 Hello and welcome to Newsclick. Today we're going to discuss what is in everybody's mind, the possibility of another wave starting with Omicron, the newest variant of concern, which is currently clearly reaching different countries and is not obeying the rules that the governments would like to put don't enter our country. Of course, South Africans have already protested, they have been penalized virtually internationally isolated for having actually done really serious genomic surveillance and discovered this variant pretty early. Satyajit, various reports are now out on preliminary terms, of course, all of them, but on the Omicron variant of concern that we are talking about. One of them is, is it spreading faster than the other variants, and particularly Delta, which is the dominant variant was the dominant variant in South Africa. And some of the reports coming from South Africa that in the gotten down area region, we have seen that it seems to have outnumbered out transmitted as it were the Delta variant. So how seriously should we take this as an indicator that this could be the pattern elsewhere as well. So, since we are talking about the Omicron variant, let's start this by underlining the first point that you made that all current available evidence is preliminary and sketchy. So the bulk of what not simply we but anybody else in the world says is going to be at least in part informed guesswork and speculation. So with that caveat as it were, let me respond to that. It's clear that in South Africa, the Omicron variant has been transmitting quite rapidly and has been replacing the Delta variant. So from 1890% plus of sequenced cases being that of the Delta variant, less than 3035% of cases in South Africa are now of the Delta variant. And that's within a period of a few weeks, that's a major transition. This is accompanied by steadily increasing numbers, although the numbers are not increasing as rapidly as they were last week this week. So, all of this as I keep pointing out is a little provisional, but the South African epidemiological viral genetic epidemiological evidence seems to suggest that it is clearly transmissible very efficiently under real life conditions in South Africa and likely to be replacing or at least competing very, very efficiently with the Delta variant. Whether this will happen elsewhere or not is subject to a fair number of known unknowns and unknown unknowns. And as everybody, including Anthony Fauci keeps pointing out everywhere else is early days. So what will happen over the next two to four weeks is really what we are going to evaluate as the proof of the pudding as it were. But initial evidence suggests that under appropriate conditions, it can be very strongly efficiently processed. Coming to the second concern, the second issue of concern apart from the transmissibility is also the fact that it seemed to have affected or reinfected people who are either earlier infections or had vaccine immunity. In fact, it seems to be affecting people who are infected earlier, more than possibly those who have been vaccinated. So again, as you have said, and I'm going to repeat that as well, that data is extremely early in early stages, it's very preliminary data. So unless we get a better picture, we won't know. The only of course, saving grace here is because of the normal RTPCR test does use one of the segments or places which identify that it is COVID-19. And out of the three, one of them is deleted in the this particular Omicron variant. And for RTPCR itself gives us some indication whether it's Omicron or not. But again, all all questions are to be addressed now to our expert on the panel that given this. Is it possible for us to say that yes, we do see with the Omicron variant changes that in the genome sequence that we are seeing that there is vaccine escape that is taking place and immune escape that is taking place. It is both who have been infected earlier, or who have been immunized with vaccines, both in could in fact face the threat of infections. So let me start with the question that you didn't ask but alluded to which is diagnostic tests. And I think it's important to make this clarification. It is true that many, but not all diagnostic tests use the three different locations on in the virus sequence as diagnostic locations and therefore, instead of a three way positivity, because the spike protein gene, which is one of the regions in these tests has been quite substantially altered in the Omicron variant. That location does not pop up as positive. So the Omicron variant in these tests pops up as two out of three positives. Number one, this is not true of all RTPCR commercial tests. It is true of more than half of them, but not of everyone. And secondly, that dropout doesn't necessarily mean that it's Omicron sequencing has to be done for actual proof of Omicron. So that's one issue. Let me ask you your question about whether reinfections of the previously infected or the previously vaccinated is a major issue or not. The answer is yes, clearly there are substantial numbers of people who have been previously vaccinated who are being infected previously infected who are being infected. If doing comparisons is at some point we are comparing apples and oranges. So in a situation where there is a certain rate of spread, there is a certain transmissibility, what is the statistical likelihood that previously infected people would be infected by the Delta variant previously vaccinated people would be infected by the Delta variant. And under identical conditions, would the Omicron variant show a greater propensity to cause infections in one or the other. We are demanding very rigorous comparative estimations and really the data are extremely inadequate to provide these. The moment all we can say is yes, previously infected people are reporting Omicron infections, previously vaccinated people are reporting Omicron infections. However, no findings that suggest widespread infection. In fact, the emerging sort of semi anecdotal, all that semi anecdotal means is not yet statistically reliable. The story is emerging, is that the frequency of infections in the vaccinated group still appears to be much less than the frequency of infections in the vaccinated group. Now, we don't even know whether this is absolutely accurate and robust as an observation, leave alone beginning to investigate what differences there are. But for what it is worth, that's where we are at the moment. Yeah, I think what you're saying is what the African paper is that has come out and on the pre print server and so on, not yet peer reviewed but available to us would seem to indicate broadly what you're saying that it seems among the non vaccinated. And there is a second assumption that even though they're not vaccinated, probably they have faced infections earlier, either got immune, you know, had immunity, or really been infected, and that is available in the record that that frequency seems to be higher than the frequency of people who are vaccinated being infected. So some differential yet more protection from vaccinated for the vaccinated, then for those who have suffered infection. Now, both this are. Some causes for concern that you know you are infected once you can be infected again, COVID twice. It's not unusual to have COVID twice, but nevertheless, the propensity of this being more with Omicron seems to be there, as well as vaccine escape as well. And that is something so a lot of the commentators early on have been talking about their fear that this might be true looking at the changes that have taken place, of course, all conjecture. But other good news since you've given two bad news to our viewers, let's give the good news also coming out of the preliminary results from Africa that the number of infections is not reflected in the number of serious cases or hospitalization. Again, caveats, early days yet, because normally the seriousness of a case manifests itself two weeks after you have got infected. So we'll have to wait a little more time to say yes, this is a strong statistical correlation that we are seeing. But according to again, the authors of the papers and anecdotal evidence that by now, in a wave of this nature in South Africa, we would have been seeing many more hospitalizations than we are seeing now. So some hope yet that okay, there is going to be a new, new variant which is going to take over the world, possibly, but at the same time, it may not cause that serious illness. And here people have talked about some common cold coronavirus segment coming in here and so on, which seems to be a little far fetched in terms of prognosis of what will actually happen in the real world. So let's get something clear. What people have been expecting is all based on the pattern of the changes in the virus in the genetic code of the Omicron variant. There are 50 plus changes compared to last year's strain, 30 out of which are in the spike protein, which is an immune response terms, a crucial protein, a dozen of which are in the receptor binding, the so-called receptor binding domain or RBD of the spike protein, which is the business end of the spike protein as it were for immunity and vaccine purposes. So in all of this is where the concerns and worries have been, both for increased transmission efficiency and for weakening of vaccine mediated protection. The increase in transmission efficiency seems as we just discussed to be borne out. The somewhat weakening of vaccine protection, also the initial data may be indicating that that's the case, although that case is being made much more weekly even now. But all of that is consistent and plausible. All of this said, the fact remains as you pointed out that both within South Africa and outside South Africa by now 30, 40 plus countries across the world together have reported hundreds. And none of those are hospitalized cases. The instances of Omicron variant infection, none of those appear to be hospitalized. Exactly similarly as you pointed out, despite the fact that this wave of increase in numbers began over two weeks ago. The proportion of hospitalization since South Africa do not appear to be rising as yet. This is all early days. Another caveat there is that the South African data in general appear to be that of young, much more frequently unvaccinated people being infected and then serious COVID illness is as it is somewhat lower. But all of that said, everybody's pointing out as you mentioned that by now surely if it had been like the other variants, hospitalization numbers would have been increasing and it's promising and hopeful that it has not done so far. And if that works out, then the intensity of the new uptick in outbreaks as it were would be somewhat mellowed by a lower proportion of hospitalization. I hasten to point out however, wet blanket that I am that if the transmission efficiency of Omicron is really very high, I hasten there is no really hard evidence about it. But if it happens to be high, then the fact that the severity of illness is low is counterbalanced by the fact that very large numbers of people will be infected at one time within one short period of time. And so even though the proportion of hospitalized people is low, the absolute numbers might still end up being like substantial. And these are trade offs that we need to worry about in public health policy terms. All of this is to say that we don't know nothing yet for sure. And it is true that this particular numbers game that how many and transmissible as well as how many become in the proportion seriously in is something we have to see. And yes, one increase cable not be balanced by the other automatically. Coming to Satyajit, the other question, which has been worrying, almost all people that how is it such a strange virus variant seems to have emerged, because if you go back in its lineage and we have the next train, very nice pictures showing where it's progeny is, in its middle of 2020, at least 18 months before the current strain emerged, or, you know, maybe 16 months before the current strain emerged that at least it is that that break is at least that old. What was this virus hiding. And why has it suddenly emerged I know that it's not possible for you to give you know, answers, unless you really have something access to something which human beings don't, but knowing, while accepting that hesitation, can you walk us to what are the possibilities, and what you think a very informed guests, and of course guests, what is the what is the possible likelihood of this emerging suddenly in this fashion. So, before I answer the question, again, let me make a preliminary point about this. And I make this because it reminds me of the debates that have now mercifully faded a little bit into the background of whether this is a whether SARS-CoV-2 itself is a virus that is natural or it is unnatural whether it emerged because these are debates in which it's very unfortunately possible for public discourse to segue into a blame game. And I'm, and I'm therefore making this point up front. This Omicron variant is not anybody's fault. Just as the original SARS-CoV-2 is not somebody's fault. These are natural phenomena that will occur over virus evolutionary time, which is a much for shortened timescale than our evolutionary times, given a large enough population of the virus. That said, there are four or five distinct academically interesting possibilities of how this variant that has two characteristics, one a large number of alterations and two alterations that don't seem to be related to relatively recently dominant variants such as the beta gamma delta variants in its closest relative in fact is the alpha variant. And in those possibilities are as follows. Number one, it's possible that this many alterations and hesitating to use the word mutations, these many changes in the genetic code may have been unnoticed because they may have actually taken place within the body of a single individual who has been chronically infected by long COVID. Let's not call it long COVID because all cases of long COVID are not necessarily virus positive. The disease long COVID is a much more complex matter. So simply let's say chronically infected individuals, people who are unfortunately in a window where they don't die of severe illness because they are completely immuno inadequate but who don't overcome the virus infection either and therefore the virus infection simply lingers as a prolonged long drawn out feature. Within the body of that individual, the virus, because it's an RNA virus, it's copying itself copies are replete with errors in the body there are body to virus interactions going on which are going to put selective pressure on these multiple different variations popping up. And it's plausible that such a virus variant may have emerged. This has been given a certain amount of prominence, unfortunately, in my eyes, because of the HIV positive. The people living with HIV in South Africa under drug control and chronic HIV infection does compromise the immune system somewhat. And I'm therefore reiterating what I said that even if this were to be the case, we don't know that this is the case, we may never know whether this is the case or not. This is still not a matter of people with HIV who catch COVID being particularly and especially to blame that would be not just unfortunate that would be a criminal claim to make. The second possibility is that in fact, we already know that SARS-CoV-2, unlike what the early conspiracy claims were of being optimized for human infection, actually infects literally scores, not dozens, but scores of different mammalian species. All sorts of animal species are infected with SARS-CoV-2 and it's possible that it went off into some animal reservoirs and it underwent a whole set of changes in that animal reservoir and through happenstance has bounced back into human circulation. Again, do we have evidence for this? No, not at all. Is there indication? Just to interject for a just an amusing side note to this, the hippos have recently emerged also having been infected with SARS-CoV-2. Recently, that has been seen somewhere. So forget us, families of close to us, but even hippos. So that's in zoos, but let me point out that wild populations of white-tailed deer in very large numbers have been found to be infected and the preliminary analysis of genetic sequences from those samples of SARS-CoV-2 indicate that unsurprisingly, they would go off in a different trajectory of changes. So is it possible that this is how this virus has come about? Sure, it is. There is a sub-theme of this possibility, which is that given that in Africa, particularly in countries of southern Africa outside the Republic of South Africa, test coverage for COVID-19 is low just as vaccination coverage is low because public health systems are relatively fragile. In those, the virus may have circulated in human communities without being noticed and may have emerged from those unregarded marginalized communities into communities where it has been detected again. Is this possible? Sure. So there are all these multiple possibilities of scholarly academic interest. At the moment, they do not provide us any evidence-based guesses to make. So I'm not going to venture any guess on which one of these is positive. I'm simply going to reinforce the point that all of these remaining guesses, number one, number two, they do not allow us to blame each other. And that we may never know where it emerged from, definitively, even that's possible. Though I would say that in the three possibilities you identified, an unidentified isolated group, which did not interact too much with the surrounding population, is perhaps unlikely the modern age, where we see the speed at which this particular set of mutations, changes, whatever we want to call it, have moved in the world. In fact, one of the things perhaps which we have discussed, I think you pointed this out earlier, that this is already across the borders. And therefore to talk about border controls by isolating South Africa is to punish the people who have brought the bad news to us, rather than congratulating them for a wonderful piece of work, early detection of this particular variant, which is at least making us, giving us at least four weeks of time to prepare for what could be, again, another wave. Satyajit, thank you for being with us, explaining to us in detail what each of these complex processes mean for us, even if we don't have the definitive answer as yet. And for some of these questions, we will never have a definitive answer. This is all the time we have for news click today on this issue. Do keep watching news click and do visit our website.