India should prepare for the worst with Omicron

India has been witnessing a surge in cases in many States. There is no reason to believe that the variant will behave differently in India or that Indians have some unknown shield of protection against the virus.

The Omicron variant is galloping across the U.S. and many countries in Europe at a pace never seen since the pandemic began. If the U.S. set a new record of fresh cases on a single day on December 27 with over 0.54 million cases, the seven-day average is at 240,400 cases a day, a 60% increase compared to the previous week. At least seven countries in Europe — Britain, Denmark, France, Greece, Italy, Portugal and Spain — are witnessing a similar trend this week.

The World Health Organization said the number of COVID-19 cases recorded globally shot up by 11% last week (December 20-26) compared with the previous week, while the number of new deaths stayed nearly the same as the previous week. But globally, the weekly new cases are close to but yet to surpass the peak witnessed in the last week of April this year. The sharp increase in daily cases is not surprising given the highly infectious nature of the Omicron variant.

It is estimated that it spreads nearly three times faster than the highly transmissible Delta variant. While the Omicron has emerged as the dominant variant in a few countries, it has not completely displaced the Delta variant. The twin threats from the two variants are responsible for fresh cases reaching record numbers in many countries.

The Omicron variant has superior ability to cause breakthrough infections in fully vaccinated people and also cause reinfections in people who have been previously infected. Early data from South Africa and the U.K. suggest a reduced risk of severe disease requiring hospitalisation particularly among those fully vaccinated and previously infected.

But it still too early to draw conclusions as there is an inevitable lag between infection and hospitalisation, and the protection offered by vaccines against Omicron in older and other vulnerable populations is still not clear.

India has been witnessing a surge in cases in many States. As in the case of the first two waves, the increase in cases is currently seen in large cities. The total number of Omicron variant cases reported in India is inching closer to 1,300 and has already been reported from 22 States.

There is no reason to believe that the variant will behave differently in India or that Indians have some unknown shield of protection against the virus. The highly transmissible nature of the variant and its ability to cause breakthrough infections and reinfections, and the fact that people with no travel history or contact with international passengers have tested positive for the virus should alert the policy makers to take the Omicron threat seriously.

The first step in addressing this concern is to increase the daily testing numbers and adopt a dual RT-PCR testing strategy — testing all positive samples with a kit containing the S-gene target — before sequencing for Omicron detection. India should not repeat the same mistakes committed during the second wave by allowing Omicron to spread widely.

Published in The Hindu on January 1, 2022