Omicron: Sound Alert Not Alarm

Omicron: Sound Alert Not Alarm

Too little is known as of now to presume this variant will be worse than Delta

K Srinath Reddy

29.11.2021

Covid virus variant B.1.1.529 had the shortest wait time for acquiring a Greek name, from the time of its first reported arrival into the world. Initially identified in Botswana and later confirmed by South Africa, it has been labelled as a variant of concern (VOC) by the World Health Organisation which named it Omicron. By November 26, it was also reported from Hong Kong, Belgium and Israel. By the next day, Omicron was detected in more countries, including two cases in the UK which had announced a ban on flights from African countries.

Several other countries too have banned flights from Africa and Hong Kong. It is not clear whether the ban will be extended to more countries that now have Omicron infected persons, such as the UK itself. It is also unclear how effective travel bans are, given the experience with the Alpha and Delta variants which slipped through such restrictions. The South African health minister has protested that his country is being unjustly penalised for efficiency in testing and honesty in reporting The heightened concern is linked to the large number of new mutations that Omicron has acquired, especially in the spike protein which the virus uses to enter the human cells. It was reported that these provide Omicron a greater ability, than the currently dominant Delta variant, to bind to the human ACE 2 receptor which opens the door to the interior of the cells. After entry, the virus uses human genetic material to make many copies of itself. They can then infect other humans, to continue the chain of transmission. Through these mutations, Omicron appears to have acquired features that give it greater infectivity.

Is the new variant to be feared more than the Delta variant? Will it dethrone Delta in a militant march around the world? Apart from higher infectivity, will it have greater virulence than Delta or other variants? Will it evade the immunity provided by currently available vaccines? Will it bypass the immunity acquired through natural infection with the ancestral virus or any of the variants that emerged later, including Delta?

While these are legitimate concerns, it is too early to definitively answer any of these questions. Data are still being gathered from the populations of different countries to assess infectivity and virulence and laboratory studies are being conducted to evaluate the ability of the variant to evade previously acquired immunity, whether from vaccines or natural infection. Statements from scientists are currently strewn with phrases like ‘may’, ‘could’ and ‘possibly’ as they await definitive evidence. However, many sections of the media and politicians of several countries have already assumed the worst and proclaim Omicron as the most dangerous coronavirus yet to emerge since Covid debuted in Wuhan.

It was breathlessly reported that two persons in adjoining rooms were infected, as proof that Omicron spreads via aerosols, while it is by now well accepted that the Covid virus had both aerosol and droplet modes of transmission all through the pandemic.

It is possible but not necessary that a variant which possesses more spike protein mutations will have spreading and staying powers that can conquer the world. The Beta variant, first reported from South Africa, was greatly feared because of mutations that gave it greater prowess of immune escape.

However, that variant has not spread wide to become the global threat it was feared to be. Neither did Lambda or Delta Plus variants, which too failed to displace the Delta. While Omicron might achieve greater success than other competitors to Delta, it still needs to demonstrate that its bite is as bad or worse than its bark.

Will the variant make all of the currently available vaccines useless for our defence? The most widely used Covid vaccines in the world, made on either mRNA or virus vector platforms, have exclusively targeted the spike protein antigen. It is likely that the virus has evolved numerous new spike protein mutations to evade the immune response they evoke. However, reduced efficacy does not mean absent immunity. It is possible that a considerable degree of protection against severe disease and death may still be offered by the vaccines.

Other vaccines, directed against multiple viral antigens through the use of an inactivated virus, may not be stymied by spike protein mutations. A broader band of immunity, produced by them, may help to capture and quell the masquerading mutant. We still need data to test these possibilities.

The debate on variants should not be confined to vaccines alone. We must recognise that masks effectively protect against transmission of the virus, including all its variant forms. Ventilation too helps in reducing transmission. Crowding is fraught with danger of a super-spreader effect. We can go on tweaking vaccines as new variants emerge but, unless we exhibit discipline to curb transmission in a sustained manner for several months at a stretch, the virus will find enough human bodies where it can experiment with new mutations.

It is time we stop periodically celebrating the presumed arrival of herd immunity and get down to the task of closing the channels of transmission, even as we work on developing vaccines and drugs against variants. Apart from entry point screening, which will only be partially successful because of negative RT-PCR tests early after infection, we should strengthen follow-up of entering travellers and trace contacts of those diagnosed even later.

The new mantra should be MVVT (masks, ventilation, vaccines and testing) rather than LTBP (lockdowns, travel bans and panic).

The writer, a cardiologist and epidemiologist, is President, Public Health Foundation of India (PHFI). Views are personal

It is possible but not necessary that a variant which possesses more spike protein mutations conquers the world. The Beta variant was greatly feared because of mutations that gave it greater prowess of immune escape. However, it has not become the global threat it was feared to be

Govt docs to go on strike from today

Govt docs to go on strike from today

Ahmedabad:29.11.2021

The pending issues of the teaching staff at government-run medical colleges have not been resolved in the stipulated time, so the doctors have called for a strike from Monday. About 10,000 doctors associated with various organizations will participate in the strike, senior doctors said.

At BJ Medical College, doctors will gather outside the college and start the protest at 9.30am, said organizers. “We had tried to urge the authorities to revoke the order of November 22 — which is the polar opposite of the resolution of May 16 when the government of the day had accepted our valid points,” said a Gujarat Medical Teachers Association (GMTA) member from Ahmedabad.

The staff will submit a memorandum to their respective deans, said the organizers. TNN

TN on high alert over new Covid-19 variant

TN on high alert over new Covid-19 variant

TIMES NEWS NETWORK

Chennai:29.11.2021

The state health department on Sunday advised all district collectors and major airports to be on high alert regarding Omicron, the new variant of Covid-19. Health secretary J Radhakrishnan has advised all collectors to keep track of people entering into their districts from foreign countries, particularly from atrisk countries and enhance surveillance.

The new variant (B.1.1.529), first reported in South Africa earlier this month, has a large number of mutations associated with higher transmissibility than the Delta variant. Cases have been detected in Belgium, Hong Kong, Israel and some European nations. But till date, none from Tamil Nadu has tested positive for this variant. “In case another major surge of Covid-19 takes place driven by Omicron in the region, consequences will be tough and we have to take all measures to prevent its entry into our state as like Delta this may pose overwhelming demands on healthcare systems, and may lead to increased morbidity and mortality. The impact on vulnerable populations would be enormous,” Radhakrishnan wrote to collectors.

Reports of breakthrough or re-infections from populations expected to have a high level of immunity (due to prior infections or high vaccination coverage) could indicate the presence of a variant able to evade the immune response.

Samples collected from such clusters should be sent to the state health lab in Chennai’s Teynampet on a priority basis to help in epidemiological studies. Despite uncertainties over Omicron’s immune escape potential, Radhakrishnan said it is legitimate to say available vaccines may offer some level of protection against hospitalisation and death.

Travellers from 11 other countries including England, Brazil, Bangladesh, New Zealand, Mauritius, Zimbabwe, Singapore, Israel, Botswana and China should have covid negative certificate while entering the state.

No bank account means no lessons for Irular student

No bank account means no lessons for Irular student

Komal Gautham@timesgroup.com

Chennai:29.11.2021

The rain and the floods couldn’t deter Rakesh* (name changed), a Class IX student from going to school. But he didn’t know there was another obstacle: a bank account. The boy who hails from an Irular tribal hamlet in Kannima Nagar in Thiruporur, Chengalpet district, hasn’t been allowed to attend classes in the government school located close by, as he did not have a savings bank account.

All tribal students under pre-matric scholarship scheme get ₹8000 per year and that money is credited to their personal savings bank account.

His mother, Rekha* said they were uneducated and also unemployed due to covid and the floods. “ Most of us don’t have identity proof. With great difficulty I opened the bank account for my elder son and daughter. However, for the third child, I was told to have a minimum balance of ₹1,000. It is impossible for us to save ₹1,000. But the bank officials said we can’t withdraw the scholarship money without having a bank account for my child. Now I have taken up a job and am waiting for my salary to open my son’s account,” she said. She added that when she went to the school after it opened a month ago, the teacher there told her to come back only after the bank account had been opened.

Many in the hamlet have dropped out due to several factors including lack of roads leading to their hamlets and the distance from the school. “However, no child was so far stopped from studying because of a bank account,” said S Mohana, one of the village heads. She added that many of them faced this problem this month.

When TOI spoke to the headmaster of Government Higher Secondary School, Nemmeli, she said the allegation is not true. “Yes, we do insist on them opening a bank account. But we have not stopped any child,” she said. The teacher who had stopped the child from attending classes could not be contacted.

Deepa Umashankar, of Wings to Hope, an NGO that works exclusively with these tribes, said no student can be stopped from attending classes.

A senior education department officer told TOI he would look into the issue and ensure the child is allowed to attend classes. “No one can be stopped from attending school. We will set this right,” he said.

Eye on variant, India updates its norms for int’l passengers

Eye on variant, India updates its norms for int’l passengers

TIMES NEWS NETWORK

New Delhi:28.11.2021

All international passengers, except those under five years of age, flying into India from Covid atrisk countries must undergo RT-PCR test on arrival, starting from 12.01am (IST) of December 1, 2021.

This will include those transiting from these places too. Those testing negative must home quarantine for seven days and then re-test on the eighth day.

Those testing positive will be admitted to seperate isolation facility and their sample sent for genomic testing and would be discharged if found not infected with the Omicron variant. Those found infected with this new variant will be kept in “strict isolation” and treated till they test negative.

Union health ministry on Sunday issued a new protocol for international arrivals in the wake of a new variant found in southern Africa, Hong Kong, and some other countries to prevent its spread here.

This adds to the existing norms like a negative report from a RT-PCR test done within 72 hours of flying into India and filing a self-declaration form. They must also add details of their travel in the last 14 days from the time of arrival.

To be sure, the government will keep updating the list of at-risk countries as the situation evolves.

Five per cent of the passengers flying in from not-atrisk countries will also be tested on arrival on a random basis. “The cost of testing of such passengers would be borne by the aviation ministry,” the order says. Their samples will also be sent for genomic testing and they will be treated as per “standard protocol.”

Children unde five years of age continue to be exempt from both pre- and post-arrival test if they are asymptomatic. “Contacts” of positive cases from at-risk countries -- their co-passengers seated in the same row and three rows in front and behind their row and identified cabin crew -- will be kept under institutional or home quarantine, under strict monitoring of the state government concerned.

As of November 26, the health ministry’s list of atrisk countries include: countries in Europe including the UK, South Africa, Brazil, Bangladesh, Botswana, China, Mauritius, New Zealand, Zimbabwe, Singapore, Hong Kong, and Israel.

‘Omicron 6 times more transmissible than Delta, could infect even vaxxed’

‘Omicron 6 times more transmissible than Delta, could infect even vaxxed’

Experts Say Cocktail Drugs Might Not Help

Syed.Akbar@timesgroup.com

Hyderabad:28.11.2021

The newly emerged variant of concern B.1.1.529 (Omicron) may not respond to monoclonal antibody therapy or cocktail treatment, experts fear.

Based on preliminary analysis of Omicron infections in South Africa and elsewhere, experts suggest that it has six times higher potential to spread (R value) than the Delta variant that had triggered the second wave in India. It could also evade the immune system. It may also cause vaccine breakthrough infections.

Dr Vinod Scaria of the Institute of Genomics & Integrative Biology (IGIB) said Omicron has 32 spike mutations and some of them suggest the possibility of S-gene dropout. This means some primers (used in RT-PCR test to detect the virus) targeting the spike gene locus might not work.

The Delta variant, which causes heavy infections and mortality, responds to monoclonal antibody therapy. However, its offspring, the Delta plus, did not respond to this therapy, considered a miracle treatment for Covid-19 in initial stages of infection. After the Delta plus, Omicron is the second variant of concern that may not respond to monoclonal antibody treatment.

According to Mercy Rophina, research scholar at IGIB, the new lineage carries a total of 53 variants precisely including 32 spike protein variants. “Most of the observed variants are found to possess resistance against immunity and other functional implications. Six variants with spike receptor binding domain on G339D, S373P, G496S, Q498R and Y505H are found resistant to monoclonal antibodies (mAbs) including etesevimab, bamlanivimab, casirivimab, imdevimab and their cocktails,” Rophina tweeted.

In a series of tweets on the new variant, Scaria, an expert in genome sciences, said at least one case of B.1.1.529 in Israel seems to have received a Covid-19 vaccine booster, suggesting the variant can cause vaccine breakthrough infections.

“The disease severity is yet to be known, which is the most important point to consider. While vaccine breakthrough infections per se are not the major concern (Delta also caused vaccine breakthrough infections), transmissibility and clinical outcomes (severity and mortality) are the key points,” he said.

Rophina, who is from Scaria’s lab, compiled the structural context of the immune escape mutations in Omicron.

Scaria said three mutations in the S1/S2 furin cleavage site possibly suggests better cell entry (and may be transmissibility). He, however, added that properties of single mutations don’t always add up when they occur in combination. Nevertheless, they give potential directions to explore.

Full report on www.toi.in

TESTING TIMES CONTINUES: A health worker collects a man’s swab sample in Jammu on Sunday

Omicron reportedly has 30+ mutations in spike protein region, may bypass vaccines: AIIMS chief

New Delhi:

The new Omicron variant of coronavirus has reportedly got over 30 mutations in the spike protein region giving it the potential to develop a immunoescape mechanism, and thus the efficacy of vaccines against it needs to be evaluated critically, AIIMS chief Dr Randeep Guelria has said.

“The new variant of coronavirus reportedly has got more than 30 mutations at the spike protein region and therefore has the potential of developing immunoescape mechanisms. As most vaccines (work by) forming antibodies against the spike protein, so many mutations at the spike protein region may lead to a decreased efficacy of Covid-19 vaccines,” AIIMS director Dr Randeep Guelria said.

In such a scenario, the efficacy of vaccines including those in use in India needs to be evaluated “critically”, he said. The future course of action will depend on what more data on its transmissibility, virulence and immunoescpae shows, he said. PTI

Man flies from Dubai with severed thumb just in time

Man flies from Dubai with severed thumb just in time

New Delhi:28.11.2021

Unable to afford medical treatment in Dubai, a 34-year-old Indian carpenter flew into Delhi with a severed thumb wrapped in a bandage after 22 hours of the incident. A delay of two hours would have drastically reduced the chances of recovery.

Sandeep, who hails from Rajasthan, lost his left thumb while working on a saw machine in September. His modest income did not allow him treatment in Dubai. Doctors there put the thumb between the fingers and wrapped a bandage around it.

On arriving in India, the family took him to Aakash Healthcare, it being the nearest hospital to the airport.

The saw had cut three vessels causing loss of 300ml of blood in less than 24 hours, doctors at the hospital said. He had a successful surgery and is recovering well, they said. PTI