In October and November, 2021, COVID-19 numbers were once again beginning to give rise to hope. Except for Kerala and parts of the North-East, the cases had more or less stabilised, markets had opened up, children were going to school, and theatres and stadiums were once again full.
While there was talk of India having entered the endemic stage of the pandemic, there was always an exception to the rule - the exception being a new variant of concern.
Omicron's rise across the world a few weeks after South Africa and Germany has now reached India. In the last one week, there was been an exponential increase in numbers across states and the most populous cities.
Are we hurtling towards India's third wave? Data seems to indicate as much.
R Nought, and Why it Matters
We are once again talking about the R rate. If your R is greater than one, your number of cases on a day-to-day basis keep increasing, if it is less than one, they are decreasing. "If they are increasing they signal an incipient leading to potential pandemic / epidemic locally. If they are decreasing it tells you that the epidemic has run its course and is on its way down," said Dr Gautam Menon, professor of physics and biology at the Ashoka University, in an earlier interview with The Quint.
"Many things can interfere with it for example a new variant can come along which is more transmissible and moves more easily between people. That can drive your R up," he'd added.
Well, that seems to have happened.
India's overall R value is around 1.2, but in the city of Mumbai and Delhi, it has crossed 2.
Other cities like Chennai, Kolkata, Bengaluru and Pune have reported an R value of over 1. The Health ministry has also highlighted 12 cities of concern as positivity rates in some jump to over 1.5 percent.
A COVID tracker at Cambridge had recently pointed out that India may see a spurt in the Covid-19 growth rate within days and head into "an intense but short-lived virus wave." This tracker had got India's second wave right.
Lessons From South Africa
The one word that brings some hope is short-lived. This has been seen in South Africa as well where scientists believe Omicron-led wave peaked in two weeks and hospitalisations were half or less of the Delta wave, peaking at 9000. Since then cases have fallen by nearly 40 percent.
In an interview with The Washington Post, a South African scientist drew an analogy comparing Delta wave in the country to scaling "Kilimanjaro. Omicron’s is more like we were scaling the North Face of Everest.” But he also said that the fall in the graph is like coming down the south face of the Everest, meaning, it has been just as dramatic.
Will a similar trend be seen in India? Dr Gagandeep Kang, a leading virologist and member of NTAGI, in a tweet points to India and South Africa's high sero-positivity.
However, epidemiologists have warned that any intense wave, short-lived or not, will lead to increase in hospitalisations, despite the hybrid immunity of infections and vaccinations. And we all know what happens when health systems get overwhelmed. The wounds of April May, 2021 have not healed.
We have identified under 1000 cases of Omicron so far, but with the rate of increase in infections, it's clear that this is not a real picture. And with most cases in Mumbai, as this Scroll article points out, are among those who have never travelled, the infection is already spreading in the community.
Remember, "Community Spread" is another lesson from 2020, when COVID-19 spread fast across the country among those with no travel history during the first wave.
Various Omicron Studies, and Where They Leave Us
Omicron was first reported in Africa around mid-November, although experts believe it could have been around from mid-October.
What makes Omicron concerning is the “unusual constellation of mutations" that makes it "very different" to other variants that have circulated.
32 of these mutations are in the spike protein, remember it is the spike that most vaccines target. Of these, 10 are in the receptor binding domain -that the virus uses to attach to human cells. Delta had 2 mutations here.
Various early studies have indicated that some vaccines will not be as effective in protecting against Omicron - these include the mRNA vaccines and AstraZeneca, available in India as Covishield. But the same studies indicate that a booster dose of an mRNA vaccine will greatly increase protection, irrespective of what primary doses you have taken.
Most of these studies look at antibody protection provided by vaccines. There is another type of protection called T cell protection that scientists believed would still protect against severe disease - and now two new studies from South Africa and Netherlands have shown just that. The T cells seem to be kicking in against Omicron in both those with previous infection and those with vaccine-acquired immunity - this is the best news so far. This could also explain the less number of mortality seen in South Africa and Europe.
There is more good news in other early studies. One study found that the omicron variant was 80 percent less likely to lead to hospitalisation, in comparison to Delta variant. For those who were hospitalised, the risk of severe illness was 30% lower.
Another new study from South Africa seems to suggest that Omicron can enhance immunity against Delta variant. This means once you've been infected with Omicron, there is less chance of getting infected with Delta. This could also lead to less severe outcomes in patients.
Early Days: Do NOT Let Your Guard Down
When it comes to booster doses, India's lagged behind the developed world. Lack of data on how boosters for Indian vaccines Covishield and Covaxin work means we are largely entering our 'precautionary dose' programme blind. We have data on mRNA vaccines but those are not available in India. Remember, Moderna's mRNA vaccine has emergency approval in India, but not a single dose has been given out due to legal hurdles.
There are ongoing studies on booster doses in India, but with delay in green lighting these studies, there has been difficulty in recruiting volunteers.
India's two new Protein vaccines, Corbevax and Covovax could theoretically work as possible boosters as well, but lack of data and studies means we just don't know what the efficacy will be.
The decision to give boosters 9 months after the second dose at a time when Omicron is rising has raised questions.
And supply continues to remain a problem.
Giving all that we know, double mask up, stay safe, and hope for a more peaceful new year.
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