, just make sure more and more people get the two doses. Booster shots might help,” reiterated Jameel in an interview.