‘Omicron’ Sets Alarm Bells Ringing

The first, the second, the third, the fourth and now the fifth wave of COVID-19 strikes especially the European countries. Fearing the fifth wave due to sharp and sudden rise in COVID cases, governments are forced to re-impose restrictions to control the pandemic. Among the countries badly hit in the latest surge are France, Germany, Denmark, Norway, South Africa, the Netherlands, Austria and Russia. Since the beginning, SARS-CoV-2 infection has been peaking and plummeting in a roller coaster fashion. The virus has in fact turned this epidemiological pattern to its advantage, evolving itself into a more resilient and acclimatized version.

People already weary of living under COVID restrictions for more than 18 months are now turning violent and coming out against COVID regulations. Demonstrations against the re-introduction of COVID restrictions have sparked across several European countries. This mass psyche is a manifestation of frustration influenced by living under protracted restrictions curtailing freedom.

Even as the world is still battling to contain the pandemic and damage caused by Delta variant, the South African scientists have discovered a new coronavirus variant. The WHO on Nov.26, 2021 classified the B.1.1.529 variant of SARS-CoV-2 detected in South Africa, the ‘Variant of Concern’ (VoC) and designated it as ‘Omicron’. This variant has mega mutations, several of which are novel, affecting the spike protein used for most vaccines (except COVAXIN where whole inactivated virus is used). These mutations raise questions regarding its transmissibility, immune system evasion and vaccine resistance. The variant may also escape cell mediated immunity conferred following a previous exposure to SARS-CoV-2 virus and/or vaccination. The measure of transmissibility, the R- value (refers to how many people an infected person infects on an average), in case of Omicron is far higher (experts say six times) compared with the ancestral SARS-CoV-2 virus. While vaccine breakthrough infections per se are not the major concern, (Delta also caused vaccine breakthrough infections), clinical outcomes in terms of severity of infection and mortality are the key concerns which remain to be seen.

The virus will keep on transforming itself continuously unless herd immunity is acquired i.e., a large portion of community becomes immune to an infection by way of natural infection and/or vaccination, a crucial factor in ending the pandemic. Relying on natural infection of COVID to achieve herd immunity would involve colossal life loss, morbidity, depletion of resources and have a far-reaching impact on economy. Universal vaccination, that too in shortest possible time-span is the only key to effectuate this objective. But the challenges involved are many, to name a few -

• i. Vaccine hesitancy: Due to religious reasons, fears about the possible risks, skepticism about its benefits, people shirk taking the vaccine.

• ii. Uncertainty about protection: It is not clear how long the COVID vaccines will protect you from the disease. People are not fully convinced about vaccine effectiveness and are apprehensive of long-term side effects.

• iii. Uneven vaccine roll-out: The distribution of COVID vaccines greatly varies among and within countries for one reason or the other. If one community achieves a high COVID-19 vaccination rate and surrounding areas do not, outbreaks can occur if the populations mix.[1]

By virtue of their inherent nature, viruses are always changing resulting in evolution of new variants. So long as the chain of coronavirus transmissibility among the population is not broken, mutations will continue to happen. Infections occurring in fully vaccinated people, re-infection in those who have already suffered from the disease, ineffective immune response resulting in prolonged COVID, make favorable ground for new strains to emerge and not letting the pandemic die down. Scientists believe that people especially immune-compromised who harbor virus for a longer time and experience prolonged active infection because they cannot clear the virus may act as harbinger host for new variants. Omicron, according to initial reports was first detected in an immune-compromised patient suffering from HIV/AIDS in South Africa.[2]

Given the unpredictable and highly contagious nature of the virus, sustainability of COVID infection for prolonged time in immune-compromised patients, and emergence of new strains, the pandemic is not halting. Demographic surveys have shown that re-infection and vaccine breakthrough infection are occurring despite high levels of vaccination and other COVID restrictions. Serosurveys have shown that antibodies in fully vaccinated people start waning after 5–6 months of second dose. Concerns over waning immunity and SARS-CoV-2 variants have convinced some countries to deploy third vaccine dose (booster dose) so that circulating antibody cover is maintained for a longer time. Even the WHO has endorsed administering booster doses as a priority to at least the most vulnerable and “at-risk” populations.

Need of the hour

• Stepping up surveillance and genome sequencing.

• Not letting the guard down and continue to follow COVID appropriate behavior.

• Accelerating vaccination drive; addressing uneven roll-out of vaccination universally. “No one is safe until everyone is safe.”

• Pushing for booster dose.

Ultimately, evenly rolled-out universal vaccination and booster dose together with non- pharmaceutical interventions are still our best bet.

Remember, the virus is not at rest!

Disclaimer

This article documents current events and experts' opinion available at this point in time. Information may change as latest updates pour in.

Publication History

Article published online:
31 December 2021

• References

• 1 Herd immunity and COVID-19 (coronavirus): What you need to know. Accessed on 22 November 2021 at: https://www.mayoclinic.org/diseases-conditions/coronavirus/in-depth/herd-immunity-and-coronavirus/art-20486808
• 2 Omicron variant could have emerged from AIDS patient with prolonged Covid. Available at https://theprint.in dated 30 November 2021. Accessed on December 1,2021