Omicron variant: ‘Immediate ban should be imposed on travel from high-risk countries’

Omicron has been classified as VOC based on the 50 plus mutations. Of these, 32 are specifically in the spike protein, and 10 are exclusively within the ACE receptor binding domain of the viral epitope.

The presence of several mutations clustered in the spike region indicates the emergence of higher transmissibility, higher immune evasion, and possibly challenges with vaccines and other remedies such as monoclonal antibodies.

At least six countries have detected the presence of this new variant — South Africa, Botswana, Hong Kong, Belgium,  UK and Israel. Not surprisingly, the UK and the US government have reimposed the countermeasures to curtail the spread across borders.

The Risk

Initial reports suggest that the transmissibility of the new variant is several times stronger than the Delta variant.

Also, if the mutations in the spike proteins are considered to have a phenotypic effect (and we do not want to wait to watch if they develop phenotypic effect), then it may be a pointer to another wave of infections.

Best policy options

Policy options are dependent on the level of compliance in the community. Given the population’s highly erratic pattern of compliance, it is pertinent that the policies be stringent enough to curtail and contain the virus to nip it in the bud. This will ensure the virus is stopped before it spreads in the population and creates devastation similar to the one following the spread of Delta Variant not too long ago.

Concrete policies

There should be no ambiguity to restrict travel from high-risk countries. An immediate travel ban should be imposed, as has been done by the UK and the US governments.

Business as usual should continue within the country. Policies should not be enacted to restrict any schools, colleges, business, and professional activities unless a variant of concern is found that is likely to disrupt the economy and living.

Implications?

By restricting and imposing travel restrictions from high-risk countries (only), we will ensure that business and interactions with other countries are not disrupted while mitigating the spread of the variant from high-risk countries. Business as usual within the country will not disrupt the economy and other activities despite low compliance within the country. The downside to this is the restriction to travel to these six countries. In the larger scheme, this is not a risk worth taking. However, if we deny this option, India will expose its vast non-compliant population and subject it to a potential of a surge like the one from Delta not too long ago.

Can we afford to wait?

Policymakers are worried that we have little data except for the mutations. The phenotypic correlation for the mutation is not obviously established.

Logically, it is right to wait for the mutational data to be correlated with the clinical, vaccine, and other phenotypic features. However, pragmatism indicates we can impose travel restrictions and wait and watch. If the data indicates no phenotypic correlation, we can always remove the restrictions.

Delta variant had caught us badly unprepared, and it had a huge toll on life, economy, and living. Repeating such an episode only indicates a paralysis of decision-making or an aptitude to accept risk in the absence of substantial data. Our best course of action is to impose strict travel restrictions on those high-risk countries without further delay while we watch data emerge and substantiate a decision.

Dr Shashank Heda is the Founder and Chief Executive of CovidRxExchange, an international non-profit organisation that was established to enable medical doctors and policy planners. Dr Heda brings a confluence of experience from molecular medicine, pathology, and risk management. He has led the policy papers for select states and has been an adviser to policymakers.