Author : Mona

Expert Speak Health Express
Published on Jan 11, 2022 Updated 2 Days ago
While lockdown might not be necessary in this third wave, ensuring compliance with COVID-appropriate behaviours is a must to prevent any untoward consequences
The Omicron Update: Assessing early indicators in India The World Health Organisation (WHO) tagged the new COVID-19 Omicron (B.1.1.529) variant as a variant of concern on 26th November, 2021, only two days after it was brought to its notice. The first known specimen of this variant was recorded on 9th November, 2021 in the Gauteng province of South Africa, after a new surge of cases was witnessed post-Delta. By 17th December 2021, the infections had already peaked at a higher than ever record (see below). Figure 1: South Africa’s Covid-19 Trajectory Source: Our World in Data Figure 2: Early rise in cases due to Omicron across countries Source: Our World in Data South Africa’s peak was seemingly as rapid as its fall. Other countries like US, UK, India and France are also witnessing a similar trajectory of sudden, unprecedented rise. While WHO warns that the doubling time of this variant is 2-3 days, an England study estimates it to be probably lower. Further, the risk of reinfection from the Omicron variant is almost 5.4 times higher than Delta due to its immunity-evasive (both natural and vaccine-led) characteristics. This implies that those vaccinated are also at significant risk. After analysing anecdotal data from Denmark, the University of Copenhagen has emphasised that the heavily mutated virus has much higher transmissibility than Delta, but the reason for such an expedited rise is its feature of breaking through vaccine immunity. RNA viruses like the coronavirus have a tendency to evolve gradually, but it is believed that more immunity and numerous mutations have led to decreased severity. Studies from the UK have found a lower overall risk of hospitalisations and a substantially lower risk after three doses of vaccines compared to the unvaccinated. Early studies from South Africa also found that severe hospitalisations during the Omicron wave was 28.8 percent compared to 60.1 and 66.9 percent in the previous two waves. Moreover, within the hospitalisations, it was further 73 percent unlikely for the patients to develop fatal conditions. The infection was primarily higher between persons who are 18-39 years of age in both the UK and South Africa studies. Figure 3: Hospitalisations across countries Source: Our World in Data The above graph shows that except for the US, the emerging data on Omicron-led waves from France, UK, Italy, Spain, Israel, Netherlands, Canada, and Belgium show considerably lower growth in hospitalisations than previous ones.

What do India’s numbers look like?

Unlike the second wave whose climb was fast but gradual, the third wave, dominated by Omicron, in India is rather hurried and steep. Though India’s sharp rise closely resembles the growth in France, the UK and Italy, it is currently at a lower number. This likely is a result of poor testing and surveillance as actual infections on the ground are not captured. Figure 4: Early development of COVID-19 during the second and upcoming third wave Source: covid19bharat.org; Analysis: Author’s own Note: Here, the Second-wave covers the period between 11th March - 9th May, 2021 and Third-wave is studied from 11th November 2021 to 9th January, 2022 Between Christmas to 9th January 2022, India’s seven-day average of new cases and the daily positivity rate have jumped by almost 1600 percent. At this point, public health officials believe that more than 80-90 percent of the new cases emerging out of hotspots like Delhi and Mumbai are Omicron cases, despite the delay in genome sequencing results. Figure 5: COVID-19 Trajectory: 7-day average of new cases and the positivity rate Source: ORF Covid Tracker Additionally, the early study of the variant shows that it hasn’t affected the number of deaths as much as the new infections and predictions of lower hospitalisations remain prominent. But the assumption that growth will be less does not imply that there will not be as many deaths. Between Christmas to 9th January, 2022, the seven-day average of new deaths (after excluding backlogs) has risen by 71 percent. It is a clear indication that the virus will kill, if we let it. The first death by Omicron was reported from Rajasthan last week on 5th January, 2022. Figure 6: Covid-19 growth in India in New cases and deaths Source: ORF Covid-19 Tracker In addition to the virus’s increased transmissibility, several risks make our populations vulnerable. India has fully vaccinated only close to 65 percent of its population (see below). It is much less compared to other advanced countries like Denmark, the UK, Spain, and Italy, driving the world numbers in Omicron cases. Twelve states in the country still have not reached the benchmark of the country’s average, with the bottom three being Punjab, Nagaland and Jharkhand with less than 50 percent of full coverage. With evidence suggesting depleting immunity against COVID-19 despite two doses of Astra-Zeneca, it should force us to manage the spread of the Omicron variant immediately, to prevent similar catastrophic consequences  to the Delta wave.
Twelve states in the country still have not reached the benchmark of the country’s average, with the bottom three being Punjab, Nagaland and Jharkhand with less than 50 percent of full coverage.
Moreover, with cases surging, testing has not ramped up accordingly. During the second wave of the virus, testing was increased to up to 2 million a day, leading the way for health systems surveillance of the delta variant. Currently, the average still looms at around 1.3 million tests per day, as of 10 January 2022. The coming 15 to 30 days are incredibly crucial to how the virus’s ‘third-wave’ will play out, and testing plays a quintessential part in it. In addition, Uttar Pradesh, Goa, Uttarakhand, Manipur and Punjab have upcoming legislative assemblies in February-March 2022. Hence, upcoming political rallies and mass gatherings will trigger a steeper growth in numbers if precautions aren’t undertaken. Figure 7: State-wise vaccination coverage of both doses Source: ORF Vaccine Tracker (as of 7th January, 2022)

The problem of the ‘mild variant’ narrative

A popular narrative of calling Omicron a ‘mild’ and non-killing variant has gained ground over the past few weeks. Presuming its speculated ‘mildness’, people and governments are not rushing to depute resources, and mask-wearing behaviour has taken a back seat. But being swayed by this misinformation will only hurt our own. WHO and early indicators warn us of the ill effects of giving-in to this myth. Less severe diseases are being diagnosed in people infected with Omicron, but it is infecting the vaccinated whilst severely hospitalising the un-vaccinated. It manifests in newer kinds of symptoms and pervades at a rate that can easily overwhelm our health systems. India’s population has been immunised with the necessary anti-bodies but had this been the first variant of the SARS-Cov-2 virus, the fatality rate would have been much higher.
Less severe diseases are being diagnosed in people infected with Omicron, but it is infecting the vaccinated whilst severely hospitalising the un-vaccinated.
It is also important to note that as Omicron emerges as the dominant variant of the building third wave, previously identified strains are also reverberating in the background. Observations from Chennai and Mumbai indicate that while Omicron and Delta drive hospitalisations, most ICU admissions may still be led by the Delta variant. Data from Mumbai, Bengaluru, and Delhi shows that Hospital and ICU bed occupancy is already 25 and 17  percent, respectively, as of 10 January 2022. Hence, with the looming double threat, it is crucial to expedite surveillance and enhance primary vaccination for the under 18 years population who remain the most vulnerable.

Conclusion

If early indicators are believed, India will soon see a rise higher than the second and previous waves, but the deaths will likely remain comparatively lower if precautionary behaviour is followed. Experts believe that stringent measures like complete lockdowns will not be needed to tackle this variant, but smart testing, identifying red zones and dealing with them in pockets will be helpful.
The emergence of new variants will possibly be a recurring event in the future and that should prepare us to follow appropriate behaviour instead of indulging in misinformation and panic.
But owing to the massive population India has, it will soon begin to strain existing infrastructural resources in terms of number hospital beds, it can lead to the hoarding of medicines, and a surge in oxygen requirements— all of which will risk widespread panic. Primary vaccinations should be accelerated to prevent adverse outcomes, while booster doses should also be equally prioritised amongst high-risk groups. The emergence of new variants will possibly be a recurring event in the future and that should prepare us to follow appropriate behaviour instead of indulging in misinformation and panic. On a rather positive note, it is a relief that high antibodies have shown effect with lesser than before hospitalisations and severity. Nevertheless, it is the same virus that cost us more than 5 million deaths globally. Underestimating it early on or laxity in preventive measures will prove catastrophic.
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Author

Mona

Mona

Mona is a Junior Fellow with the Health Initiative at Observer Research Foundation’s Delhi office. Her research expertise and interests lie broadly at the intersection ...

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