If Omicron is the second new ball, it is unlikely to do much damage because the pitch has slowed

If the new variant of the coronavirus is the second new ball in a Test match, it is unlikely to do much damage because the pitch has slowed and there is no grass, points out Dr Amitabh Banerjee

If Omicron is the second new ball, it is unlikely to do much damage because the pitch has slowed

Dr Amitav Banerjee

The strategy to check the current covid-19 pandemic started like a limited-overs cricket match but has seamlessly taken the form of a test match.

The initial promise was a limited two to three weeks of lockdown in most countries. This was ostensibly to “flatten-the-curve” and “break the chain” of transmission, allowing time to boost up the health infrastructure and prevent them from getting overwhelmed.

This expected short term manoeuvre turned into long term restrictions in most countries in anticipation of availability of vaccines round the corner. The pandemic however threatens to settle into the longest version of the game with the arrival of the “second new ball”, the Omicron variant of the novel coronavirus.

The first new ball was the Delta variant with perceived nip and pace. The panic of this first spell of the new ball led to high fatalities as large number of asymptomatic and mild cases scrambled for admission to hospitals in a sort of “medical stampede.”

The associated chaos and anarchy affected care of those patients who really needed it. This contributed to large number of fatalities, some of which could have been prevented had the pandemic been managed according to the principles of public health.

To avoid making the same strategic blunders with the arrival of the second new ball, the Omnicron variant, we should take a hard look not only at the second new ball but also on the pitch which influences the swing and nip of the ball.

We are in the last days of the test match when the pitch loses grass and pace. Presently, our population has a very high level of population immunity predominantly after recovery from natural infection, which renders a more robust and lasting immunity.

Viruses, to survive, follow nature's laws of adaptation - Darwin's Law. These adaptations are by way of mutations, which are natural phenomena and not new, due to errors during replication, and occasionally due to selection pressure, like mass vaccination during a pandemic.

According to principles of successful parasitism, this adaptation is beneficial to both the virus and humans. Errors that make the virus fittest for survival propagate, while others lose out due to laws of natural selection. Lethal or virulent strains perish with the victim leading to a dead-end infection. Less virulent strains which do not kill but cause symptoms also do not go far because patients resort to self-isolation. Thousands of such mutations have already occurred with the novel coronavirus, majority of them going undetected.

The mutant strains, which survive and go far, are the least virulent ones, which do not kill the host and cause very mild symptoms, if any. People infected with such benign variants will mingle with others and transmit these mutants wide and far. The high contagiousness does not translate to high lethality directly. The new mutant Omnicron is following the Darwin's law of natural selection perfectly. From reports so far, it causes very mild and self-limiting symptoms.

It is very important therefore, not to raise the panic button presently by sealing borders and imposing quarantines and lockdowns, measures which did not achieve any interruption of transmission of even the less contagious variants earlier.

These mistakes will raise fear and anxiety among people, leading to a medical stampede where asymtomatic patients fill up hospital beds and drain medical resources depriving the more severe cases the much-needed care management.

The bulk of the Indian population now have immunity from natural infection, which invariably provides more lasting immunity compared to vaccine immunity. This is because in the case of infection, the body's immune system and memory and T cells are exposed to the virus for 10-15 days compared to vaccine induced immunity which is directed only at the spike protein (where 30 mutations have taken place).

The Omnicron mutant is unlikely to pose a problem in the country. On the other hand, due to its higher infectivity coupled with negligible lethality, it may raise the population level immunity still higher, applying the ‘brake’ to the pandemic which has already entered the endemic state in India, bringing it to a dead halt.

Historically, natural infections even after decades give long lasting immunity even without vaccination. This has happened with H1N1 pandemic in 2009 when people over 60 had milder impact compared to the young. Immunity to the novel coronavirus too shows cross immunity from infection from previous SARS infection. People exposed to SARS-CoV-1 17 years ago show strong T-cell immunity to the SARS-CoV-2 according to published research.

Keeping all these factors in mind, Omnicron may achieve at population level what any ideal vaccine should achieve, i.e. raising the herd immunity without causing fatalities or hospitalization. Chasing such a mild variant with huge resources is akin to chasing the common cold. Only the moderate to severe cases should be monitored leaving the asymptomatic cases alone.

Stakeholders with conflicts of interests including pharmaceutical industry, private players, politicians and career scientists should be “quarantined.” This will promote good science and lead humanity back to sanity. Anything short of this will result in a wild goose chase for ‘Zero Covid Cases’. If they are again let loose, even when new variants cause zero deaths, it would be tailormade for leading to huge economic and social setbacks.

(The writer is Head, Department of Community Medicine, Dr DY Patil Medical College, Pune and a clinical epidemiologist with over 20 years experience in the Armed Forces)

(This article was first published in National Herald on Sunday.)

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