Riding out the Omicron storm
At least 13 Covid-19 vaccines in the world have been approved for emergency use. Until the middle of 2021, there was no authorization yet for children, who were considered less vulnerable.
We have been tired of fighting the Covid-19 pandemic for two years now.
Despite the discovery of Omicron cases in Indonesia, we still want to see the storm subside soon. In the words of singer Berlian Hutauruk, “Enyahlah engkau awan hitam di hati yang gelisah semusim yang lalu; jangan lagi ada daun-daun berguguran [begone with you dark clouds in the anxious heart of the past season, no more leaves should be falling]”. It is beyond enough to have seen the deaths of about 144,000 people, including hundreds of healthcare workers, as a result of the virus. Now even the younger generation aged 6 to 11 have been summoned to beat the battle drum to crush the virus. This age group totals over 26 million.
Indeed, the time has come for us to be more optimistic. So far, first-dose vaccinations in Indonesia have reached 70 percent of the population, while second doses have reached 50 percent, 10 percent above the target of the World Health Organization (WHO). “This gives some relief,” said a senior vaccine researcher and pediatrician.
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At least 13 Covid-19 vaccines in the world have been approved for emergency use. Until the middle of 2021, there was no authorization yet for children, who were considered less vulnerable. Now the situation has changed. Actually, in March 2021, United States drug producer Moderna announced its first clinical trial on children aged 6 to12. Pfizer, also from the US, is ready to test its injections on children aged above 12. AstraZeneca, a joint British-Swedish company, is also conducting a clinical trial on children aged 6 to 17.
Why should clinical trials on children be different from those on adults? Until mid-2021, children were not the main target of vaccine developers because they rarely fell ill. However, evidence has indicated that vaccinating them can protect the entire population. Those infected without symptoms can still transmit the super-tiny “thug” virus that causes Covid-19.
There are also rare cases of infected children developing a fatal condition called multisystem inflammatory syndrome. Yet many children turn out to display persistent symptoms like those of long Covid in adults. It’s unclear why children tend to suffer from less severe Covid-19 than adults do, but several studies connect the condition with a change in the system of immunity when they grow older.
The immune system appears in two forms. First, there is innate immunity inherent in the body since we are born and which arises as an initial response to attacks, foreign agents and all kinds of pathogens.
Second is adaptive immunity, which is acquired along with increasing age. Simply put, the body is very smart at adapting to changing situations through the immune system at its disposal. It takes action when the first, innate system fails to prevent the spread of pathogenic attacks.
It is most likely that the innate system of children is “smarter” at identifying new pathogens and fighting them than that of adults.
It also records with its “memory” all kinds of viruses previously identified. Like criminals, the pathogens coming later will be seen by the body as “recidivists” ever robbing us of our wealth: health. It is most likely that the innate system of children is “smarter” at identifying new pathogens and fighting them than that of adults.
If Covid-19 has different impacts in children and adults, the same is true of the effects of vaccines. That’s why it is important to prove that the vaccines are equally safe and effective for all ages, for adults as well as children.
Normally, only after researchers have succeeded in proving that the vaccines are safe and effective for adults will they continue their studies involving younger groups by the method of deescalation, starting from a group of teenagers, followed by younger children and lastly toddlers and infants.
In clinical trials on children, the quantity of antibodies produced in response to the vaccine doses given will also be examined to take note whether they obtain the same protection as that of adults. Certainly, the clinical trials go along with the measurement of other markers of success, such as side effects, case numbers and emerging symptoms.
Flight crew from Air China arrive in hazmat suits in the international terminal at Los Angeles International Airport on December 3, 2021, as Los Angeles County reported its first case of the omicron variant.
Yet the number of tests is not necessarily as large as that for adults because researchers have gathered (and will keep collecting) the same data from millions of results of vaccinations already administered to adults. Moderna, for instance, recruited more than 30,000 adults in its third phase clinical trial, while for its clinical trial on children, the mRNA vaccine producer with its head office in Cambridge, Massachusetts, the US, only involved 6,750 participants.
We can expect herd immunity—when the majority of the population becomes immune to virus attacks—to be realized soon, as a result of vaccination or previous virus infection. The existing data in many regions with high rates of vaccination coverage such as the United Kingdom show that the millions of injections are indeed effective.
However, a quarter of the world’s population is now under the age of 14. If they are not yet vaccinated, it will be impossible for the world to halt the spread of Covid-19 totally. The sooner children are vaccinated, the greater the chance for us to rid the Earth of the virus. This is reason for us to be optimistic, because the start of the program for children’s vaccination in our country has almost coincided with the appearance of Omicron, so there’s even higher hope of preventing the spread of various Covid-19 variants. Two thumbs up to the Indonesian government, even more so because first- and second-dose vaccination coverage is making rapid progress.
Booster shots
Nonetheless, the virus elimination cannot be thoroughly carried out if the antibodies of many people decline after the second vaccination. Research has shown that the post-immunization antibodies formed will continue to decrease significantly. “From the sixth month after the second vaccination, the lessening antibodies can reach over 50 percent compared with that after three months,” said the senior researcher.
So far, post-immunization examination has concerned antibodies, in part, and factors such as the grade of memory cells in blood (which may still provide protection for the body) are not monitored due to their extra high cost.
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By relying on the partial data (on antibodies) with a declining grade, many countries give their people third-dose injections, commonly called booster shots. We feel grateful that along with children’s immunization, the government will soon realize the booster jabs. This is expected to thwart the threat of a third wave, especially one arising as a result of the new Omicron strain.
The new Omicron (B.1.1.529) strain itself is still steeped in many mysteries. US epidemiologist Michael Osterholm, also the director of the Center for Disease Control and Prevention (CDC), for example, told CBS News on Tuesday (30/11/2021) that at present we were more vulnerable because a number of people already vaccinated 6.7 or 8 months ago had not yet received booster shots and we were again entering a higher-risk situation.
Earlier, the Moderna vaccine producer’s CEO was quoted by CBS News as saying that the existing vaccines were most likely ineffective against Omicron.
A boy receives a dose of Pfizer-BioNTech COVID-19 vaccination for children aged 5 - 11, in Rome, Wednesday, Dec. 15, 2021. Italy has started vaccinating children aged 5-11 against COVID-19 as the government braces for the spread of the omicron variant during the holiday season.
An internist from Surabaya, RA Adaninggar SpPD, who is also an influencer on Instagram (@drningz), quoted findings on 17 Dec. that the Omicron variant was infecting 70 times faster than the Delta variant or the original SARS-Cov-2 and replicated in the bronchus (air passage connecting nasal and mouth cavities with the lungs).
This means that Omicron is far more transmissible. But research conducted by Michael Chan Chi-wai and his team from the University of Hong Kong (HKUMed) also found that 24 hours after infection, the rate of replication of the Omicron virus in the lungs was only a tenth of that resulting from infection by the original SARS-CoV-2 variant. This can serve as an indicator of the less virulent nature of this variant.
Still it’s important to note, “The severity of illness is not only determined by the rate of virus replication, but also by the response of the immune system of the host [patient] to the infection, which can indicate the presence of confusion in regulating the innate immune system [like the presence of a cytokine storm],” said Dr Chan.
It is also worth noting that with many people being infected, the most infectious virus can cause more severe illness and death event though the virus itself is not so
pathogenic. The study revealed that the Omicron variant could evade the immunity produced by vaccines and previous infections, so in general, the threat posed by Omicron may be very significant.
Research by Haogao Gu and his team, also from HKUMed, confirmed this. As written by Gu and the team in the Emerging Infectious Diseases journal published by the CDC on 3 Dec., two travelers from South Africa and Canada arriving and quarantined at a hotel in Hong Kong were found to have been infected with Omicron. Both patients had been fully inoculated with Pfizer vaccines. The website of the journal Nature on 25 Nov. also mentioned the case of both travelers. Nature wrote that the infections taking place in South Africa had affected recipients of the three vaccines used in the country: the products of Johnson & Johnson, Pfizer-BioNTech and Oxford-AstraZeneca.
It seems that in 2022, Omicron will dominate the spread of Covid-19 in the world, shifting the role
strain. Therefore, we are now racing with time to rush vaccinations, including booster injections. The problem is that Omicron is very ferocious: only within 10 days, between 15 and 25 Nov., the number of cases of this new Covid-19 variant in South Africa soared from about 400 to over 2,000 per day. Apparently, Omicron is “craftier” at overwhelming human cells and cleverer at evading the radar of antibodies emerging out of vaccination and previous infection.
Yet even if the ferocity of the new variant is not as “cruel” as the original virus, what makes us worry is the far more extensive transmissibility of the Omicron variant. Although it has been identified in more than 77 countries, “it’s probable that many countries have not yet detected it due to their low genome sequencing records”, said WHO director general Tedros Adhanom Ghebreyesus.
While waiting for Omicron to display its true colors several weeks ahead, Indonesia should speed up genomic
data recording. This is because this genomic tracing is highly important to identify the presence of new variants. Although we do not expect it to, Omicron may be able to paralyze our health system as has previously been the case.
Syafiq Basri Assegaff
Our two-year experience in managing the pandemic gives us lesson to remain optimistic without ignoring the existing signs of danger. Compliance with health protocols should not be relaxed. Before herd immunity is achieved, during every long-holiday season like Christmas, New Year and Idul Fitri, vigilance should be heightened so that the storm of the past season will not recur.
Syafiq Basri Assegaff, Doctor, alumnus of the Medical Faculty at Padjadjaran University; lecturer at the Communication and Business Institute of the London School of Public Relations in Jakarta.
(This article was translated by Aris Prawira)
