With omicron reinfections, are we back to square one of the pandemic?

The omicron variant of SARS-CoV-2 that causes COVID-19 evades natural immunity and immunity to vaccines and is highly transmissible, recent evidence has established. The World Health Organization (WHO) has officially warned of an increase in reinfections.

Clinically, now that the susceptible population is back to the same as it was in early 2020, would it be fair to say that we are back at the starting point of the pandemic?

One month since its classification as a variant of concern, omicron has already been detected in more than 100 countries. The WHO has warned that it may be present in many more; its mild or asymptomatic infection makes it more difficult to detect.

Satyajit Rath, an immunologist and visiting professor at the Indian Institute of Education and Scientific Research in Pune, argued that although everyone is now susceptible to an omicron infection, we are not in the same position we were when the pandemic began.

This is due to the knowledge, experience, and availability of responses to the infection acquired in the last two years, he said. Masks, vaccines, increased testing capacity, and oral treatments for COVID-19 as tools that we did not have in early 2020, the expert added.

But he also underlined a caveat:

As of yet, we have not established any policy for the affordable manufacture and distribution of high-efficiency masks. Until now, we have not provided a basic level of vaccine coverage to all of our people, including in India and, of course, in large swaths of the global south. Even now we have not established an effective policy for easy, on-demand, free, and locally available testing. We have not established policy provisions for the actual large-scale deployment of drugs such as Merck’s Molnupiravir and Pfizer’s ‘Paxlovid’.

Several experts are of the opinion that the evidence on the reduced efficacy of the omicron vaccine is not yet conclusive. They are still our best way forward.

Currently, 48 percent of the world’s population has received two doses of COVID-19 vaccines. All continents have twice vaccinated at least half of their entire population, but Africa has done so with just 8.8%.

As the vaccination campaign completes a year, a large population has yet to be inoculated with even a single dose. The current situation, even without the omicron threat, is pretty bad, Dr. Chandramouli Bhattacharya, an infectious disease expert at Peerless Hospital in Kolkata, told Down to Earth.

There are still many susceptible people around the world who are not vaccinated and that is the basic problem, he added. “COVID-19 is an RNA virus and it will keep mutating when it gets the chance.”

While global cases will triple in the coming months, omicron’s virulence remains questionable.

“I don’t think omicron can undo the progress made so far, but it has the potential to lead us to a situation similar to the second wave in India,” warned Dr. Bhattacharya. Even if we assume that it is not as virulent as the delta, given its infectious nature, the absolute numbers of hospitalizations could be much higher, he added.

Experts agree that we have not returned to the starting point of the pandemic. Dr. Chandrakant Lahariya, a public health analyst and epidemiologist, argues that today we are at a much more advantageous stage in terms of serious illness.

“Vaccines were not designed to protect us from a COVID-19 infection. Their role has never been to stop the spread, but to prevent hospitalizations and deaths, “he said.

If omicron had emerged in March 2020, our situation would have been much worse. But today, it is unlikely to cause serious harm, Lahariya added. “The increase this time is not likely to be as bad as the second wave, but a lot still depends on government intervention and citizen behavior.

The world’s population is again equally susceptible to omicron infection. But that’s where the similarity of the situation to early 2020 ends, according to health experts.

Due to vaccination or natural infection, our immune system now has a memory of the disease and therefore can muster a response, despite the lowered antibodies, and protect us against serious diseases.

Ram Vishwakarma, Immunologist and Former Chairman of the Covid Strategy Group of India, Scientific and Industrial Research Council, said:

All the studies published so far on waning immunity only calculate the antibodies. It says nothing about our memory B and T memory cells. Scientifically speaking, fewer people will progress to serious illness. But what worries me is the young population. The pediatric population has little or no protection unless it has been infected.

Several countries have started vaccinating children against COVID-19; India will start the process for 15-18-year-olds in January next year. However, it is not clear which vaccine they will receive. At present, of the vaccines administered in India, only Covaxin from Bharat Biotech has received emergency use authorization for children.

Early 2020 is also closely remembered for the varying degrees of blockage it induced. India was among those with the strictest restrictions. The delta outbreak earlier this year prompted a similar response. What should we expect with omicron?

Rajib Dasgupta, president of the Center for Social Medicine and Community Health at Jawaharlal Nehru University, believes that the mild clinical features of this infection are possibly an indicator that it will not return to square one when it comes to severe restrictions. “Given its transmission force, physical restrictions are likely to have less of an impact, despite a lack of appetite for restrictions between governments and businesses.”

Cautious guesses are being made about the severity of the disease caused by omicron and what that means for the biological evolution of the virus. With five worrying variants and countless other mutations, the SARS-CoV-2 virus has mutated rapidly since it infected humans. And it is likely to mutate again. As long as the virus is not easily transmitted or causes long-term illness, its new forms will have higher transmissibility but lower virulence, according to health experts.

“That is the logic of evolutionary biology that guides the virus. We should create such evolutionary pressure through our behaviors, ”Srinath Reddy, president of the Public Health Foundation of India, told DTE.

If we can establish a stable equilibrium with a low-virulence virus that lives with us endemically, we will see the end of the pandemic in a year, according to Reddy. “Until then, we will see peaks and valleys scattered around the world in different months.”

Dr Subhrajyoti Bhowmick, Peerless Hospital, Kolkata, made similar arguments, underscoring that we are at the downhill part of life from a pandemic. The killing power of SARS-CoV-2 has diminished, he said. “The survival of the virus depends on the survival of the host, the first cannot exist without the second.”

Dasgupta, however, disagrees. Arguing that it is difficult to predict whether omicron means that we are closer to the beginning of the pandemic than to the end, he said. “Cholera, for example, had seven pandemics, which began in 1817 and resulted in millions of deaths. It continues to cause new outbreaks, but it has evolved into a much milder disease with only occasional deaths. ”

The history of public health has taught us that it is unwise to judge a pandemic caused by a virus as virulent as these in months; it would be a matter of years, if not decades and centuries, the expert added.

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