Facing Omicron with Vigilance without Panic
The 3M + 3T + vaccination management has proved to be effective for the original Covid-19 strain and other variants. It is also expected to be effective for Omicron.
Didie SW
The Omicron variant has entered Indonesia. According to Health Ministry data as of Saturday (25/12/2021), based on whole genome sequencing results, the number of cases in Indonesia has reached 46.
A month after being identified in South Africa, 77 countries have reported the presence of this variant. Its entry into Indonesia had in fact been predicted. Some experts even believe there were many cases of this variant even before its detection.
The World Health Organization (WHO) also had the same view. This variant had presumably spread over many countries although it was not yet detected or reported. Omicron is the 15th variant. Like the previous variants, at least four aspects related to Omicron arouse the concern of experts: its high transmissibility, its clinical effect and severity, its potential for reinfection and its effect on vaccine efficacy.
The capacity and speed of transmission is the new variant’s crucial issue. Several reports have concluded that the Omicron variant spreads sporadically and rapidly. Its transmission is considered phenomenal as it far exceeds the spread of preceding variants, including the Delta variant. The French Prime Minister even described it as spreading at lightning speed. The number of people infected has been recorded as doubling within just 2-3 days.
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Just compare it with Delta’s doubling rate of 10-12 days. As a result of its transmission speed, Omicron has promptly dominated the Covid-19 variant map. In the United States, only within a week the proportion of Omicron rose sevenfold from 0.4 to 2.9 percent. In Britain, its proportion increased from 20 to 44 percent in several days. The European Center for Diseases and Prevention Control has estimated that in January this variant will dominate Covid-19 in the entire European continent.
There are many hypotheses of this transmission rate. In the respiratory tract, this variant can multiply very rapidly, dozens of times faster than does the Delta variant. Its amount can also shoot up in the tissue only within 48 hours after infection.
The high transmissibility becomes a specter for the health service system. The escape of one or several cases into a country can trigger sporadic transmission. Within a short time, many people can be infected and seek health service. Some of them certainly need hospital treatment, oxygen and drugs. The rapid and sporadic spread has the potential to lead to an overload that threatens the stability of health service. The collapse of health service is imminent.
As for its clinical effect and the severity caused, there are conflicting hypotheses. Doctors in South Africa have reported that patients’ complaints and clinical symptoms are mostly mild in nature.
Most of them have a slight cough, runny nose and get exhausted. Only a few need hospital treatment and none of them have died. Although the Omicron variant has dominated the Covid-19 transmission map in South Africa, there are no signs of increasing necessity for hospital service.
Even compared with the time when the Delta variant was dominant, the need for hospital treatment at present is 30 percent lower. In Johannesburg, 90 percent of Covid-19 cases are dominated by the Omicron variant but the rate of hospital treatment has not risen. This serves as the reason for some experts’ argument that there is no indication of Omicron causing severity of illness or fatality.
However, the WHO views it from the other side. It is premature to conclude that this variant does not cause illness severity. The reason is that this variant is new and the cases observed are limited in number. The theory and model of disease transmission suggest that the fatal effect of a new variant can be noticed if the number of cases observed is quite large and the duration is longer. It means that the current number of cases is not adequate to draw any conclusion.
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In realty, every day a lot more information appears about this variant. Recently, a confirmed case of this variant in Britain was reported to have died.
The variant’s capacity to cause reinfection in people already developing antibodies also gives reason for serious concern. Theoretically and empirically, people who have been infected or vaccinated build up antibodies that protect them from Covid-19 for a certain period.
Omicron disturbs this protection and has the potential to cause reinfection. In South Africa, most of its population has once been infected with Covid-19 and developed antibodies. When Omicron emerged, many of these people were reinfected.
This means that the antibodies induced by their previous infections do not provide protection against Omicron. Research in the US also has the same result, in which 80 percent of those infected with Omicron turn out to have received two vaccine doses and even almost half of them have got booster shots. Nearly one fifth of patients also have suffered from Covid-19, meaning that the antibodies derived from previous infections or vaccinations prove to give no protection against Omicron.
Regarding its effect on vaccines, several days ago Pfizer announced its initial study results, which are quite worrisome. The protective effect of the Pfizer vaccine declines significantly in the face of the Omicron variant. In people already receiving two vaccine doses and being infected with Omicron, their amounts of antibodies decrease 25-fold compared with those infected with the original virus. The efficacy of the vaccine is reduced to 0-20 percent. When booster doses are injected, the amounts of antibodies can again increase, raising the efficacy to 55-80 percent.
This means that two vaccine doses do not effectively protect against this variant. Therefore, booster shots are needed. The vaccine efficacy decline involves not only the Pfizer vaccine, but also those of Moderna and AstraZeneca. Some experts make the extrapolation that other vaccines will also undergo efficacy decrease when they encounter the Omicron variant.
The declining vaccine efficacy against Omicron has been predicted. The reason is that Omicron has more than 50 mutations, 30 of which involved the spike protein that becomes the target of various vaccines. As the target is mutating and changing, vaccines cannot work effectively. They miss the target.
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To overcome it, booster doses or vaccine modifications are needed. This of course creates a new problem. Let alone booster shots, many countries are even faltering in their attempts to broaden the coverage of first and second dose vaccinations. In South Africa, the people already receiving first doses only constitute 31 percent and second doses 26 percent. In Indonesia, the first-dose coverage of its population is 55 percent and second-dose 36 percent.
Globally, over 40 countries have not yet vaccinated 10 percent of their populations. Under such limitations, how can the countries prepare booster injections to face the Omicron variant?
Sporadic but mild?
Mutations and variants are the natural process of viruses. This phenomenon will keep going as long as viruses continue to exist. The Omicron variant is the 15th metamorphosis continuum of Covid-19. As long as the pandemic is not yet effectively handled, new variants will keep arising. Some variants may be less lethal and not dangerous but others can be the reverse.
To date, the Delta variant is still considered the most dangerous one. Its magnitude of morbidity and mortality is indeed serious. Yet the appearance of Omicron can change the variant distribution map. Some experts believe that before long the Omicron variant will take over the Delta variant’s domination all over the world.
Although Omicron studies are still ongoing, experts have different views of the magnitude of this variant. First, some are convinced that this variant will have a serious negative impact on the development of the pandemic. It causes the rates of infection, sickness, severity and mortality to rise significantly. Consequently, the pandemic is expected to last longer.
The yo-yo phenomenon will continue to occur. The acceleration- deceleration-plateau graphs of cases and deaths will keep going on. Countries will repeatedly impose lockdowns and allow relaxation. The pandemic control is trapped in a vicious cycle. The world economy will remain gloomy.
Second, other experts adopt a more optimistic stance. Although the faster and sporadic transmission of Omicron has been confirmed, they expect a milder clinical effect and illness severity. In other words, there’s no problem with the rapid spread as long as it’s not severe. Sporadic and fast but mild.
Indeed, so far there has been no solid evidence yet that this virus produces a high rate of severity and fatality. If later the assumption of being sporadic and fast but mild is correct, this condition is just seen as a blessing in disguise. A loss that brings goodness.
With its high transmission rate, this variant will replace the Delta variant’s domination. Owing to its mild effect, the serious morbidity and mortality of the Delta variant will be replaced by the morbidity and mortality of less lethal Omicron. It means that Omicron is at large but not dangerous.
With its high transmission rate, this variant will replace the Delta variant’s domination.
Today it is premature to determine which assumption in more accurate. The journey of Omicron has only lasted for over a month. Many things about this variant are still obscure. Experts keep focusing on and examining the various sides of this variant. This is crucial especially to anticipate the worst that may arise from it.
The WHO has warned the world against feeling panic in the face of new variants, including Omicron, let alone implementing super-tight steps without being founded on clear clinical and epidemiologic evidence. Over-restrictive policies will just result in inefficient management.
While furthering its studies, the WHO has warned the world to keep vigilance. The world is encountering a new virus whose structure can change at any moment. As a result, its morbidity and mortality may also change. Interestingly, despite the changing structure, morbidity and mortality of the virus, it can be managed in the same way by implementing 3M (mask wearing, hand washing, distancing) + 3T (testing, tracing, treatment) + vaccination.
Iqbal Mochtar
It has not changed significantly yet. It sounds stereotyped but that is the reality. The 3M + 3T + vaccination management has proved to be effective for the original Covid-19 strain and other variants. It is also expected to be effective for Omicron. So, some experts have every reason to say, “Whatever the variant may be, it should be managed by 3M + 3T + vaccination”.
Iqbal Mochtar, Physician and Doctor of Medicine and Health, Chairman of the Indonesian Medical Association of the Middle East
This article was translated by Aris Prawira.
