Omicron: This variant may prove to be a blessing in disguise, says AIIMS Trauma Centre Chief, Dr Rajesh Malhotra

Interviews

If this variant is five times more lethal than the Delta variant and causes lower fatalities, it will prove to be a blessing in disguise, Dr Rajesh Malhotra, Chief of AIIMS Trauma Centre told Medically Speaking while discussing about the new Omicron variant that is wreaking havoc all over the world and has spread 21 cases in India now.

Read the full interview here:

What do we know till date about the Omicron variant and what does it mean for our country?

Dr Rajesh Malhotra: Covid is not yet over and somehow due to our optimism, the layman chose to ignore this fact. It is about evolution, like we evolved, the virus also continues to evolve into something more transmissible than Delta and brought together very concerning and worrying combination of mutations. We knew that the South African variant could escape immunity and infect people with antibodies and vaccination. The worry is that we are dealing with a virus that has got together two strong points of different strains and is emerging to be a formidable opponent which will be worse than Delta. But then it is very likely that this virus will become a predominant strain all over the world. Our concern is how is it going to behave as we have insufficient evidence and vaccination is not going to protect us from this completely. There is an immune escape that may not be a cause for panic but definitely needs surveillance.

One of the cases found in India had not come from foreign and neither had the infected person mingled with any carrier. Could it mean that the virus was already present? How are you interpreting the information which is pouring in now?

Dr Rajesh Malhotra: The only way to confirm the existence of a variant is by genome sequencing. In an article on genome sequencing, I wrote that whenever there is an outbreak, we need to look at need to see whether there is something new that has evolved to cause cluster of infection. There has been a similar thought in many of the countries where they had isolated the variant before South Africa declared it. There has been a geometric rise in the cases in South Africa but there has been a problem with the African continent three fold: Firstly, their testing has not been so large and widespread, secondly, their vaccination has been very limited and thirdly, large number of people in Africa are immunosuppressed.

There is an ethical debate when it comes to boosters. But do you think with this “horrible mutation” in consideration, the government should act faster on booster shots?

Dr Rajesh Malhotra: Data from South Africa has shown that those who were immunized had minor illness and those who were not immunized needed hospitalization, which means that an immunized person will be better after catching infection than the one not immunized. Therefore, we have to immunize all those who are yet to get their second dose and the reason is very clear that even if you have a breakthrough infection after immunization, you are not at high risk. Secondly, we have a high seropositivity rate among a huge population, so the thought process is that maybe a vaccine from different platform like nasal vaccine will be more effective. Thirdly, the breakthrough infections are largely to mRNA vaccines, which have hardly been given in India so we need to see whether the breakthrough infections are as common with Indian vaccines as they are with other. It is good to be cautious but I believe we may be overreacting till the time we have more data but we have to be on the guard because even if the hospitalizations increase, we do not want it to become uncontrollable. Even if it is destined to become predominant strain all over the world, if we handle a lesser dose at a time, we will get more time to react to it and see how it behaves and prepare accordingly. We also do not know about long Covid, so if everyone says that symptoms are very mild, and it does not cause fatalities or hospitalisations, we do not know how it is going to behave in the long run, whether it will cause disabilities or not. Considering everything, we have to protect ourselves and have greater surveillance and genome sequencing apart form accelerating vaccination drive.

What do we know about this virus’s ability to overcome the immunity provided by vaccination?

Dr Rajesh Malhotra: All the data on this has mainly come from South Africa which is its place of origin and the main vaccines used by them are mRNA by Pfizer, vaccines by J&J and AstraZeneca. You cannot extrapolate that data to the Indian population where there is large seropositivity. Secondly, this data does not pertain to the Indian vaccines. Not that it is totally ineffective, they said that it is 30 or 40 per cent less effective in preventing infection. We have always known and said that vaccines do not protect you from infections, but hospitalisations and death and ICU admission. It is only shot into prominence because of its high transmission and a rising number of infections. Hundred thousand people catch common cold, none of them panics, so what if even a small percentage starts needing hospitalization?

South African government says that a large amount of children need hospitalisations which has sent alarm bells all over the world, especially India. Would you say we have appropriate healthcare system if large number of infant and toddler hospitalisations are needed?

Dr Rajesh Malhotra: Firstly, I cannot see any reason why this cannot be fought by children. Secondly, there is a high seropositivity in children also. Thirdly, I would like to tell you that delta is highly infectious and there were hardly any households where one person got infected and the family did not. Same thing applies to children and only the children with major comorbidities like liver failure, childhood cancers died during the second wave. We are raising our guard because now we have been into the pandemic for close to two years. It is always said that a mask is a vaccine in your pocket which protects you against the virus just like the vaccines. Delta was a problem indoors and if this is five times more transmissible than delta, which is why you have all the more reasons to remain indoors. If this virus turns out to be more lethal than Delta, it will be a blessing in disguise because it has wreaked havoc all over the world and if it turns out to be infectious but does not kill, it will be a blessing. Therefore, we have to watch how it behaves among the unvaccinated, vaccinated, and those who were exposed to native virus. So we need to observe universal precautions at all costs. Do not go for rumors, only trust the data coming on from reliable and authentic organisations. Avoid all unnecessary gatherings and follow social distancing. Keep the vaccination drive in fast mode. We have been augmenting our infrastructure, we have to keep it ready but you must remember that it is counter intuitive for a virus to kill all its hosts. The virus is already five times more transmissible than delta and if it becomes as lethal or even worse, it will wipe out entire mankind which cannot happen. Therefore we can say that this virus has evolved itself to coexist with the mankind which will ultimately become and endemic, keep nurturing or feeding on a group of people. We will eventually have to vaccinate children. The only thing is that we do not know about the risk benefit ratio yet because very small number of children have actually dies due to pandemic but maybe there will be a time when there will be a vaccination for children while they are undergoing other vaccinations. But during the peak of the pandemic we always think that those who are not vaccinated remain vulnerable and death rate for children is much higher for adults than for children.