BENGALURU: Eminent virologist, nodal officer the INSACOG lab at NIMHANS, Head of Research and Development, Tata Medical and Diagnostic Centre, Dr V Ravi, in an exclusive interview with The New Sunday Express, speaks about the INSACOG’s changed strategy and also on how districts in Karnataka will now have to be careful as they will start to peak soon. Excerpts from an interview:
The last time we spoke, you had termed the Omicron variant as Usain Bolt amongst all SARS-COV2 variants. This has now spread across the globe. How much do we know now about the variant?
We have much more information about the variant now. The virus has now spread across to more than 100 countries and in India, it is causing a large number of infections in major metros as of now. We know from genomic sequencing results, even though in small proportions, that Omicron has taken over in Mumbai, Delhi and Bengaluru. The good news amidst the surge, however, is that most of the patients who have got Omicron have mild illness. I think vaccination has helped in a big way to minimise the severity of the disease and drastically reduce mortality. It is still the Usain Bolt of SARS-COV2.
Karnataka is now seeing a surge. Yet we have had several political rallies, fairs, festivities.What are the most likely scenarios over the next two months?
I would like to say wherever there are crowds, especially in closed spaces, the transmission is going to be very high. It is the festive season and people are fed up with restrictions. For the next few weeks, there definitely will be an increase in the number of transmissions. The severity of the disease will be less, but that leaves no room for complacency whatsoever. Having said all this, the indian institute of science and indian statistical institute have been doing a great job on modelling for the state of karnataka and their predictions are that blr will probably peak towards the end of this month but like in the first and the second wave, Bengaluru will peak first and then it will go out to the districts. That is where festivities, travel and rallies are going to contribute to the migration of the virus, from being a Bengaluru-centric pandemic right now, to other districts.
When will it exactly peak?
Classically if you see the first and the second wave other districts are one to two weeks behind from Bengaluru. Bengaluru will peak in the last week of January and other districts will peak in mid-February. I would say, at the end of February, we will see a decline across the state and Bengaluru will start declining much earlier, and it will probably trail into March. But there may be a tail which will wag till the end of March. How long it will wag is difficult to say.
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Will the Test Positivity Rates in districts also be as high as now in Bengaluru?
It is a very evolving situation. TPR at this point of time depends a lot on how much people adopt Covid Appropriate Behaviour. If people in the districts realise that, Yes, we don’t want to go the Bangalore way and be responsible then we may see positivity rates less than bangalore. Many districts have already crossed double digits like in Bengaluru so I would expect most of the districts would also reach there. However, in terms of immunisation we have done very well across karnataka so we are better off in terms of morbidity and mortality expectations from these districts.
Now that we know it is an Omicron-driven wave, what is INSACOG going to look at? Are we still sequencing international travellers and clusters?
INSACOG is changing its strategy; it is now going to focus on hospital admissions. We will be sequencing patients with different grades of severity, continue to watch variants and look at clusters in newer areas. For example, right now, it is all city-centric. Once the cases start to move to the districts, we will start looking at clusters in newer samples. Children will now be on the INSACOG radar.
What are we trying to find out from this?
Clinical correlation of genomic sequencing is very important. We will also need to see if there is any evolution of this lineage. As of now, predominantly, the Omicron lineage is producing more or less mild form of disease, but if it does produce severe disease in certain individuals, it will give us some insights into whether comorbidities are responsible for the severity or whether the lineage itself is evolving into sub-lineages, because there will be mutations continuing to occur in the lineage.
Omicron is evolving? How many sub-lineages we have?
Globally if you look at because I have been associated with the development of RT PCR kit know Omisure and every day we do variant watching and we know now that apart from B.1.1529 we now have BA.1, BA.2 and BA.3. BA.2 and BA.3 are increasingly being reported from some parts of Inida. Northeast,Rajasthan and some other places. In Karnataka it has predominantly 529 but a couple of them are BA 1 and BA 2 also.
There is no clear cut evidence to say that phenotype is different.
SARS COv2 is unpredictable. We know it is throwing surprises. How many more days to continue to go with boosters and will every variant need a new vaccine? What is the scenario going to be like?
An honest answer is, I don’t know. But the way Omicron is spreading, it will give a booster kind of effect to all those who are vaccinated as well as the unvaccinated, if they get infected. To that extent, we should expect that for sometime, at least after this wave subsides, there will be a lull. Looking at what happened during the Spanish Flu a century ago, it subsided after three waves let’s hope this one too goes the same way. But having said that, this virus comes with surprises. Evolutionarily speaking as a virus goes on mutating what we know atleast with respiratory viruses js that disease severity will come down because it will get more adaptable and eventually it will become an endemic like flu.
As far as vaccines are concerned: My own guess is another precautionary dose vaccine, as we call it in India, and a booster dose for all should be enough. I think there may not be a need to go on tinkering with the vaccine.
One thing we realised with omicron is, vaccines did help in terms of preventing severe disease but to expect vaccines to prevent infections is a tall order . Those kind of vaccines probably will be available as a nasal vaccine in early phases has been showing tremendous promises nasal vaccines are probably the ones if at all can give “sterilising” immunity.
What is the relevance of Omisure test kit to understand the clinical picture?
It is an RT-PCR test that can specifically detect the Omicron variant. It can also detect other SARS-COV2 virus which is not Omicron. This has clinical relevance, especially in those who are hospitalised, to know if it is Delta or any other variant. Delta is still around. It also helps in knowing if monoclonal antibody cocktail drugs can be used for those patients.
Also, when you see new clusters in the districts, you want to know if the virus is from the main metro or a new one. If it’s not Omicron, then sequencing it will yield faster results to know if it’s a sublineage of Omicron or a new variant itself.
When will it be in the market?
Post 22nd January 2022. There has been a little challenge in getting raw materials. It will definitely be available by 22 January.
The spread is definitely going to depend on people's behaviour so what should the government and people do now?
Let’s start with people. A large part of responsibility rests with people. First, to wear a mask properly. Unnecessary travel and going out into crowds should be avoided atleast for two three weeks so that you know one can protect one self. The good news is that it is a very short peak and it will move on faster.
Government’s main responsibility is to give right information to people. Get the health infrastructure ready in case virus changes or huge numbers occur. Small proportion even in those huge numbers can occupy hospital beds so be prepared for oxygen drugs and so on. And start CCCs continue to emphasise to people that crowding is avoided and most importantly have some semblance of restrictions.
If the government doesn’t impose any restrictions then it may not be giving the right signals. Many people ask “oh does omicron spread only in night?”. Answer is obviously NO. But people like us are not fools to say that.
It is good to have some restrictions because it is human psychology to get together in the evenings. That is the time when people get together. The Whole day they are busy working. So the chances of spread is likely to be more when there is crowding in markets, in places where they go to functions etc. Have you seen crowds early in the morning?
I have always said this pandemic is like a long road with many road humps. You only need to slow down at humps and move ahead. You don’t have to stop. Stopping is lockdown thats not needed. But slowing down is necessary.