Do Not Lower the Guard as COVID Virus Can Change Its Behaviour

CME INDIA Presentation by Dr. G. C. Khilnani, Chairman, PSRI Institute of Pulmonary, Critical Care and Sleep Medicine. Formerly, Professor and Head, Dept. of Pulmonary Med. AIIMS, New Delhi.

The silver lining is that it causes mild disease.

“The Omicron variant is spreading quickly and has the potential to impact all facets of our society. CDC’s updated recommendations for isolation and quarantine balance what we know about the spread of the virus and the protection provided by vaccination and booster doses. Some updates* ensure people can safely continue their daily lives. Prevention is our best option: get vaccinated, get boosted, wear a mask in public indoor settings in areas of substantial and high community transmission, and take a test before you gather.” – CDC Director, Dr. Rochelle Walensky.

New Updates* (CDC-28/12/2021)

Given what we currently know about COVID-19 and the Omicron variant, CDC is shortening the recommended time for isolation from 10 days for people with COVID-19 to 5 days, if asymptomatic, followed by 5 days of wearing a mask when around others. The change is motivated by science demonstrating that the majority of SARS-CoV-2 transmission occurs early in the course of illness, generally in the 1-2 days prior to onset of symptoms and the 2-3 days after. Therefore, people who test positive should isolate for 5 days and, if asymptomatic at that time, they may leave isolation if they can continue to mask for 5 days to minimize the risk of infecting others
For people who are unvaccinated or are more than six months out from their second mRNA dose (or more than 2 months after the J&J vaccine) and not yet boosted, CDC now recommends quarantine for 5 days followed by strict mask use for an additional 5 days. Alternatively, if a 5-day quarantine is not feasible, it is imperative that an exposed person wear a well-fitting mask at all times when around others for 10 days after exposure. Individuals who have received their booster shot do not need to quarantine following an exposure, but should wear a mask for 10 days after the exposure. For all those exposed, best practice would also include a test for SARS-CoV-2 at day 5 after exposure. If symptoms occur, individuals should immediately quarantine until a negative test confirms symptoms are not attributable to COVID-19.

Few facts have emerged during last 3 weeks

1. Omicron variant evades vaccine immunity and is 2-3 times more contagious than Delta variant and is leading to severe outbreaks in Europe and USA among fully vaccinated persons too.

2. The silver lining is that it causes mild disease, especially in vaccinated persons. All the cases with severe disease with Omicron have been in unvaccinated individuals.

3. Although antibody levels diminish with course of time (6 months) the cellular immunity (Memory cells) persists, giving protection from infection and more so for severe disease.

4. India’s seropositivity is largely due to natural infection. This is proven by the high seropositivity in children (was 67% despite NO VACCINATION).

5. Natural Infection gives a broad-based immunity across all variants.

6. It is my thinking that `Due to these facts’ India is at a `position of advantage.’ However, we should not `lower the guard as virus can change its behaviour (as seen in past with Alpha variant) and continue `COVID APPROPRIATE BEHAVIOUR’ of which the use of mask and stopping indoor gatherings and parties is most important.

CME INDIA Discussion

Dr. Ashish Jha, Dean of Brown University’s School of Public Health in Providence, R.I. UK:

Time to focus on COVID hospitalizations and deaths, not cases.
“Look, for two years infections always preceded hospitalizations, which preceded deaths. So you could look at infections and know what was coming. Even through the delta wave that was true, because it was largely unvaccinated people getting infected.”
“Omicron changes that. This is the shift we’ve been waiting for in many ways, where we’re moving to a phase where if you’re vaccinated, and particularly if you’re boosted, you might get an infection. It might be a couple of days of not feeling so great, but you’re going to bounce back – That’s very different than what we have seen in the past.”

Dr. Rajkamal Chaudhary, Asso. Prof of Medicine, JLNMCH, Bhagalpur:

Sharing latest WHO Information:

“Some experts are warning against writing off the omicron variant as milder than other variants, and preliminary findings from the U.K. suggest it appears no less severe than Delta.”- Health Security Agency and U.K. health service for all PCR-confirmed COVID-19 infections in the area from Nov. 29-Dec.
“It is probably unwise to sit back and think ‘this is a mild variant, it’s not going to cause severe disease,’ because I think with the numbers going up all health systems are going to be under strain,” chief WHO scientist Soumya Swaminathan.
This data included only 24 hospitalizations of patients suspected of having the omicron variant and has not been peer reviewed.
The study found limited changes in severity compared with delta. The risk of COVID-19 reinfection with the omicron variant has been found 5.4 times higher than that of delta.
Assuring: Data released by Pfizer/BioNTech suggested that protection, as measured by the level of neutralising antibodies in the blood offered by two doses of its vaccine, was reduced against Omicron compared to the original Wuhan strain. However, when they tested blood drawn from vaccinees one month after receiving their third “booster” dose, the level of neutralisation was comparable to that seen against the original strain after two doses.
Preliminary findings from South African researchers has suggested that breakthrough infections can occur, even in people who have received three doses of vaccine (including the Pfizer vaccine).
Certainly, there has been an extremely rapid increase in COVID-19 cases in South Africa. Many of these countries have relatively low COVID-19 vaccination rates, so possibly the virus would spread less quickly in more highly vaccinated populations. It is also plausible that enhanced testing means more cases are being detected than before.
Some countries with high vaccination rates are also experiencing a sudden surge in cases. In Scotland, where 72.7% of the population is fully vaccinated, the Omicron variant is predicted to overtake Delta as the dominant variant within days.
“Omicron right now is rising exponentially. Indeed, what we are seeing in the data just now is perhaps the fastest exponential growth that we have seen in this pandemic so far,” Scottish First Minister, Nicola Sturgeon.

Dr. H. D. Sharan, Sr. Cardiologist, Ranchi:

138 new cases in Jharkhand on 26/12/21. More than 2 times the no on Saturday. No facility for Genome sequencing. Samples sent to Bhuvneshwar. Report not received even after a month. Is this how we are going to fight this pandemic. Cases doubling on a Sunday is a serious matter.
Another super spreader marriage at Jamshedpur. Possibly spread by the relatives and groom’s party from Delhi.

Dr. G. B. Sattur, Consultant, Diabetologist, Hubli:

True. Agree with most of your views. But there is huge scope for our own data, which unfortunately is lacking. Mix and match study should have received no 1 priority. Failure of bureaucrats and corruption add extreme dimensions to any of our justified accolades to Indian government.
However, considering 4th, 5th waves in other parts of planet, and low death rate in both waves in India (estimated death by mathematical module was 4 crores!!!) is still a mystery.

Dr. S. K. Gupta, MBBS, MD (Med), CFM (France), Senior Consultant Physician, Max Hospital, Delhi:

Our Scientists and Scientific Community have done an excellent job.
There would be chest beaters all along .
India’s better performance is not going down the throat of world media.
Only once in 21 months, I have been able to find an article in Reuters complimenting India’s Covid management Culture and results.
In any sector, there would be people for and against any issue. Impossible for any Govt. to bring all to a consensus. All the data of Boosters is in public domain. It is up to anyone to interpret it the way it suits their mindset.
If Govt. allows childhood vaccination people like Dr. Sanjay from AIIMS upraise their tentacles and start frowning. If not Govt. bears wrath of worrying mothers.
India is one country which has to its credit the first DNA Covid vaccine.
One point in editorial regarding Indian trial results of boosters appears concerning.
Rest appears to be written out of malice and contempt.

Dr. Keyur Acharya, Intensivist, CCU-Royal United Hospital, Bath, Somerset, UK:

It’s not only vaccines. Its implementation of what we already know and this, have a lot of scope of improvement. Unwarranted scans, IL6, indiscriminately used Remdesivir, steroids of all kinds in all doses could have been dealt differently. As I have mentioned, cost of treating COVID in India especially mild to moderate was very high compared to other nations.
Do we know who are these scientists behind vaccine? Have they been honoured with due recognition?
I appreciate I am not the best person to comment on these matters but these are just observations from talking and treating friends and family members there. For an average patient, even with mild disease, it was very scary experience.

CME INDIA Tail Piece