THE Technical Advisory Group on Virus Evolution of the WHO declared B.1.1.529 a variant of concern on Nov 26, 2021, and named it Omicron. As of Dec 22, 2021, the virus had been found in 110 countries and as I write this article the variant is now circulating around the globe.
It spreads faster than any other known variant of Covid-19. The doubling time of the Delta variant was up to two weeks whereas that of Omicron was found to be two to three days. Doubling time is the number of days required for the number of cases in an epidemic to double, based on the rate of cumulative increase in the number of cases. One has to remember that the doubling time keeps changing with the evolving epidemic.
Finding 75 cases of Omicron in three major cities of Pakistan, as reported in the media with reference to the National Institute of Health, must be clearly understood. Taken as an absolute number, this can be very misleading. In reality, this represents just the narrow tip of a huge submerged iceberg. The community transmission of Omicron is at work in Pakistan and every two to three days the number of infected people is doubling. But since we don’t know the exact base number of Omicron cases at any given time, it is extremely difficult to calculate the future number of cases. However, there are all indications that the number of cases is going to rise in the coming days and weeks and they will rise sharply due to a short doubling time. In fact, although miniscule, an upward trend in cases has been notable in the last 48 hours in Punjab, Balochistan and Azad Kashmir.
The risk posed by Omicron largely depends on four key factors: one, how fast the variant spreads; two, how effective the vaccines are against this variant and how much protection is provided by the previous infection; three, how virulent the variant is compared to other variants for causing the disease; and four, how people and governments understand these factors and take timely and appropriate public health and social measures to avoid risk.
The number of cases represents just the narrow tip of a huge submerged iceberg.
Are we ready to deal with the upcoming Omicron tide? Keeping in view the previous experience of dealing with the four waves over the last two years and on the basis of the knowledge gained so far about the characteristics of Omicron, and the vaccination statistics in the country, we can effectively deal with the virus if we take appropriate and timely action. However, there is absolutely no room for complacency.
The previous experience of the four waves in Pakistan informs us that for known and unknown reasons the intensity of the waves was far stronger and damaging in the US and Europe than in our part of the world. This is despite their much more developed and resourceful healthcare systems — Omicron is already a dominant variant in the UK and the US. Within the region, Pakistan has also done well when compared, for example, with Iran and India. For this, credit must go to the apex NCOC and its timely and consultative decisions on the basis of available data and more importantly, the efficient national coordination for implementation of decisions across the country. The data has not been adequate but still has served as a basis for making and enforcing timely decisions.
Omicron on the one hand has been found to spread rapidly, but on the other hand, and thank heavens for that, has not been found to be more virulent in terms of causing severe illness. “Early data from the United Kingdom, South Africa and Denmark suggests there is a reduced risk of hospitalisation for the Omicron compared to the Delta variant, however, further data are needed to understand the clinical markers of severity including the use of oxygen, mechanical ventilation and death, and how severity may be impacted by vaccination and/or prior SARS-CoV-2 infection,” says the weekly epidemiological report by the WHO, published on Dec 28, 2021.
Although it is preliminary data and to draw definitive conclusions can be erroneous, studies suggest that the current vaccines are providing protection against Omicron. Prior infection, and the resultant immunity, also protects against the Omicron variant. Notwithstanding this early evidence of protection however, cases are being reported of many fully vaccinated people being reinfected as well. So, vaccination is essential but not sufficient and so is the case with immunity due to previous infection.
Pakistan has done quite well on the vaccination front. Against the end-of-the-year target of fully vaccinating 70 million people, until yesterday more than 68.5m had been fully vaccinated. In the given context, it is quite a remarkable achievement.
So, how can people protect themselves from Omicron? By getting fully vaccinated and following now well-familiar SOPs ie wearing masks, keeping a safe physical distance from others, avoiding unnecessary social mingling especially indoors, when in closed places keeping the place well-ventilated and ensuring hand hygiene. The NCOC and the federal and provincial governments need to not only continue monitoring the situation very closely but also redouble their risk communication campaign.
The clouds are gathering and there is a lull before the storm. The reality is that Omicron and Delta are now two dominant variants circulating in the world. The combined effect of both variants is a widespread surge in the cases. The WHO director general in his speech on Dec 29, 2021, said, “Right now, Delta and Omicron are twin threats that are driving up cases to record numbers, which again is leading to spikes in hospitalisations and deaths. I am highly concerned that Omicron being more transmissible, circulating at the same time as Delta — is leading to a tsunami of cases.”
Pakistan needs to go quickly into an emergency mode once again to avoid the looming surge which in our case can rapidly overwhelm our healthcare system.
The writer is a former SAPM on health, professor of health systems at Shifa Tameer-i-Millat University and WHO adviser on UHC.
Published in Dawn, December 31st, 2021