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Tuesday, January 18, 2022

Defending ourselves against Omicron

🔴 Rajesh M Parikh writes: Among other measures, we must overhaul our vaccination policy, particularly with regard to booster doses in vulnerable populations

Written by Rajesh M Parikh |
Updated: December 18, 2021 9:31:11 am
A worker sticks social distancing markers at Sardar Vallabhbhai Patel International airport amid concern over 'Omicron' variant of coronavirus, in Ahmedabad (PTI Photo)

If all the world’s a stage on which Covid-19 has been the longest-running act in a hundred years, then the theatrical axiom about the unsustainability of two prima donnas in the same scene was bound to take effect. On December 12, British Prime Minister Boris Johnson bowed before Omicron and declared an “Omicron Emergency”, predicting a “tidal wave” of Omicron cases.

Johnson’s announcement was preceded by the publication of a not yet peer-reviewed modelling study by the London School of Hygiene and Tropical Medicine (LSHTM). The model suggests that if additional control measures are not put in place in the UK, the Omicron variant may result in higher levels of cases and hospitalisations in the country than those seen during January 2021. In the most optimistic scenario, between December and April, there will be close to 25,000 deaths. If no measures are put in place, this number rises to 75,000. With immediate effect, the UK introduced booster doses for all eligible persons.

In the same announcement, Johnson also stated: “Some medical appointments are to be postponed to focus on boosters”. This could be the unfortunate scenario around the world. Due to a diversion of attention and resources towards Covid, a large number of people are deprived of treatment for existing medical illnesses. In the time since the detection of Omicron in Botswana, while there has been one known death due to Omicron, there have been three million deaths due to other preventable or treatable causes. These include cardiovascular diseases, cancer, diabetes, tuberculosis, malaria, diarrhoea, AIDS and suicide. In the months to come, the indirect cost of Omicron may be higher than that of the variant itself.

According to the WHO, we are facing a large undercount of overall deaths directly and indirectly linked to Covid-19 with the latest Covid deaths reported to the global health agency already reaching 3.3 million, based on the excess mortality projections calculated for 2020. According to the WHO’s most recent malaria report, an estimated 241 million malaria infections and 6,27,000 malaria deaths occurred globally in 2020 — around 14 million more cases than in 2019, with 69,000 more fatalities. During the pandemic, almost two-thirds of excess fatalities were attributable to interruptions in malaria prevention, diagnosis and treatment.

Epidemiologists consulted by The Economist have developed a machine-learning algorithm that calculates the number of excess deaths in each nation on each day since the pandemic began. It is based on over 100 statistical variables as well as estimates of deaths in excess of official figures. Although the official mortality toll from Covid-19 is currently 5.3 million, the best estimate is that the true toll is 17.6 million. Based on the model, there is a 95 per cent possibility that the actual number of fatalities is between 11million and 20.5 million more than the official number. In India, the model indicates that 2.3 million people had died from Covid-19 by May 2021, compared with about 2,00,000 official deaths. These figures include unaccounted death due to Covid and mortality due to other causes.

Omicron is spreading relentlessly and is currently on every continent and in over 80 countries. It exacts a different toll across nations. For instance, for reasons that are unclear, patients in South Africa are recovering faster with milder illnesses than those in the UK. The WHO Director-General has warned that health authorities should no longer assume that Omicron is a mild variant.

To minimise the effects of Omicron we need to look not only at the low lethality of the variant, but at its larger impact on global health. Only by minimising hospitalisations due to Omicron can we focus on other illnesses. An increase in testing to identify and isolate individuals with Omicron for prompt treatment, increasing the capacity for genome sequencing within the nation and rapidly deploying booster vaccinations along with reiterating Covid appropriate behaviours are measures that will minimise the collateral damage caused by Omicron.

Genome surveillance tracks changes in the virus’s genetic make-up to examine how variations in the order of the nucleotides influence viral actions. We need to better understand Omicron’s transmissibility, severity, evasion of antibodies acquired from past infections or immunisation and the likely evasion of detection.

Vaccination continues to be the best global defence against SARS-CoV-2. To contain Omicron and its collateral damage, it is time to overhaul our vaccination policy, particularly with regard to booster doses in vulnerable populations such as immunocompromised patients and healthcare workers. Alternatively, we can consign our rapidly expiring stocks to the dustbin. This need not be a Shakespearean dramatic dilemma.

This column first appeared in the print edition on December 18, 2021 under the title ‘On Omicron alert’. The writer is Director, Medical Research and Honorary Neuropsychiatrist at the Jaslok Hospital and Research Centre, Mumbai

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