 Hello and welcome to NewsClick. Today we are going to review what is the status of Omicron in the world and how are we equipped to face it. We have with us Professor Satyajit Rat as he has been usually with us during this entire Covid period. Satyajit, straight question to you. Omicron has really taken over at least in UK and US and also looks like in the European Union. So, this is the current state and already we are seeing the wave actually overtaking the earlier waves in some of these countries. Does it mean the Omicron has been spreading much faster than any of the earlier variants? Well, clearly that's what the real-life epidemiological evidence indicates that Omicron is spreading faster than Delta, although I will come to a couple of nuances for that in a moment. And there is also laboratory evidence that says that in petri dishes it also does spread faster and grow faster. So, there is evidence that its spread is much more rapid compared to Delta. Now, the caveat, the sort of nuance that I wanted to point out is that Omicron as a viral variant strain is even more changed than Delta is from the original virus strain of last year. And as a result, prior infection with last year's strain and or vaccination with any of the existing vaccines, all of which are based on last year's strains, is already a little more mildly protective against reinfection with the Delta strain and even more so with Omicron. So, whether it is spreading hugely rapidly as an absolute characteristic or whether it is under these conditions where the communities are largely either exposed to last year's strain infections and or vaccinated with last year's strain based vaccines. And in this situation now, Delta and Omicron are competing with each other and it is in this situation that Omicron is beginning to take over. Now, that's just a nuance because it begins to get at the root of what the pathways are through which Omicron is spreading faster. But the fact that you pointed out is supported by evidence now in multiple countries that Omicron is overtaking Delta. You know, even otherwise, the speed at which it seems to have risen is more than the earlier variants that had started at the time when we had the naive immune system. So, to say that we neither had infections nor vaccines. So, the fact that Omicron may be facing up similarly that we earlier infections is not protecting us enough in terms of an infection, repeat infection, we are not getting into serious cases as yet. But the fact that others may be in that sense being less able to spread Omicron relatively has an advantage is one issue. That's how it's overtaking Delta. But even the speed is much faster than what we have seen earlier. Yes and no. We should keep in mind that to a certain extent when we look at epidemiological evidence in real life communities and try comparisons, we're always comparing apples and oranges to some extent. So, for example, we were much more afraid last year than we were this year just before Omicron emerged. European countries, North America had essentially begun to open up because they thought they had vaccinated the bulk of their populations. They had reached this esoteric figure of herd immunity, some of them thought and therefore they were opening up. So the conditions under which Omicron had access to potential people to infect may well have been different this year compared to last year. None of this is to say that Omicron is not capable of spreading very rapidly. It is simply to point out that when we draw these conclusions, we should always be a little cautious and keep in our minds that there may be contributory factors involved rather than one simple linear explanation. Not an apple to apple comparison in any case because epidemiological conditions are different and because they're different, therefore you're taking a number of countervailing factors into account and then to come to crude generalizations may be a problem but nevertheless we are very fast rise of Omicron and the second issue that again here you are I know going to take a nuanced position and if one can help you can't help that that's your profession but if we look at it if there are two things that I want to bring to your attention. First let's start with the number of serious cases. Say in UK we have some information now out of the hospital system because the NHS, the National Health System, they are better organized than they are in most other countries and the figures that are coming out from there is that the serious cases seem to be proportionately much higher among the unvaccinated and this I'm referring to really London hospitals because again the figures are really from London and again these are very impressionistic figures as of now but also the interesting part is in spite of all the vaccination programs, booster doses, etc being available in London there is about 30 percent almost a third of people who are not vaccinated. So that's a very large number which is potentially there for feeding round for serious infections not mild infections which Omicron of course will do but among the unvaccinated the potential for serious cases seems to be much more. Yes I'm afraid I am going to start with a sort of a cautious disclaimer but that's only the generic one to remind all of us together that these are emerging numbers these this is all very preliminary evidence and we shouldn't jump to definitive conclusions on their basis but that said let's look at some of these propositions in the first place there was a suggestion from South Africa from real life community spread of Omicron that was supported by laboratory studies from Hong Kong that suggested that the Omicron strain may perhaps cause somewhat milder disease than say the Delta strain. In South Africa it was properly and cautiously pointed out that Omicron was infecting when it was infecting unvaccinated people they were all young non-comorbid people who hadn't gotten access to vaccines and when it was infecting the elderly comorbid people many of them unusually in Africa South Africa it is true that many of them are vaccinated and the vaccination we have quite plausibly reduced severe infections and therefore there was this careful argument that while Omicron based Omicron driven infections may not lead as commonly to severe illness that may not be an intrinsic characteristic of the Omicron strain but simply as we pointed out just a couple of minutes ago the altered circumstances and the altered sort of host targets that Omicron has accessible. The Hong Kong study on the other hand which suggested that the Omicron strain grows hugely better in the upper airways of throat and nose and so on rather than deep down in the lungs began to suggest that if it really grows less well in the lungs then maybe it is causing a little less inflammation in the lungs and therefore it may have somewhat lesser inclination to cause serious lung and related illness. The UK data supports the first explanation that it is the characteristics of the target population that are determining these the incidence of severe illness rather than whether the strain is Delta or Omicron but let me point out that there is a little bit of a number problem there. If you look at the UK numbers we are talking about comparing hugely larger numbers of the Delta variant compared to the numbers of the Omicron strain in the UK numbers. Now that doesn't make the analysis implausible but it does underline the fact that we are still looking at very, very preliminary data. For those of us who have some level of statistical understanding, vastly unequal sample size comparison is always fraught and difficult as an issue. Magnifies errors. It magnifies errors. So as a result it is true but we need to be cautious. That's one issue. The more practical concern that you pointed to that the Omicron strain is spreading very, very rapidly in Europe and North America in unvaccinated pockets. Now clearly that has a biological basis that the Omicron strain spreads very well but it also has a socio-cultural political context to it which is that the unvaccinated amongst us are not atomized individuals spread uniformly in a community of the vaccinated. They are small sub clusters, sub communities. Sometimes they are communities of the marginalized, of the disenfranchised who have empirically well grounded suspicion of the state as well as deeply flawed and limited access to healthcare systems as well as to vaccination campaigns. The poor, the minorities, the underprivileged. All of them tend to cluster and it is in clusters that respiratory viruses will spread. On the other hand, the most striking example of course in the United States of America although European countries don't seem to be very far behind. There are clearly irrational anti-vaxxer, anti-science groups and again those are communities. They are people who live together who sort of you know breathe the same air and therefore when we say that 70% of our population is immunized we've been pointing out on this chat over and over again that how the 30% are distributed in the community is going to make an enormous difference to the availability of these clusters for very rapid spread and maintenance of growing virus in human communities and populations. And that's a very that's a very important point that you're bringing out. It's also in a different way. It can also be seen that why is it from South Africa it has really jumped to Europe and United States and a simple communication map physical communication airlines and so on would show that Africa is not networked with itself because most of the African countries were X colonies and they're better networked to the parent country and South Africa therefore is better networked with UK and UK is better networked with European Union and the United States and this has been the hinterland of Omicron growth. Let me let me qualify that. There is an enormous amount of cross-border transport between South Africa, Botswana, Namibia, Mozambique, Zimbabwe in fact all of us will recollect the anti-foreigner tensions even in the working class in South Africa. The difference is that we are talking about airline travel carrying infection in very very contained and infection amplifying boxes namely airplanes over long duration flights to far away countries and that's what we are noticing. Are we getting Omicron variant evidence from the far poorer countries across South Africa's African borders? No we're not. Yeah but you know Satyat you would still see the rise of COVID numbers even within South Africa outside the Gotang province. We haven't seen this kind of spikes that we are seeing for instance in London or you're seeing in Denmark and you're of course now tending to see in New York. In fact even here it's really the interconnections the density of the interconnections particularly as you say air travel which seems to be the first spark but as we know from history past a couple of years that this then spreads slowly but surely in all other places. It's a matter of time. So two points one a caution to point out that we really don't have very strong robust data even about basic numbers of cases from many of these countries and the bus and train and informal taxi based cross-border travel is quite extensive and it would not surprise me if we begin to see either now or sometime later retrospectively evidence of case numbers piling up but let me make a second point that is in agreement with yours and that extends it and that is ever since last year it has been apparent that closed environments with recirculating air handling systems are leading to amplified rates and efficiencies of transmission of SARS-CoV-2 in what I keep calling socio-culturally coherent communities in office buildings in apartment complexes in malls in and and so on and so forth and everything that you are pointing out feeds into that plausible likelihood that you have airplanes which are amplifying it because they are exactly the same thing it's recirculating air you have airports which are amplifying it and those are in busy urban and temperate zone countries in November in December and therefore a great deal of community life is indoors in these large settings under circumstances as I pointed out where just before Omicron hit these these communities had relaxed both their worry and their COVID appropriate behaviors thinking that they they vaccinated a very substantial proportion of themselves all of this is converging I think into these exploding numbers and to support what you are saying South Africa is having actually summer so therefore much less enclosed and so on and so forth coming back to the last point it also brings out that while we are talking about booster doses in countries which have had two shots for 70 60 65 percent of its population the 25 30 percent quite often actually are not wanting vaccines or were not wanting vaccines so it's not that it was because they were not covered but that was a sort of choice that they were making while at the same time African numbers including South Africa and Morocco which are very good numbers and some of them also like Botswana have good numbers including all of that it's still about 7 percent so you are really looking at Africa which is the if you take the low income countries in Africa probably about 2 to 3 percent vaccine coverage and we are talking about booster doses for the rich countries now this is going to create COVID-19 scenarios every year if we don't address it oh absolutely it is quite plausible as a scenario what you what you lay out let me make three points here number one at the moment we really do not have very robust evidence we have fragmentary evidence but we don't have really robust evidence about just how much protection against infection and transmission is provided by vaccination or indeed by boosters there are small encouraging indications that vaccines provide some degree of protection and that there are a couple of small studies that suggest that boosters may increase this efficiency a little bit further with reference to the delta strain but we really don't have evidence of this let's all keep in mind that all vaccine trials have been based on vaccine approvals have been based on evidence for protection against serialness and depth not for massive protection against simply asymptomatic or or mildly symptomatic infection it is not unreasonable it is biologically plausible to expect that even that will show some quantitative effect of the vaccines it is also plausible that against strains like delta and even more like Omicron that is going to go down somewhat but we are working at this point on the basis of biologically plausible arguments rather than really robust evidence this is one point the second point is we know following on from my first point we know that vaccines are providing exemplary protection against severe illness in depth meaning hospitalizations in depth from the delta variant and the emerging fragmentary data suggests that they are also doing a reasonably good job against Omicron again the Omicron evidence is so preliminary that none of these statements can be made with certainty but clearly the initial evidence is beginning to look like that under those circumstances you'd expect that what you really want to do is vaccinate everybody across the world now it is not at all my case that booster doses are useless we do I think booster doses can be quite plausibly useful suddenly so if we were in the fortunate position today one year after we began vaccinations of having vaccinated the bulk of the world with a basic two dose vaccination schedule I would have been an enthusiastic supporter for booster vaccinations but at this point we have landed ourselves in this utterly unenviable trap of beginning to think of this versus that we really desperately need to be able to set aside the either or and to say we are going to vaccinate everybody and we are going to provide booster doses without regard to nationality particularly for those categories of people across the world who are at high risk and susceptibility so it's a tragedy it's a tragedy that instead of really expanding your vaccine capacity which we had ample time and ability to do we are talking about either or rich countries booster doses versus low income countries no vaccinations or very low vaccinations this is not the choice we should have been making the at least not one year down the line we have so many successful vaccines in our kitty so that's something that we will take up next time in more detail but one warning that I have to give Satish may or may not agree with me that given the past history of COVID-19 we are likely to see the spread of Omicron across the globe when and how much is a matter of checking it out waiting to see what is happening but given the speed at which is overtaking countries it seems plausible to argue that it is going to be everywhere sooner or later and the second point is that if the numbers increase and it's a simple issue even if it is one-tenth likely to cause serious illness illnesses if even if that's taken for granted 10 times a large number will lead to the same result so essentially more cases mean even if statistically numbers are less you are likely to see large numbers at a time when the hospital staff may also be infected and therefore there is going to be less attendance even in the hospitals so the collapse of the hospital system is the key to prevent deaths and let us hope keep our fingers crossed that this time it doesn't hit us as hard as it did for instance in India when we had a huge wave and we saw hospital collapse across various states and and in the country Satish thanks for being with us we will discuss the vaccine issue in more details both vaccine apartheid and also vaccine profiteering both these aspects probably in our next show and possibility of a universal vaccine thank you very very much for being with us do keep watching do click and do 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