 Hello and welcome to NewsClick. Today we are going to discuss what of course is in everybody's mind. The news trade which has appeared Omicron with some people of Christianism, oh my God, Kron, that is currently haunting the world again, that we might have a third wave in India and the fourth or fifth wave in many other countries. What is the threat of Omicron? Is it really premature to raise such fears or is it that yes, we need to be prepared this news trade which has potential for causing again further spikes of COVID-19 cases. To discuss this we have with us as we do on Monday or Tuesday. Professor Satyajit Rath. Satyajit, good to have you with us. You are the expert in the sphere of immunology to tell us whether our existing vaccines will work, whether we have enough pool of people who have not been vaccinated already and also what are the possible dangers thereof. We will start first with the possible spread of Omicron as a new variant. So what are the possibilities that we see and is there cause for concern as of now or is there a cause for more than concern, meaning we should start taking steps already? The first thing that all of us need to keep in mind is that there is a great deal that we don't know. So any definitive claims, conclusions and expectations are premature. On the other hand, SARS-CoV-2, the virus and COVID-19, the pandemic disease have taught us over the past two years that abundant caution is a wise policy. So we shouldn't be worrying about this, but we shouldn't be panicking about it. Let's start with what we do know. What we know is here is a virus variant strain that was detected a few days ago in Latin province in South Africa, although the first recorded sample seems to have been a Botswana sample going back a little further. And there are two things that are odd and unusual about this particular variant. Our viewers will recollect that over the past two years, we've discussed regularly that because it's an RNA virus, SARS-CoV-2 is an RNA virus, every copy has some variation. So there are going to be literally hundreds of thousands of variations popping up and we don't keep reporting each one of these. Why is this a variant of interest and variant of concern? The two reasons. The first is that this particular genetic sequence of the virus strain has an unusually large number of changes. Usually changes are incremental, a few more, a handful here, a handful there. This one seems to have accumulated whether in a human host individual afflicted or perhaps some people have speculated in some animal reservoir, a rather large number of variations. So this is not a descendant of the delta variant, it seems to be a cousin of the delta variant from the sequence. These large number of variations themselves are cause for interest. What converts that into a little more worry is that a lot of these variations are located in the viral spike protein, which is what is involved in both how the virus enters human cells and in how our vaccines currently developed COVID-19 vaccines by and large seem to protect us against the virus. So if the target of the vaccine immune response is changed, then there is at least potential that the virus, this particular strain will evade the vaccine generated immune response. And so for example, the delta variant has just over a dozen changes in the spike protein. This one has more than twice as many. So as soon as we say this, we begin to fall into the binary trap of carelessness versus panic. We ask, so is the vaccine going to work or is it not going to work? And what we need to remember is that the vaccine working is not a yes-no phenomenon. The vaccine will work well, the vaccine will work not so well, but still reasonably the vaccine may work even less well, but still reasonably and so on and so forth. And the odds at this moment, the most likely possibility at this moment that many scientists have pointed to is that the vaccines across the world will work even against this variant, particularly in protecting against severe illness, disease and death, but may not work quite as well. So that's one thing to remember and we'll come back perhaps to what a reasonable policy response could be. But the second property that has made this a variant of concern is that it's been associated with a sudden spurt in case numbers in the province where it was detected. A significant proportion of those cases seem to be of this Omicron variant. And if you very roughly calculate the so-called R value that has been famous these past two years, it seems to be quite high at an approximate estimate of two. This is a very crude estimate. There is no assurance that this is correct, but it does seem to be at least associated with rapid transmission and some of the changes in the sequence are also consistent with the possibility of rapid transmission. So what we seem to have is a virus variant that will spread rapidly and against which vaccine protection may be a little less efficient. Let me take you up on the issue that you've raised that in the province where it was detected, Natal, there seems to be some reason to believe that it is spreading faster than other variants are. And we saw with the Delta variant how quickly it replaced other variants in India. For example, where you had pointed out in one of our discussions, I remember, that how in Punjab and Delhi, it was UK variant initially which was prevalent, but it was overtaken by the Delta variant quite quickly. In fact, in a matter of weeks, Delta variant became even in these two places the dominant variant. So given that, if a differential of say two, which is what it was between the UK and the Delta variant in terms of transmissibility, in fact, less than that, it could replace so quickly. And this is really a geometric progression, therefore the rapidity which it progresses. It means there could be concerns, particularly if there is a large body of people who are not vaccinated. So even if it does work partially, as you said, doesn't lead to serious cases. If there are unvaccinated people and we know whether it is Africa, even South Africa, which is a better record than most other African states, but even in South Africa, the numbers who are have received one shot, not fully vaccinated are still very, very significant, as also in fact in India. So we are looking at possibilities of transmission being rapid, particularly if there is vaccine escape as it is, it may happen. So as you said, no reason to press the panic button, but we need to take precautions. Coming to precautions and I want to get your opinion on that, but maybe later. But could you comment on the possibilities that now exist, particularly because Africa has been left to fend for itself in terms of vaccines and therefore the danger now to the rest of the world, as we have been discussing time and again in this show. So let's all record our appreciation of the black irony involved in this. We have South Africa where on the African continent with an average fully vaccinated population percentage of 6% odd, South Africa has just over 20%. You can imagine what the situation is in the rest of non-South African Africa. India, I remind everybody is just over 30% at the moment of fully vaccinated. Number one, so the majority population is not fully vaccinated by a long shot. Number two, there is a significant proportion of HIV positive individuals undergoing treatment in South Africa and as in many other countries. And it's clear that HIV infected individuals are a little more at risk of developing chronic long-term SARS-CoV-2 infection, where the virus can undergo a fair number of selection processes within the body. So that's a second issue. And yet, unlike many other countries of the global South, including India, South Africa from day one has had one of the world's most outstanding SARS-CoV-2 tracking processes and systems driven by their experiences with HIV driven by the interaction that they've set up between public health in the community on the one hand and molecular biology laboratories on the other hand, which is why they find the viruses, the new strains that keep cropping up. And as they've pointed out, you're not giving us vaccines, we are giving you information in real time. And the only response we get, some of them have said, is that we are penalized by being blocked off in travel restrictions from the rest of the country. The layers of Black irony involved in this and the sheer inadequacy of inclusive, meaningful public health responses at the global level involved in this need to be appreciated as an object lesson by all of us. So that's one issue. Transmissibility has two layers. One is, is it transmissible in unvaccinated population? And as you point out, it's quite likely that it is going to be transmissive. Even if vaccines don't work as well, transmission amongst the vaccinated is still going to be a little bit lower. But the really crucial question that we don't have an answer to, we again, simply have anecdotal evidence about is just how much of severe illness is going to result from a Omicron, because of which large numbers of people will land up in hospitals and tertiary hospital healthcare systems will be overwhelmed if there are large numbers. And you'll appreciate that if total numbers of infections go up, but the proportion of severe illness goes down, then we are still not as bad. Is that the case? Is it not the case? The only thing we know so far is what is widely circulated in public discourse is a set of comments by Dr. Susan Cotsy, who's the, I think the president of the South African Medical Association, who's pointed out that all the Omicron variant COVID-19 cases that they are seeing seem to be milder than other COVID-19 variant illnesses. They have other interesting nuanced differences as well, but by and large, her court seems to suggest that they are mild. Is this real evidence? No, it's not because it's anecdotal. So we need to wait and see. But that's the one thing that we have to say that even if case numbers increase, total infection numbers increase, cases landing up in hospitals may not increase at the same rate. We need to put all of this together when we formulate policy. Policy does therefore have to be extremely nuanced in response to this. Numbers double in terms of infections and only half land up in hospitals as a proportion. We still will get larger numbers. So we have to see what is the rate of increase as opposed to the rate of people landing up in hospitals. And this is also something that we need to track, not just simply infections or not simply people landing up in hospitals, but both. Because that will, according to you, give us a better handle and what should be the public health response. At the moment, as you point out, apart from putting in a faster vaccination rate, particularly for Africa, which is going to be the storm center, so to say of this new COVID-19 infections, because large parts of Africa are well below South Africa's level of vaccination. Given that, obviously, the rest of the world has to prepare, let us face it, any kind of isolation is not going to work. The virus is already out there and if it is more transmissible as it appears to be, it cannot be contained. This is our past experience. Whoever has tried to isolate and so on, unless they can follow the rigor with which the Chinese seem to be doing a zero COVID policy, I don't think this is really possible for most other countries. Given that, back to masks and social distancing, at least as a immediate measure. Absolutely. And again, an object lesson in this is something that biomedical scientists have been crying in the wilderness for months now, that we need to not let our policies, our cultural norms about physical distancing down at all. We need to be maintaining those because protection against transmission by those means is strain insensitive. It is strain-independent. It will protect against all strains and this is important to remember. And it reminds me of quotes that repeatedly come out which point out that even some of the drugs may not work as well against a micron. And I was wondering which drugs are people talking about and then it suddenly dawned on me with a little bit more reading that what people are talking about as drugs is the monoclonal antibodies from Russian Regeneron, which of course will quite possibly not work as hotently against a micron, exactly the same way that vaccines won't work because both are antibody-based. But the bulk of the drugs that we are talking about, molnupiravir from Merck, which incidentally may not be quite as effective as originally claimed but is still not too bad, and paxilovid from Pfizer, those should work quite well. And yet we are conflating antibody responses. We are conflating strain-specific efforts with non-strain-specific efforts such as masking. We really, really, really need to make masks and a certain measure of caution in physical distancing our cultural norm for a while and a while yet. Even the fact that every winter in North America, winter and in the rainy season in South Asia, we find other vaccines which are airborne, aerosol-based, also causing infections. Anyway, masking when people are having or sneezing, etc., around you or you yourself, masking is a very good idea. Particularly, I have an asthmatic as I have been saying in the shows and I have found that my asthma has shown remarkable improvement in the last two years because others are masking as well as me. So that is for a, shall we say, a sample size of one what I have been able to observe. But coming back to the point you raised again on the issue of medicines and we're running out of time but I still want a short response from you. So quick response should be therefore the antiviral drug should be really bulk produced across the world. And this is an urgent requirement that we have and vaccination rates need to be increased and examination whether of new vaccines which I'm told are very simple to do with the current platform that we have built, introduce new vaccines to protect against the new strains is also possible to do very quickly. So could you give us a quick answer on these two possibilities so that we can end with some hope? So drugs, as I said, the molupiravir from Merck and Paxlavid from Pfizer possibilities are going to be very easy to mass produce and to distribute in a matter of months, if not weeks. New vaccines, even tweaked vaccines are going to take time that's much significantly longer simply because there are regulatory approvals that we cannot and should not be riding rough shot over. So that's not going to come before at the earliest February or March of next year, even the most rapid vaccine platforms. By that time what the micron based situation if at all might be the world over remains anybody's guess at the moment. Drugs certainly clearly are a possibility and should be mass produced. We've been saying that on this forum for quite some time and I go back at the end again and again to masking and I remind everybody of the other issue that we've been raising on this platform which is sustainable, high quality, N95 level, biodegradable, accessible, cheap masks for people and communities of the global south have not been a global priority, have not been a national priority in almost any country in the world and this I think is thrown up in stark relief as a public health lacuna by the emergence of a micron just as it was by the emergence of the Delta variant. And just to finish what Satyajit has said as a public good all this viral, virus, drugs, antivirals, sorry, all these antiviral vaccines and masks, high quality masks as public good. This is the need of the hour. Thank you very much for listening to us on NewsClick and also do visit our website.