Saturday, May 28th, 2022 00:56:24

Omicron: India faces Infection Surge, the Size of a Tsunami : Vaccination emerges as the best bet against highly transmissible new variant

By Dhananjay Kumar
Updated: January 16, 2022 3:12 pm

The whole country is staring down the barrel of the gun called Omicron. The new variant and its breath-taking speed of transmission is scary even if it is considered mild.  Fearful memories of the second wave keep haunting. Everyone is askance what if it spins out of control!

India is in the throes of 3rd wave of Covid 19 in the form of highly transmissible variant Omicron. As omicron cases gallop, the projection of infected numbers is really intimidating, one estimate putting it at astronomical 10 lakh new cases a day against maximum up to 4 lakh new cases a day  in previous second wave. But ‘mild’ is the word that seems to blunt its edge a bit and is comforting. Vaccination is going to be sheet anchor in the middle of raging infection. Lung fortunately seems to have been spared by the new variant. Symptoms are mostly skin deep and can easily be tackled by basic medicines.

But if we collate what experts across the board have to say, cautionary notes are loud and clear- no matter how mild omicron may seem, the fact should not be taken as a license to throw caution to the wind. The fine print is – do not push the luck and tempt fate. Rush to get vaccinated and stick to covid appropriate behaviour. Protection from infection still emerges as the best strategy. If we are looking for any last word on Omicron, there is none. Despite far less virulence of Omicron, experts are not giving any concessions for deviant behaviour. They are saying discretion would be better part of valour.

As Udai India talked to a number of experts, the extent of vaccination emerges as the best bet against prowling variant. The ‘mildness’ of the infection might be the function of COVID vaccination. Omicron may exemplify vaccination triumph in India. PM Narendra Modi might emerge as saviour for being focussed on vaccination and consistently pushing the drive.Experts have said vaccination drive will have to race the omicron pace to keep the impending crisis at bay.

The best-case scenario being envisaged by the experts is that the Tsunami size of infection might simply wash over the Indian multitude without leaving a trail of deaths witnessed during second wave of the pandemic. The hope is only miniscule percentage of infected personsshould show severity of symptoms and need hospitalization. Data so far are supporting the optimism. Experts also vouch that India is now better equipped to tackle the surge.

Though vaccination might prove a saving grace, experts are advocating alertness and preparedness, saying if we fail to prepare, we might prepare to fail. Lest the astronomical numbers overwhelm, experts are emphasizing speeding up of vaccination to cover yet unimmunized population and religiously following of covid appropriate behaviour i.e., masking, social distancing et al. They fear the propensity in Indian population of throwing caution to the wind. So, describing omicron mild and far less deadly might be fraught with risks in Indian context as well. According to them, India can size up the 3rd wave provided we behave sensibly.

3rd wave is a fait accompli and latest estimate added up by researchers at the Indian Institute of Science (IISc) &Indian Statistical Institute (ISI) predict that the country is likely to witness over 10 lakh Covid cases in January itself. The Bangalore study predicts that 3rd wave may peak between January end and early February, in varying degrees in different states. The study also predicts flattening of curve by beginning of March.

In the meantime, World Health Organization (WHO) is overly cautious and wants people not to be carried away by mildness of Omicron. The apex health body is of the view that Omicron is less severe only in people who are fully vaccinated. Dr Tedros Adhanom Ghebreyesus has reg flagged saying that it is a fallacy that Omicron is mild, only that vaccination is making it less severe. He expressed concern that by the going rate of vaccination, many countries might fall short of fully vaccinating their 70 percent of population which is threshold for herd immunity. (WHO) has called mild as misnomer because according to it vaccination is making the difference. The apex body also fear that over emphasising mildness of omicron may induce people to lower the guard.

Dr N K Arora, the chairman of the COVID 19 working group of NTAGI (National Technical Advisory Group on Immunization) has announced that third wave is already upon us but said many things that lessen worries the kind of which we confronted in the second wave.  According to Dr Arora, in the major Indian Cities, the omicron variant of the coronavirus is accounting for more than 50 percent of the fresh cases of the infection and the massive surge in the number of cases over the last couple of weeks is indicative of a third wave of the pandemic as is being witnessed in several countries. Omicron are being detected in most of the states in the country.

According to Dr Arora, there are some factors that instil hope of better tackling the surge. He stressed that there is no need to panic as over 80 percent of the people in India have been infected with the virus naturally, 90 percent of the adults have received at least one dose of an anti- covid vaccine and over 65 percent are fully vaccinated. These facts put India on a stronger position in grappling with the infection surge.

Dr Arora adds- If we look at the behaviour of the omicron wave in South Africa, where it rapidly increased in two weeks, the number of cases started coming down and most of the cases were either asymptomatic or had a mild illness, along with decoupling of the total number of covid cases vis a vis those requiring hospitalization. All these factors indicate that the omicron wave in South Africa may soon subside.

Arora pointed out that there are some epidemiological similarities between South Africa and India. The natural infection rate in both countries is very high adding that however immunization rates in India are several folds higher. In view of that, we may see a somewhat similar pattern in India as far as third wave is concerned. He said, ‘Those who are yet to take the vaccine or are partially vaccinated should get the jab for protection against severe disease and hospitalization.’

Dr Devi Shetty, Chairman, Narayana Health, is one expert who has always cautioned government just in time and prompted it for preparedness, is bullish about country’s ability to tackle upcoming Omicron. Dr Shetty says – Though Omicron is yet to be fully understood, we know it for sure that it is contagious and can spread very fast. Given data from South Africa, where Omicron reared head, and our own so far, it is apparent that it is causing mild symptoms. What is important for everyone to know is not whether they are going to be infected or not but that whether they will land in ICU or not. That fear so far is not there. It is very unlikely that it will be more vicious than we have gone through in second wave which was really very terrible. As for Omicron, there is no cause to push the panic button.

Dr Shetty further adds- Even if Omicron spreads fast, India is now in position to manage it. We have done it in 2nd wave and our experience during delta spread has taught us many lessons that will come handy is sizing up Omicron surge. We are certainly better equipped now. The country is fully prepared to handle any eventuality. We need not worry about what we went through in 2nd wave. We have adequate number of ICU beds, all the medicines required and our doctors have become extremely smart to manage it. The govt has taken all the necessary steps and plugged the gaps that surfaced during Delta wave. There is no more concern about oxygen availability. That has been take care of adequately. Half the country is already exposed to Covid, remaining half or more are already immunized which put us in much stronger position to manage it. In the meantime, keep wearing your mask and practising social distancing and maintaining hand hygiene.

Describing COVID Vaccine as medical miracle, Dr Shetty further adds- booster dose will for sure be necessary but our first priority should be to fully vaccinate people. we should concentrate on completing second dose vaccination. Only after that we should think of taking up booster dose, which of course will be needed. At least vulnerable people need to be protected by booster doses. We still have some time left for booster dose. We really first need to work hard for completing full vaccination. It is a positive development that there is no more the problem of vaccine reluctance. There are enough vaccines available for this. There are more than 50 lakh vaccines stuck in private hospitals. Civil society should also take some responsibility. The govt cannot do everything. Vaccination is a medical miracle. It is certainly proving a real bulwark against new variant.  We see only report of number of people being infected by omicron. If we look the data for how many of them landed in ICU, we come to know that only a miniscule percentage needed ICU, even if hospitalised. So, rush and take second dose. It is not a vaccination against COVID, it is vaccination against death. In one instance, out of 300 infected persons, hardly anyone landed in ICU.

Dr Naresh Trehan, Chairman and MD, Medanta, red flags any lowering of guard thinking Omicron is mild and asserts protection from infection is still the best bet. Dr Trehan says, ‘Omicron is a super spreader. One infected,person can infect at least 20 people. Its doubling rate is also extreme. Of course, so far, we know seriousness is less- reason being vaccination and a lot of natural immunity. There is danger that the number of infected people could be astronomical. Mild or serious, we cannot take chances and protection from omicron should be our top priority, we can nowise lower our guard thinking that symptoms are mild. We will have to realise that even in Omicron, we are facing very challenging situation. Of course, this variant is far less virulent than the dangerous delta variant in the second wave. We never know when this variant become virulent because there are always threat of more mutations. If at all omicron becomes more virulent, we would be faced with real challenge. It is why protection is the best strategy. Mild symptoms should not make us lower the guard.

Dr Trehan adds, ‘The govt needs to offer vigorous response through tracking, tracing and treating. Good regulations must be in place and strictly implemented to stop people making crowd. The number of people at any public place should be limited. No matter how mild it is, play it safe. Family, community and the government all need to come together to offset the potential danger that Omicron might trigger. Even if mild, threat of further mutations should not be discounted. This threat increases as omicron spreads more and more. It is very essential to take preventive measures. If we become proactive this threat might diminish to a great extent.

Dr D S Rana, Chairman of Board of Management, Sir Ganga Ram, says, ‘data available from all over the world says that this variant is milder in nature, which is really good news. It is comforting indeed that hospitals are now better equipped to tackle omicron variant which of course has proved a super spreader. Less hospitalization and need of less ICU beds would really make things very simple. But despite Omicron being milder version of pandemic, lowering of guard is not advisable at all. I would advise people to stick to the same number of precautions, namely, wearing mask, maintaining social distancing and hand hygiene. Accelerating the pace of vaccination is the need of the hour. It looks that vaccination has a role in making Omicron much less virulent.’

As Omicron launches itself in full steam in Delhi and other parts of the country, the words of Dr Randeep Guleria, Director, All India Institute of Medical sciences (AIIMS) are quite comforting. He has said Omicron is causing mild illness and there is nothing to worry but observance of caution and continuance of COVID appropriate behaviour is a must. According to him, it is comforting to know that the new variant does not affect lung but only upper part of respiratory tract. So, people who are not suffering from comorbidities have not much to worry and should not rush to hospitals. Effective home isolation should be sufficient for them. Dr Guleria stressed the need of effective home isolation.

In a webinar organised by Union Health Ministry on January 5, Dr Guleria and other doctors of AIIMS warned against misuse of steroid, Remdesivir and costly monoclonal antibody. Many doctors engaged in treatment of Covid in different states also participated in the webinar. The webinar discussed the protocol of Omicron treatment. It was noted in the webinar that more young people are being infected by Omicron and most cases are showing mild symptoms.It was opined that medicines should be given on the basis of

symptoms. Infected people in home isolation will have to be wary of using steroid and Remdesivir and other medicines. Dr Niraj Nischal, Professor Medicine in AIIMS said that studies being done abroad underline that Omicron is not impacting lung so much as did Delta variant in 2nd wave. He said that patients should be given medicine on the basis of symptoms, namely, if there is fever, paracetamol should be taken; in case of sore throat gargle, in case of nose being blocked steam and in case of cough any cough syrup according to the advice of doctor should do the needful. If fever continues beyond three days coupled with difficulty in breathing and oxygen level dipping below 93 should be cause for concern and calls for hospitalization.


By Dhananjay Kumar

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