Society of Environmental and Occupational Health
Society of Environment and Occupational Health
Society of Environment and Occupational Health
Stay safe, ignore alarming news-spreaders
An update by Dr Kishore Madhwani on the pandemic situation in India and globally
As Corona positive cases increase across the globe, our only weapons today are double masking, vaccinations and responsible behavior.
It has been one year since WHO declared COVID-19 as a pandemic, which resulted in confirmed 118 million cases and 2.6 million fatalities globally. As cases rise across the world and India, the governing authorities are facing the challenge of grappling the crisis exacerbated by the emergence of COVID variants, and complacency in using basic protective measures by citizens globally.
So why are fresh COVID-19 cases on the rise?
Global Situation:
In the U.S., vacationers flocked to Florida for the spring break festival defying CDC guidance. Amid the spring break crowds, there was flouting of COVID restrictions resulting in 100 arrests and two officers being injured. Migrants from Mexico have been crossing borders to be housed at Texas, raising the question of safety of keeping them all in closed gatherings – 50 individuals.
Three-fourths of the current cases in France are attributed to the U.K. Mutant strain leading to the overwhelming of hospital beds. The Prime Minister Jesan Castex announced another intense lockdown for four weeks as the increase in number of cases indicate that the country is experiencing a third wave. In Brazil, the Healthcare systems are overburdened because of the P1 variant, scarce supplies of vaccines as well as the pausing of the Astrazeneca vaccination.
The slowing down of vaccination drives has been a contributing factor in the increase of cases. Reason: more than a dozen countries in the European Union have paused or restricted the use of Oxford University (Astrazeneca/Covisheild of SII) vaccine following reports of 30 cases of rare brain blood clots (after administering millions of injections), which sent scientists and governments scrambling to determine if there was a link.
The European Union and the WHO have now declared that Astrazeneca vaccine is Safe and Effective. The incidence of such cases, in the general population, is nearly the same compared to the cases of individuals who have received COVID-19 vaccine.
Hence, the benefits of the vaccine far outweigh the risks. The Greifswald University Hospital explained that the vaccine in extremely rare cases induces a powerful immune response, which is responsible for generating specific antibodies that trigger blood clot formation in the brain. Hence vaccine recipients who show symptoms like headache, dizziness, impaired vision, three to four days after vaccination should immediately consult their personal physicians as this can be quickly diagnosed by a blood test and CT scan.
It would be worthwhile mentioning here that these blood clots could trigger a heart attack (and lead to a cardiac arrest) in individuals having underlying undiagnosed coronary artery disease blocks in the arteries). Hence it is prudent for all individuals to consult their personal physicians for vaccination fitness before taking COVID-19 vaccinations to ensure efficient control of cardio-vascular, metabolic, endocrinal and allergy related risk factors for a smooth uneventful vaccine experience.
Another controversy circulating in media against the vaccine drive is the reporting of the Coronavirus infection in a few fully vaccinated individuals. These are called ‘breakthrough’ infections, which have been observed in the U.S. and Mumbai too. But these have been very mild infections and are epidemiologically expected. It would be worthwhile to mention here that the higher the rate of virus transmission or if there are more variants of the virus in rapid circulation, higher are the chances of breakthrough infections. Currently, these breakthrough infections are being tracked to trace any pattern related to where or in whom these infections are occurring.
The Indian Situation
India, over the past five days, has seen the sharpest surge in COVID-19 infections in the last 10 months, with the seven-day rolling average of daily cases rising to over 39%. The Karnataka Health Minister Dr K Sudhakar on last Sunday said the second wave of Coronavirus had begun, seeking people’s cooperation in containing spreading the virus.
India’s total active caseload is rising after touching its lowest mark in mid-February. It stood at 3.45 lakh (3,45,377) on last Wednesday.
As India witnesses the sharpest COVID spike in nearly four months, a second wave of COVID-19 is far more clearer now, as daily new cases have almost quadrupled from 10986 (February 8) to 40,715 new cases and counting, taking the country’s total cases to over 1.16 crores, next only to the U.S. Maharashtra, Punjab, Gujarat, Chhattisgarh, Karnataka and Tamil Nadu have reported a rise in daily new cases, accounting for 81% of the overall rise.
Maharashtra on Monday 22 March recorded as many as 24,600 new Coronavirus cases, the highest one-day spike since last March 2020 when the first case of Coronavirus infection was detected.
In Maharashtra, Pune leads with more than 5000 cases followed by Mumbai reporting more than 3000 new cases per day. The Additional Municipal Commissioner of Pune city, Pavan Salve, has said the carefree attitude of people and overcrowding at public places were among the few reasons behind the spike. He stated, “After cases went down in January and early February, people started attending marriages and crowding markets and public places. This is the main reason behind the sudden big spike in cases this month.”
Dr Shashank Joshi, Member National COVID-19 Task Force and Dean of Indian College of Physicians said that the Gram Panchayat elections in Amravati, Yavatmal, Akola, Vidarbha region, including Nagpur, resulted in complacency by local residents leading to the sudden surge.
A total of 795 cases of U.K., Brazil and South Africa variants, which are highly infectious (but causing less severe cases) has overwhelmed the local hospitals. In Punjab, of the 2299 cases reported, 81% of the samples are of the U.K. variant.
In Maharashtra, Monday the 22 March, took the state’s caseload to 23,96,340, while the death toll jumped to 53,138 with 58 new fatalities.
Measures taken by State Municipal Corporations and the Health Ministry:
Tamil Nadu has shut all schools. Lockdowns were imposed in Bhopal, Jabalpur and Indore. Night curfews were imposed in cities with COVID spikes. Maharashtra combats with stricter precautions: cinema halls open to only 50% capacity whereas in many other parts of India, the functioning to full capacity.
In Nagpur, schools and markets have been shut down till March 31. In Mumbai, the BMC aims to vaccinate one lakh beneficiaries daily to speed up the vaccination and reduce severe infections and deaths.
The Municipal Corporation of Greater Mumbai has issued a directive to malls to ensure from 22 March, that their visitors should compulsorily have a negative COVID report (RTPCR Test) for entry, or else a Rapid Antigen Test should be carried out at the entrance of the shopping mall. Results of the Rapid Antigen Test will be available in a very short time at the entrance itself. This will definitely lead to a safer shopping experience for customers. The asymptomatic positive carriers will be detected at entry point, informed to the authorities and isolated.
The advice is to avoid elevators, shop for essentials, use food counters for takeaways and follow COVID appropriate behavior – SMS V3 C3. This rapid Antigen testing will also be carried out randomly at railway stations and crowded marketplaces. Marshalls have been appointed all over the city to ensure masks are worn by the citizens in public places and fines imposed..
State governments with a large rural spread, including Madhya Pradesh, Chhattisgarh, Jharkhand, Uttar Pradesh, Rajasthan, Odisha and Maharashtra are focusing to vaccinate rural areas. They have chalked out detailed plans to energise primary health centres, map polling stations to nearest wellness centres and employ a cohort or camp-like approach to register and inoculate senior citizens and persons with comorbidities in the 45-59 age group and also over 45 with no co-morbidities.
Silver Lining
Total vaccinated in India: 450, 65, 998
The centre has asked Serum Institute of India (SII) to manufacture another 100 million doses of the Covishield vaccine as it plans to ramp up vaccination across the country. The Centre increased the interval between two doses of Covishield to 6-8 weeks following recommendations by the National Technical Advisory Group on Immunization and the National Expert Group on Vaccine Administration for Covid-19. It has been found that protection is enhanced if the second dose of Covishield is administered between 6-8 weeks. This will also help in covering a larger population with the first dose of vaccine. From 1st April 2021, vaccination will be available for citizens above 45 years without co-morbidities.
Maharashtra has now allowed more hospitals (with more than 20-plus beds) to carry out vaccination drives to curb the spread of the virus. Maharashtra has vaccinated 45 lakh people so far, every day 3 lakh people are being vaccinated. In Mumbai, the MCGM plans to inoculate one lakh beneficiaries every day.
Breakthrough Oral Vaccine
There has been an announcement of an oral capsule vaccine (multi-component re-combinant protein base) for COVID-19 manufactured by Oramed and Premas Biotech, which could be a game-changer for defeating COVID-19. The advantages of this vaccine are:
- Far-reaching implications for the ease of wide-scale distribution and administration anytime, anywhere.
- Better for protection against COVID-19 variants due to triple antigen targeting that has shown efficacy after a single dose.
After a single dose of the COVID-19 capsule, efficacy was evident through antibody production in a pilot animal study – since the vaccine promoted both systemic immunity through Immunoglobulin-G(IgG), the most common antibody in blood and bodily fluids that protects against viral infections, and Immunoglobulin-A(IgA), which protects the respiratory and gastrointestinal tracts against infection.
Vaccine candidate creates triple protection against the SARS CoV-2 virus Spike, Membrane, and Envelope targets. The vaccine candidate is also safe, efficacious and well-tolerated at normal to high doses, and generates high litres of neutralizing antibodies. The vaccine is highly scalable and can be manufactured on large scale and can be administered by anyone anywhere. While the ease of administration is critical today to accelerate inoculation rates, an oral vaccine could become even more valuable in the likelihood that a COVID-19 vaccine may be required annually or biannually like the standard flu shot.
Potential game-changer - Rapid one minute test: more sensitive than conventional RTPCR
There has been an announcement of a one-minute rapid diagnostic test based on a path-breaking technology, which can drastically improve diagnostics and care for COVID-19 patients. This technology is very promising particularly because of the speed of diagnosis in just 60 seconds per patient as well its accuracy . The test has a sensitivity of 93 per cent and specificity of 95 per cent, with machine-learning algorithm. This kind of rapid diagnosis has the potential to be a game-changer. Breathonix, a spin-off company from the National University of Singapore (NUS), has developed this test. UAE Ministry is carrying out a trial of this test to assess its accuracy and feasibility as an easy-to-use breath test to detect COVID-19 within a minute.
In the test, a person only needs to blow into a disposable mouthpiece connected to a high-precision breath sampler. The exhaled breath is collected into a breath sampler and fed into a mass spectrometer for measurement. A machine-learning software analyses the volatile organic compound (VOC) profile and generates the result in less than a minute. If more clinical research studies confirm its accuracy, this could be a revolutionary breakthrough.
Let me end on the note that only speeding up vaccinations with maximum coverage in local areas along with double masking, an important weapon of responsible COVID appropriate behaviour (SMS V3) are our only best bets against the virus.
SMS V3 means – Sanitisation, Mask wearing, Social distancing along with ensuring Vigilance to detect and act fast, follow Ventilation principles and take precautions when going out of home.
- Avoid close conversations, restrict to 5 minutes (wear mask and face shield, in case you have to closely interact.
- Avoid closed gatherings of 50 individuals.
- Avoid closed confined spaces with poor or nil ventilation
Hope and the horizon
Dr. Kishore Madhwani updates the facts on the COVID virus and asserts the need to stay calm while under the pressure.
There’s no need to be stressed. Neither can we hide from facts. Currently, the second surge in India and a third surge in a few countries globally, has resulted in Coronavirus fatigue. Indian scientists have also predicted a third wave for India. We are in the epicenter of a race between speeding up vaccinations and handling the dynamics of the Variants of mutants from U.K., Brazil & South African (VOC). The media in Japan has urged for the cancellation of the Olympics 2020.
India witnessed its first wave of cases reaching a peak in September 2020 and subsequently cases came spiraling down to less than 10,000 a day on February 21. The national authorities, then, announced the gradual easing of lockdown restrictions, opening up of public spaces (with strict protocols) in private and public offices (with restricted staff), a few educational institutions, as well as gyms and malls. But mass election rallies in various Indian states, the historical Kumbh Mela gathering of lakhs of devotees for the Shahi Snaan (Holy Bath) are few reasons that resulted in letting the guard down against the virus.
In India, the sharpest ever rise of over 4 lakh new cases and 4000 deaths every day was witnessed earlier in the month of May. However, the R Rate of the virus, which has the capability of an affected person affecting 3 others, has reduced to 1 in Delhi and Mumbai, and in U.P. from 1.5 persons to 1. Consequently, the Stay-Home-Stay-Safe advice has to be followed for the next couple of months until the curve flattens. This is a tough call to take, but as of now imperative. Maharashtra, which has reported the highest number of cases in urban as well as rural areas, has advocated compulsory institutional isolation (no home quarantine permitted) in 18 districts from this week, with the exception of Mumbai city.
RESTRICTIONS AT CENTRAL AND STATE LEVELS
Currently, 98 percent of our country is in a lockdown mode, which has reduced the burden on overwhelmed healthcare facilities, speed up at war footing vaccinations for all age groups including children in order to protect them from the third wave, build up the herd immunity in local populations, and achieve optimal coverage albeit with shortages of vaccines and other hurdles that face us. Of late, there has been a definite dip in the total number of cases though the death rate continues to be high, as there is a lag period of two to three weeks between the onset of fresh cases and number of reported deaths. Currently approximately 2 lakh cases (lowest in last 40 days) and 4157 deaths have been reported from India taking the total to over 27 million cases and 3.1 lakh fatalities as per official government records, which however are being questioned.
Cases have increased in Kerala, Karnataka and Tamil Nadu. All the states have imposed lockdowns till June 7. Delhi showing a dip in new cases has extended the lockdown till June 1. West Bengal and Rajasthan have also extended lockdown till the month ends. Cases have spread to interiors of villages in Punjab, UP, Bihar and Haryana.
INTERNATIONAL AID
The UAE sent 0.5 million Favipiravir doses. Oxygen Tankers have been sent by South Korea, Italy, Belgium and Singapore. The USA has dispatched oxygen concentrators as well as raw material for manufacturing of vaccines.
DIFFERENCE IN THIS SECOND SURGE
It has affected the vulnerable non-vaccinated groups who had not acquired immunity. There has been an Increased morbidity and mortality in the 30 to 50 years age group. Many of them were RTPCR negative but a CT scan and blood test showed effects of COVID-19. Hence the rule that POSITIVE RTPCR reports is not mandatory for hospital admission. Children and adolescents in the 11 to 17 years age group have been affected.
As far as the national economy is concerned, over 70 lakh jobs were lost in April. The unemployment rate from 21.7 per cent in May 2020 reduced in January 2021 but again increased exponentially in April 2021. According to official statistics, there will be a loss of Rs. 1.5 lakh crores, if lockdowns are extended beyond June 1. However, the impact of lockdowns in saving lives and raising the human capital will enable us to bounce back and revive the economy eventually according to the government.
Social media, while largely creating alarm, has also had its positive side. A tweethaton spiralled by student Ayan Kapoor from Delhi regarding the vaccine situation went viral drawing 5000 responses across India. Clearly, the government should immediately import vaccines from abroad and vaccinate the vulnerable population of by creating a task force involving private and government partnership to protect children, especially. During the crisis it was because of appeals made on social media that made good Samaritans reach help and save many lives too.
Vaccine trials for children have started globally and in India Bharat Biotech are leading the attempt for Covaxin. Private players have been invited to produce Covaxin. Let’s hope private players will focus on the needs of the pediatric population of our nation, our future, and will also produce the revolutionary nasal vaccines for children as well as adults. President Biden of U.S. has asked for the vaccination of teens based on the TEENCOVE study, highlighting the safety of Mrna vaccines in teenagers.
If adults find it difficult to wear masks, how will children follow COVID-19 appropriate-behavior? We have a moral and social responsibility to protect them before the third wave for which we need to move at lightning speed to include vaccination for children in our Universal Immunization Program. The Moderna Mrna vaccine manufacturer in the US has already launched a six month-12 years KIDCOVE study and results will be out soon to protect children in this age group in the US. Why isn’t Bharat Biotech spearheading a similar initiative?
SILVER LININGS
Dr. Anurag Aggarwal, director of the Institute of Genomics and Integrated Biology along with IIT scientists, have predicted the end of second wave by the middle to the end of June 2021. Over 20 crore Indians have been vaccinated since January 16. An estimated number of 200 crores will be vaccinated by 31 Dec 2021, according to central government estimates, of which Pfizer may commit 5 crore doses of Mrna vaccine to India.
To ramp up the vaccination drive, the center is promising to provide 1.9 crore doses to states by the end of May 2021? The third vaccine SPUTNIK V will be available commercially in private centers across the country at Rs 995 per dose; each given 3 weeks apart. Shortly, in June or July Sputnik Light, a single dose vaccine may be available in India, which could prove to be a game-changer in coverage, as it requires only one dose providing 79.4 percent efficacy (as per studies in Russia). The next gen Moderna, a one-dose vaccine will be available early next year.
Fifty percent of adults in the US have been fully vaccinated with two doses. The US now allows the fully vaccinated not to wear masks, indoors or outdoors – aha moment for America hopefully.
BREAKTHROUGH MOMENTS FOR INDIA
The Antibody Cocktail of Roche Pharmaceuticals comprising CASIRIVIMAB and IMDEVIMAB has just been launched in India at Rs 59000 by CIPLA. When administered early in mild to moderate disease, this drug would be life saving and is a remarkable stride as a treatment option in adults and children above 12 years weighing at least 40 kg (given to Donald Trump when he acquired COVID-19); as plasma administration has now been discontinued by the ICMR and WHO.
A new revolutionary life saving oral drug 2DG made in India (manufactured by Dr. Reddy’s Labs) by Defense Research Development Organization (DRDO) along with INMAS has acquired Emergency Use Authorization by FDA. The oral drug will be available in June in a powder form in a sachet to be dissolved in 100 ml of water, to be taken twice a day in moderate and severe cases of COVID 19, whose Oxygen saturation is 94 percent. The drug ensures that oxygen saturation for an affected patient is maintained and does not further drop (along with continuing the correct line of medication concurrently), thereby eliminating the use of oxygen and or Remdesivir. We can surely end this pandemic if each one of us comes together by following COVID-appropriate-behavior and getting vaccinated.
SUGGESTIONS TO ABIDE BY
1) Plan vaccination dates and execute the same with maintenance of Social Distancing at the site and let us develop a momentum to protect our children by vaccinating them.
2) Stay Home: Do not allow any visitor, as far as possible, to your home. Do not travel indiscriminately or socialize.
3) Stay Connected to boost your morale and Think Positive.
4) Do not self medicate or over-medicate yourself.
5) BEFORE STEPPING OUT OF HOME ask yourself: is this action SMS V3 (COVID Appropriate Behavior) compliant?
SMS V3 – Sanitisation of self and surfaces, Double Mask wearing, Social distancing along with ensuring Vigilance to test (then isolate), treat and track fast ensuring micro-containment to break the transmission chain, following Ventilation guidelines and taking below mentioned 3 precautions when stepping out of home.
- Avoid close conversations, restrict to 5 minutes (wear mask and face shield, in case you have to closely interact)
- Avoid closed gatherings of 50 individuals
- Avoid being for long duration in closed confined spaces with poor or nil ventilation
We can work it out
Dr. Kishore Madhwani makes a case for Don’t-Worry-Stay-Calm even as the media reports about variants of the pandemic exacerbate stress and anxiety.
It has been established that the ‘variant of concern’ (VOC) was responsible for the monstrous second surge of the Coronavirus in India. We had many more patients, a significant number were RTPCR negative but still had features of COVID-19 detected in CT scans and blood investigations.
Today the Delta variant is prevalent in 85 countries globally. It has been optimistically stated that the news is the Covidshield vaccine has beneficial effects against the Delta infection: Taking one dose shows 30 per cent efficacy and 2 doses 60 per cent efficacy against symptomatic disease. Another advantage: one dose prevents hospitalization by 71 per cent and 2 doses by 92 per cent. (Source: Public Health England data). The Pfizer and Moderna vaccines have 79% efficacy against the Delta variant and 94% for Alpha variant of 2020 (as earlier reported).
It would be best to remain calm and be sure, amongst us, that we can fight the pandemic together. Hope surges. Indigo airlines have announced discounts. Emirates have announced flight services resumption from July. People are now relatively gaining confidence to travel by air. On most modern aircrafts, approximately 35 to 40 to air exchanges per hour take place – such air exchange signifies efficient ventilation, it has been determined.
Indeed if aerosol transmission of COVID-19 is to be controlled in workplaces and locations like restaurants and pubs, it would be important to restrict the number of visitors including limiting their timing, ensuring there is entry of fresh outside air entering the premises and at the same time effective exhaust ventilation is incorporated.
This ventilation monitoring (air quality maintenance) is essential in real time for carbon dioxide levels in parts per million. The Co2 levels of outside air are 400 ppm. If indoor air levels of carbon dioxide are maintained at 700 ppm, then the possibility of aerosol transmission of COVID-19 is near zero. Hence it will be prudent for all office workplaces to monitor Co2 levels in real time to control virus transmission.
Vaccines for Children
Serum Institute of India’s Covovax (Novavax in USA) will initiate vaccine trials in children in July 2021 for 2 months. Once results are declared and if favorable, let us hope that we will be able to vaccinate children in India by Diwali or latest before the year-end, in order to have fully vaccinated families.
Needless to emphasize that opening of schools by completing vaccination of children, teachers, staff, following strict COVID appropriate behavior by all students and ensuring hygiene as well as ventilation of school premises is the top priority today. Children are becoming anxious, restless, addicted to games and developing musculoskeletal disorders due to adoption of sustained awkward unergonomic postures while attending classes and subsequent homework. These are important issues that should be addressed.
Good News
As plasma therapy is now banned by WHO and by ICMR, the good news is that in India a readymade Antibody Cocktail (casirivimab and imdevimab) is available. If given in the first three to four days of mild to moderate confirmed cases (above 12 years and above 40kg), who are at risk (comorbidities) of developing severe COVID-19 – can result in 70 percent reduction in hospitalisations. This will be extremely useful for obese, asthmatic, hypertensive, diabetic, kidney disease patients as they face greater risk of being hospitalised and also of requiring assisted ventilation. This is the same cocktail that was given to the former US President Donald Trump.
A recent study has reported that the drug used to treat gout, available as colchicine, reduces the need for supplemental oxygen as well as speeds up recovery for patients hospitalised with COVID-19 by three days on an average.
As lockdown restrictions are being relaxed across India with local governments directing the guidelines, it is important to be extremely cautious, get vaccinated from genuine vendors and step out of home only if it is absolutely essential. Above all COVID-appropriate behavior is essential since this is our ultimate armor against the virus.
Incidentally, those individuals in New York city who received Pfizer mRNA vaccine from 5th to 10th June 2021 have been recalled to take the vaccine; as they had been given jabs that had expired. There is a group of evangelicals in us (reported by CNN) who refuse to take the mRNA vaccine. Clearly, there is no country in the world where vaccination challenges do not exist.
Mindfulness Meditation
The current situation of COVID-19 across the globe arouses emotions of anxiety, feelings of uncertainty since new highly transmissible and increasingly virulent mutants have been announced. This allows negative thoughts to enter our minds, making us lose calm and in some of us becoming irritable and stressed to an extent that it affects our daily routine work and lifestyle. Due to this, we stop functioning at our optimum best personally and professionally.
Solution – consider summing up the entire pandemic situation as: The past is becoming history, the future is a mystery but we need to ‘live the present moment’ and make the most of our current lifestyle and daily routines including our professional careers by practising Mindfulness Meditation. It’s a beneficial practice – the more you do it, the more you’ll find it effective.
Mindfulness meditation is a mental training practice that teaches you to slow down racing thoughts, let go off negativity, reduce brain chatter, hone innate abilities to focus your mind, lower stress levels and calm both your mind and body. Techniques can vary, however the concept is: mindfulness meditation involves deep breathing and awareness of body and mind. The goal of mindfulness is to wake up to the inner workings of our mental, emotional, and physical processes.
Mindful movement can help you tap into that space beyond your busy mind where you become calm and you clear the clutter. You can practice anywhere for even short periods of 10 to 15 minutes (while sitting, too), though it is preferable to lie down in a cool and calm environment.
After lying down, keep all your thoughts and tensions away from your mind and focus on your breathing (in and out). Take deep breaths and synchronize your mind and body with breath and rhythm. Even after a few minutes you begin to pause and start to focus on the present, forgetting your tensions and go into a trance, a relaxation phase. You may find the experience quite different than what you expected. There’s a good chance you’ll be pleasantly surprised, rejuvenated and able to better control stressful situations.
Improved Concentration and performance: Writer Hugh Delehanty calls it as tactical breathing, which can help foster what he calls “full presence and conviction in the moment.” He advocates all athletes to use this practice for improved concentration and performance.
Boosts creativity: by incorporating it as a ritual in our routine lifestyles.
Strengthens neural connections: By training our brains in mindfulness, we can build new neural pathways and networks in the brain, boosting concentration, flexibility, and awareness thereby making well-being a skill.
I sincerely appeal to you to become a motivator and take up the responsibility for inspiring all individuals who interact with you and your families in our housing societies and workplaces to get vaccinated and also ensure that they implement COVID-appropriate behavior for the greater good. Becoming a motivator is what we owe to our existence on this planet; to make it safe and anxiety-free.
All you wanted to know about Omicron
The new variant of concern: Omicron has assumed the status of The Global ‘Scariant’ of Concern, because it has sown global chaos, informs Dr. Kishore P. Madhwani
We need to tackle Omicron with speed and science. This variant reported on November 24th from South Africa and designated as Variant of Concern by the WHO – its Technical Advisory Group on Virus Evolution on November 26th probably existed earlier in Europe and possibly in India, too. It is a matter of time before it is detected, as stated by Dr Samiran Panda, who heads the epidemiology cell of Indian Council of Medical Research (ICMR).
Data gathered in the next two to four weeks will help to fully understand this variant’s epidemiology and its global impact. Currently, the Omicron Variant has been detected in more than 57 nations in the six WHO regions across the globe. In India, till date, 23 cases have been detected.
A few facts will help you understand the current situation, allay myths, as well as uncertainties, reduce your anxiety. Here’s sharing some simple tips to ensure optimal protection against all the variants.
What is Omicron?
It is the new super mutant variant strain of COVID-19.
How many mutations are seen in Omicron?
All-inclusive there are 50, with 32 in spike protein at the Receptor Binding Domain (which is unusually high, as Alpha has 3, Beta has 5, Delta has 10 mutations).
How has it affected patients in South Africa?
It has affected a majority of unvaccinated individuals, more in young males around 35 years and children two years. The daily case numbers in South Africa were fairly low but then rose rapidly from 273 on November 16 to more than 1200 by November 25, more than 80% of which were in the northern province of Gauteng, where the first cases were detected.
As variants are now gradually emerging, for any new variant of concern, what are important factors that decide their overall impact?
For any new variant, we need to be concerned about 3 factors: I) Does it spread more easier(more transmissible) than earlier ones, 2) Does it cause more severe disease (more virulent), 3) Will our current vaccines/medication/tests be effective or will boosters, new vaccines, new medication or new innovative testing be required.
Hence let us address these issues:
How much more transmissible is Omicron? For any new variant of concern; what are important factors deciding its impact?
According to WHO; it is highly transmissible: 500% more transmissible than Delta, which was 70% more transmissible than alpha. To simplify further: it is approximately 6 times more infectious than the delta strain, which is why it has become a cause for concern. However, time will confirm this initial observation.
How much more virulent is Omicron?
Mainly mild symptoms have been experienced by a small group of patients studied in Gauteng province of South Africa. However updates in the next two to four weeks will confirm whether it is less virulent than the Delta variant, because hospitalisations have also increased in South Africa for ages between 18 to 44 years.
An assessment by Dr R. K. Dhiman, Director Sanjay Gandhi Postgraduate Institute Lucknow suggests that although transmission rate of virus is high, it is not as dangerous as its predecessors. He further said that mortality rate might also be less than Delta variant, but more time is required to confirm this. Allaying fears regarding the new Omicron variant that has the world on tenterhooks, US scientist Anthony Fauci has said that early indicators suggest Omicron is not worse than the previous strains of the virus, and possibly milder. However, he has admitted that it will still take weeks before the severity of the new COVID-19 variant Omicron can be judged. Till date no death has been reported due to omicron.
What are the symptoms and are they different?
Symptoms observed in South African patients are extreme tiredness, mild muscle aches, sore throat, dry cough and slightly high fever. However symptoms need to be monitored and if the worsening of symptoms occur -for example breathlessness or if there is drop in oxygen saturation below 94% or a 3% drop in a 6 minute walk test, one should immediately consult the doctor for further investigations/hospitalization and or treatment.
Experience from South African patients, as reported by Dr Angelique Coetzee, reveals that usually patients recover completely, without the need to get hospitalized. However, the group of patients studied by her is very small in number.
Can reinfection occur in those already infected with COVID-19 earlier?
Yes, as the virus has approximately 52 mutations, of which 30 are in spike protein, there are definitely going to be re-infections if COVID Appropriate Behavior (COB) is not strictly followed. Hence, we all need to be very vigilant. Reason: many infected individuals may be asymptomatic, as observed in South Africa.
Will the RT PCR testing work?
Yes, it will work as per central health ministry’s information on India Today TV and Dr Ashish Jha, Dean of Brown University’s Statement on CNN. However, Dr Sanjay Gupta from CNN and Microbiologist Professor Akiko Iwasaki from Yale University suggests rapid antigen testing at home should be encouraged because rapid antigen testing is based on nucleocapsid testing and not the S gene, as used in RTPCR for fast testing.
As the virus is contagious, many asymptomatic carriers could spread the disease further. Hence, the strategy should be to control the spread by rigorous rapid detection and religiously following the Test, Track and Treat early protocol. This should be the strategy in all progressive corporate organizations and local communities.
Will the current vaccines work and how well can they protect us?
The update from Dr Sanjay Gupta on CNN, in accordance with the vaccine cushioning effect, the vaccines will hopefully work, though with probably slightly reduced efficacy. A majority of the patients infected in South Africa were unvaccinated. Hence, everyone in India including children should get vaccinated as soon as possible.
Dr Fauci from the U.S. advises that the variant specific vaccine booster is the best bet. But it may take prolonged time for production and distribution in the near future. Hence today, all should take the currently available vaccine as the 3rd booster shot, when permitted officially because the protection conferred by the third dose, results in multifold antibody protection and the avoidance of severe disease or death from COVID-19.
Will any new vaccines be manufactured?
Dr Anthony Fauci has said a new variant specific vaccine booster covering all variants is a likely possibility in 2022. Meanwhile Johnson & Johnson has announced plans to make a new vaccine for Omicron in South Africa in collaborative projects with local vaccine manufacturers.
When will the booster shots of vaccines and child vaccinations be announced in India?
The good news is that probably this month, the WHO & INSACOG expert committee will decide and announce booster shot eligibility (six months after the second jab) for Indian citizens above 40 years – subsequently, announcements of child vaccinations are expected as well.
What are the treatment guidelines?
The earlier launched Antibody Cocktail and the new Merck pill Molnupiravir (the new ace up our sleeve) may probably become our best bets to combat the virus. Merck is optimistic that their anti-COVID pill will work against Omicron. According to Dr Sanjay Gupta, CNN, if Merck gets emergency use approval for Molnupiravir; patients can be prescribed the drug for home use. Hopefully the antibody cocktail (Casirivimab and Imdevimab; taken by the former US President Donald Trump), which reduces hospitalization by 7o%, may still be effective – if given within three to five days of the disease.
Will travel ban across countries stop the spread?
We have to obtain prior travel history, increase testing, trace primary and secondary contacts and treat affected patients. Various countries, including India, have outlined strict quarantine measures.
What are Health Authorities doing to control the spread?
The Union Health Secretary Rajesh Bhushan said in a letter to all states and Union Territories that all new patients affected with this variant will have to be treated in designated COVID facilities with separate isolation area.
There have been 23 cases of Omicron detected in India till date. It has to be ensured that no cross infection takes place and adequate precautions are taken by healthcare workers in the facilities to prevent transmission among other patients and healthcare workers. He also advised the need to regularly review the situation and ensure that samples of positive cases of international travelers and their contacts, as well as from emerging hot spots, are promptly submitted to genome sequencing laboratories: as per national protocol. Further to contain spread, it is imperative that states and UTs follow a mission mode and focused approach of quickly tracking primary and secondary contacts of positive cases and facilitate testing for them.
Maharashtra Chief Minister Uddhav Thackeray, on Wednesday 8th December, ordered “speedy vaccination” against coronavirus as the state cabinet expressed worry over the rapid spread of the Omicron variant across the world. The statement noted that the number of Omicron-infected patients across the world has gone up by 45 per cent in the last 12 hours; hence Thackeray stressed the need for taking precautions and strictly following health-related rules, enforced by the state.
As Omicron cases rise across the world and in India, is it safe to send kids to school & switch back to offline studies?
Children in India are currently among the unvaccinated population and thus at risk of getting infected with Omicron. Dr. Krishan Chugh, Director Pediatrics, Fortis Memorial Research Institute, Gurugram mentions; “We are definitely wiser now than in March 2020, because we have learnt that, had we not closed schools then, it would have acquired totally unmanageable dimensions”.
Today, apart from getting teachers and staff fully vaccinated, schools need to ensure safe ventilation in the classrooms (monitor real time Air Carbon Dioxide levels
Similarly, we can’t be sure that disease will be mild in all the cases, hence children should be vaccinated at the earliest to protect them from COVID-19 and its complications like multi inflammatory syndrome (MIS). We also need to bear in mind that “when children contract infection in the school, there is an increased risk of their carrying it back to home and infecting their grandparents who may be living with them. And the disease can be devastating in older people .As far as exams are concerned, children should give online examinations, as of now. In most parts of our country final exams are held in the months of March and April and the pandemic situation will hopefully improve by then for schools to fully reopen and conduct offlines exams for all ages.It is natural for parents to reconsider their decision of sending kids to school in such a situation & doctors agree with their concern,” concluded Dr Chugh.
What is the best way forward?
It is extremely straightforward: Follow Strictly COVID appropriate behavior and become a Wellness Ambassador in order to encourage your colleagues, friends, neighbors and also the local community to immanent this religiously. A collective effort is essential. The virus is more contagious than Delta but whether it will be more virulent to cause a serious disease, more hospitalizations, whether it will have a vaccine escape – though less likely, we hope to know more in next two weeks.
How can we maintain Caution, Control & Contain the spread?
We should be cautioned not to show any complacency and let our guard down now. According to the WHO we all must act now to address important factors like: Sanitization of self (with 60% alcohol based sanitizer/rubbing hands for 20 seconds with soap and thoroughly washing with water) and surfaces (with 1% hypochlorite/disinfectants). Hypochlorite solution can be purchased online or alternatively it can be prepared at home by mixing 10 grams of bleaching powder in one liter of water. This can be used for disinfecting surfaces, walls and soaking vegetables and other foods for a contact time of 10 minutes.
- Maintain effective Social Distancing by downloading 1.5-meter app (UNTIL) on android phone and keep your Bluetooth on.
- Shield yourself with a Mask (Double Mask preferably). Don a mask. Recommended: reusable highly efficient air purifier Hepa filter masks.
- Practice Meditation to allay your anxiety and boost your mind for positive thinking.
- Vaccinate with COVID-19 vaccines all adults [with two doses, followed six months later by booster (when advocated) and all children.
- Vigilant. Be vigil by following the test, track and treat protocol. This should be the strategy in local communities, currently.
- Ventilation. For controlling the spread of the highly infectious Omicron, it is ventilation during traveling, during work, during shopping – in short any activity involving interactions/gathering of a group of people that will play a crucial role in containing the spread. Hence, when stepping out of home, carry your sanitizer, don your mask, avoid elevator use, if feasible and self-drive your vehicle. If the car is being chauffeured, sit behind the car driver, exactly diagonal to the driver. Request the driver to shut off the car air conditioner and keep the window on his right entirely shut. As you will be sitting behind and diagonally opposite, the window to your left will be entirely shut. The remaining windows can be open. If >2 people are traveling in the car, please keep all windows down by 4 inches.
When entering the public or office place, kindly ensure that you:
- Avoid closed conversations > 5 minutes
- Avoid being in closed, confined spaces (with poor ventilation) for a long duration and
- Avoid close gatherings of >50 people
To sum it up easily; The Protection Mantra for OVERCOMING OMICRON is:
Sanitisation, Social Distancing, Double Masking, Meditation, Vaccination, Vigilance & Ventilation in order to AVOID 3Cs’ – closed conversations, close confined spaces and close gatherings.