Vetting the virulence of the variant
With Omicron cases on the rise every day, Dr Subramanian Swaminathan attempts to decode the threat of
this new mutation
CHENNAI: We’ve had variants of SARS-CoV-2 like the alpha, beta, gamma and delta. Omicron is the newest in a long list of variants. Given that we’ve not had a major variant in a year, we were overdue for a significant variant coming in anyway. So are we surprised that a variant happened? No. This was something always on the cards,” says Dr Subramanian Swaminathan, director - Infectious Diseases, Gleneagles Global Health City, Chennai.
The recently identified Omicron variant of the coronavirus has sparked a new wave of concern about the trajectory of the pandemic. While there’s much we don’t know yet about this particular strain of SARS-CoV-2, the World Health Organization (WHO) has designated it a ‘variant of concern.’ After a spike in cases of the variant being reported across the globe, the recent news of five active in India, in less than a week, has triggered anxiety among the general public and the medical fraternity.
With a high likelihood of further spread, Dr Subramanian speculates the probability of its emergence. “When you have one part of the world not getting enough vaccination, it drives the virus to mutate in a specific area. The first cases were detected in samples from South Africa and Botswana. Now, people living in and around South Africa have high and advanced levels of HIV. We know that people who are profoundly immunosuppressed tend to have the virus sitting inside them for a longer period of time. And this leads to it reconfiguring itself in many possible ways. That could’ve been a reason how the variant evolved. And since the variant has emerged in an unvaccinated community, its effect on vaccination is hard to gauge,” he explains.
While there’s still uncertainty on the intensity of its infectious nature, health experts are predicting that there are equal chances of it being less threatening. The doctor points out that this variant seems to have been born out of a deadly combination of the alpha, beta and delta variants, making it aggressive. “Omicron has taken off faster than other variants. The first detection in India was last Friday. Within a week’s time, we will be able to get a clear picture of its virulence. Unlike the delta variant, which hit different parts of the world at a slightly different pace, Omicron is expected to hit the whole world at the same time, so, who’s going to help one another? One good news is that we haven’t heard much on the ventilator requirement or the high mortality rate. It’s still very early to make conclusions. If in-patient and ICU admissions don’t go up then we may not have a major problem. We are short on time and long on challenges,” he says.
When Dr Subramanian was studying the data published by the National Institute of Communicable Diseases, South Africa, he made two observations — it was the children who were the most affected and the average admission was only for five to six days. “The data has looked at a province called Gauteng where Johannesburg and Pretoria are ground zero for all this. In Pretoria’s Tshwane Metro they have put out a graph that looks at the demographics of the people getting admitted. From the details, we can safely conclude that the admitted children are not badly affected. Because if we have a rush of pediatric admissions then our current system is not ready to handle that kind of a situation. Another point is that wherever Omicron variants are rising, hospitalisation is also increasing. Hospital admissions in that province have gone nine-fold since the first case was detected. WHO is claiming it’s mild Covid. In the early phase, the effects might look mild. It’s only in week two when people will get sick. We will have to closely monitor,” he notes.
Precaution is key
With not much being said about symptoms yet, the doctor suggests a few pointers to follow. “The situation is tricky with overlapping symptoms between COVID-19 and with the new variant. If you’re the only person in the family who’s sick then chances are few that it’s COVID-19 or Omicron. But if other family members report similar signs then the probability is higher. Early detection is important and quarantine is a safer option. That can reduce the strain on resources,” he says.
Given the dire circumstances we’re in, the doctor advises that having a double vaccination could do some damage control. “We have evidence of low mortality rate in countries with double vaccination. Single vaccination is not going to do much. Remember, we’re extremely short on time and jabbing people is the only option. It takes two weeks for the vaccination to show its effect. The second measure is to wear masks and maintain social distance. The viral load in Omicron is higher. Avoiding closed spaces and clamping down on public events are the best ways to ensure the virus doesn’t spread faster. Children need to be extra cautious about venturing out and maintaining hygiene,” he says.
Even if it’s going to be a short and intense wave with a milder effect, the absolute number of hospital admissions can be quite high. That’s how the law of numbers works, says the doctor. “It’s prudent to be ready for all eventualities. By staying in touch with the South African counterparts, we can stay a bit more updated. Only time will tell how the mutations found in Omicron will affect its virulence and transmissibility. Until then, do not panic. Keep a tab on the updates from the government and health experts. By taking precautionary measures, we can still keep things under control, at least at an individual level,” he cautions.