THE new sunday express Voices Anand Neelakantan Satya Mohanty Ravi Shankar Shinie Antony Badri Narayanan Mata Amritanandamayi MAGAZINE Buffet People Wellness Books Food Art & Culture Entertainment december 5 2021 SUNDAY PAGES 12 The Omicron Effect The mildness of infection suggests that panic is exaggerated, but to meet the emergence of new mutants the world needs to overcome the rich-poor divide By Ayesha Singh, Anu Jain Rohatgi and Noor Anand Chawla O n November 18, a 33-year-old patient came to meet Dr Angelique Coetzee, a private medical practitioner at her clinic in Pretoria, South Africa. Coetzee told the BBC, “He said to me that he’s just been extremely tired for the past few days and he’s got these body aches and pains with a bit of a headache.” But instead of a sore throat typical of the Delta variant, he had a ‘scratchy’ throat. There was no cough or loss of taste or smell. Seven more patients arrived at her clinic with similar systems on the same day “Something is going on,” . suspected the blonde, bespectacled doctor who is the chairperson of the South African Medical Association and an advisor to the South African Health Ministry The new cases were drastically different from the Delta . variant, though their symptoms were very mild. The same symptoms were occurring in other Covid-19 patients. Coetzee decided to test them for the virus—the first doctor to spot the Omicron virus. On November 9, genome analysis of a specimen of SARS-CoV-2 taken from an infected patient in Botswana revealed a novel variant, initially dubbed B.1.1.529, later to be known as Omicron. At this stage, not much is clinically or epidemiologically known about the variant. However, the mysterious part is that it is not related to any of the currently rampant strains like Delta or Alpha. The WHO is coordinating with many researchers in several countries to better understand how the variant will impact the current pandemic, with new findings expected within days or weeks. The important questions that come to mind are many . How fast does Omicron spread? Very . How dangerous is it? The effects seen so far are mild. But there is not enough data. Do the current vaccines work against it? Probably not. But research is ongoing and pharma companies are already tweaking existing products to counter the new variant. With countries shutting borders and the WHO designating Omicron a variant of concern (VOC), should we panic? Probably not. “The Omicron variant is a call for action rather than panic. Mutations are a natural evolutionary outcome in any viral propagation. As and when any virus runs into a huge number of its hosts, it tends to lose amino acids or acquire amino acids change in the amino acid configuration, which may result in either deletion of an entire gene sequence or a changed gene sequence in the virus,” says Dr Satyanarayana Mysore, HOD and Consultant, Pulmonology Lung Trans, plant Physician, Manipal Hospitals, Bengaluru, adding, “In the African subcontinent, the virus did go through a chain of transmission through immunocompromised patients, and the healthcare structure probably did not suffice to stop the transmission.” He further explained for the WHO to label any virus as a VOC, a number of factors have to be met, such as increased transmission, change in the clinical symptoms or disease course, response to medications, change in the diagnostic approach, change with respect to the response to the vaccine, and the immune escape mechanism. The Omicron variant in India may actually lead to increased transmission, which is the only concern. There is no data that it will not respond to monoclonal antibodies and the coming weeks will be able to provide data. “I am... concerned that several Member States are introducing blunt, blanket measures that are not evidence-based or effective on their own, and which will only worsen inequities.” Dr Tedros Adhanom Ghebreyesus, Director General, WHO How is Omicron different from Delta and other variants? Dramatically and unexpectedly different. Virologists make the mistake of assuming that future variants of concern would almost certainly descend from the Delta variant, which has been of late causing havoc over the past six months. Omicron has a large number of mutations—over 50 with 32 in the spike protein—allowing the virus to infect the body easily . “By virtue of this, it is expected to be more contagious which needs to be documented with epidemiological studies. However, there is no need to panic as the current evidence from South Africa suggests that the cases are mild and does not require ICU care,” says Prof GC Khilnani, Chairman, PSRI Institute of Pulmonary , Critical Care and Sleep Medicine, Delhi. Trevor Bedford, a virus researcher, says the new strain’s genomic lineage is not from a recent Covid-19 variant, and its closest evolutionary connection is a SARS-CoV-2 strain detected way back in mid-2020. “This extremely long branch (> one year) indicates an extended period of circulation in a geography with poor genomic surveillance (certainly not South Africa) or continual evolution in a chronically infected individual before spilling back into the population,” Bedford tweeted. In the South African province of Gauteng, Omicron is reasoned to be responsible for taking up the R number (average number of people that one infected person will pass on a virus to) from around 1.5 to nearly 2. It is also being recorded in a growing number of countries outside Africa, such as the UK, Israel, Belgium, Canada, Australia, the Netherlands and Austria. “Right now, it is most important to take action against the spread of fake news on social media platforms and news channels about Omicron because this spreads misinformation resulting in panic,” says Dr Vikas Maurya, HOD and Director, Pulmonology Fortis , Hospital, Shalimar Bagh, Delhi. According to Dr Rajesh Chawla, Senior Consultant, Pulmonology and Critical Care, Indraprastha Apollo Hospital, Delhi, as of now, we need to continue Covid-appropriate behaviour, focus on achieving the maximum vaccination numbers (as it protects from the severe manifestation of the virus), maintain social distancing and mask up for our safety . , So why is there panic? When the WHO announced Omicron was a VOC, there was panic across the globe. Financial markets dived. International borders were closed. Dr Anthony Fauci, America’s foremost virological expert who has served five US Presidents, said that Omicron is almost certainly already circulating in other countries around the world— Australia, Austria, Belgium, Botswana, the Czech Republic, Denmark, Germany Hong , Kong, Israel, Italy the , Netherlands, South Africa, and the UK, although the majority of suspected cases are people arriving from Africa. But the panic may be misplaced. What is Omicron? The variant known as B.1.1.529 or Omicron has a high amount of spike mutations that have never been seen before. It popped up in many European countries just days after it was identified in South Africa. Omicron, listed by the WHO as a ‘variant of concern’, has infected people in more than 20 countries to date. Its nomenclature has an interesting story. The WHO names variants after letters of the Greek alphabet. When Omicron was identified, the WHO had already used the first 12 letters to name the previous strains of the virus. It decided to skip the next two letters, “Nu” and “Xi” because “Nu” can be confused with “new” and “Xi” is a common last name and happens to be the name of the President of the People’s Republic of China. Omicron is the 15th letter in the Greek alphabet. The Third Wave Threat Looms? “Omicron could trigger the third wave in India if allowed to enter. We have already witnessed the disastrous effect of the previous variant. In the smaller towns, Covid has been long forgotten. Nobody wears masks. Social distancing is laughed at. In larger cities such as Delhi, Mumbai, Bengaluru, etc, people wear masks out of force or fear of penalisation. Look at the crowded markets, full-to-the-brim restaurants and over-the-top weddings taking place across India. If this continues, Omicron will create havoc.” Dr Manoj Kumar Consultant - General Physician, Internal Medicine, Manipal Hospital, Vijayawada, Andhra Pradesh Turn to page 2 “As most vaccines (work by) forming antibodies against the spike protein, so many mutations (in Omicron) at the spike protein region may lead to a decreased efficacy of Covid-19 vaccines.” “We just really need to, as I’ve said so often, prepare for the worst. And it may not be that we’re going to have to go the route people are saying.” Dr Randeep Guleria, Director, All India Institute of Medical Sciences Dr Anthony Fauci, Chief Medical Advisor, White House, USA