Not that it’s ever gone away, but the old Delta variant cases are down, the masks have slipped, it’s wedding season, and life is regaining a semblance of normalcy. Sadly, Omicron is likely to change all that.
Omicron spreads four times faster than the Delta variant. In the UK, it already accounts for almost 40% of all cases and is expected to replace the Delta variant by Christmas. The doubling rate has now been reduced to two days and on Wednesday, the UK recorded 78,000 cases, making it the highest number of positive cases since the pandemic began.
Only 57 cases of Omicron were reported in India. This is certainly an understatement. First, genetic screening for the variant is limited. The National Institute of Virology receives about 100 samples per day. Compare that to nearly half of the UK labs that can detect the variant. Second, the screening is still aimed at overseas arrivals. A local broadcast has already occurred. Finally, the presentation of the disease is different, which makes it less likely that people will be tested. More people report symptoms that suggest a common cold, and there are fewer reports of classic symptoms, such as loss of smell and high fever.
News from South Africa seems to suggest that the Omicron variant may have a “mild” impact: the fatality rate is 0.5% compared to 3% for the Delta variant. If you compare that to the sheer ferocity of the virus’ spread, the data would seem less optimistic. Simply put, 0.5% can translate into huge numbers if the virus sweeps through cities. In the UK, with its record number of positive cases, hospitalizations have already risen 10% week over week and up to 30% in London. Death numbers are delayed by a few weeks and there may be gloomier news in the new year. The population of South Africa and the United Kingdom is just a quarter of that of Uttar Pradesh. It is not difficult to see how a supposedly less lethal but much more infectious variant can overwhelm the healthcare system and cause large numbers of deaths.
The ‘mild disease’ label remains unproven. Even if true, it is not clear whether this is due to a “weak” virus or a virus weakened by immunity (vaccine or infection). Until we know, we should show off the latter. WHO emphasizes this point. South Africa recently had its third wave (July to November), which may explain why protective antibody levels may be higher and may compensate for relatively low levels of vaccination coverage (26%).
Beyond the usual advice on masking, hand washing, etc., our best defense lies in increasing our immunity. The data clearly show that protection through two doses of the vaccine diminishes after six months. A third dose may not reduce transmission as much, but it restores protection against serious diseases. It is not surprising that the UK and the EU are competing to give third doses or booster shots to their populations; All adults who are beyond three months of the second dose are offered boosters. There are huge lines at vaccination centers and almost 1 million vaccines are injected every day.
India is vaccinating almost 8 million vaccines a day and has a mature production and supply chain. As impressive as it may sound, it actually translates to 38% of the population having received two doses. The elderly and health workers were prioritized in the vaccination campaign. Most of them are six months past their second dose and are vulnerable to re-infection with Omicron. This makes a strong case for the introduction of specific reinforcements for this population (if not all adults). This should be possible without interrupting the ongoing effort to vaccinate everyone with two doses.
We cannot afford to assume that we are dealing with a weak virus. Our best hope is to strengthen our defenses. Winter, upcoming elections in various states, and the general lowering of the guard in the population can create a perfect storm.
Boosters should be offered now.
(Dr Amit Gupta is the clinical director of newborn services at Oxford.)
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