"If It Crosses Critical Point...": Karnataka Expert's Warning On Omicron

Following the detection of two cases of Covid's Omicron variant in Karnataka, there is concern over what the state government can and should do next.

Among the two cases, one is a traveller from abroad and the other a Bengaluru-based doctor with no history of international travel.

Dr Vishal Rao, member of the Genomic Surveillance Committee of the Covid Task Force told NDTV that stricter restrictions may now be inevitable.

"I think further restrictions are inevitable. Till now Karnataka has been able to keep the percentage phenomenally below 1%. They have a daunting task to maintain this, to not fall prey to another wave. At this juncture, no matter what investment is done on healthcare systems, ventilators, oxygen -- this approach (curbs) would be much smarter and safer."

Shutdown, Dr Rao said, is the last approach of enforcement that will be imposed when citizens fail. "I would say that at this juncture, every social, economic activity has to be done in a micro and not a macro aspect. That responsibility lies with the citizens, rather than involving governments which step in at a critical juncture when they think citizens can't handle it anymore. This is for every state, every nation. The citizens' role is pivotal, they must come forward and take responsibility for Covid-appropriate behaviour," he told NDTV.

On how the Bengaluru-based doctor may have been infected, he said, "I would like to say that one person had a history of international travel. The other person had no history of international travel. But it would not be correct to assume that he had no travel at all. Travel was there. Now the way the virus was intermingling. There could be potential points at which there could have been some form of interaction with a foreign traveller at some point."

Dr Rao ruled out that the Omicron variant had entered Bengaluru earlier. "This is to clarify the fact that there are some rumours - was this created de novo in Bangalore? It was not. Over the past 3 to 6 months, INSACOG, the Genomic Surveillance Committee have been very, very vigilant, mapping every single variant possible, watching all forms of Delta. There is no way we got Omicron retrospectively."

Highlighting how seriously the World Health Organization (WHO) was looking at Omicron, he said, :It took a couple of months for WHO to call Delta a variant of concern. But, within a couple of days, they called Omicron a variant of concern without going through the norms of a variant under investigation, a variant of interest and then a variant of concern," he said. "This has been a leapfrog. What were the reasons for them to have taken that? The predictive genomics of this particular variant has some very interesting things. Delta had about 16 mutations in the spike protein area -- this has about 32. So this seems to be getting stronger."

"Potentially, if you look from a predictive genomics point of view -- how does it biologically behave based on existing data -- this definitely has 3 important potentials -- higher transmission, greater virulence and greater vaccine escape capabilities," he said.

One of these aspects -- higher transmission rate -- has been seen so far, Dr Rao said. "Among the three (potentials), what has it shown us till now? It has shown us only higher transmission. How has it shown? In South Africa and Botswana, when it was first detected on November 11, the number of cases one week before that was about 219. Today they are at about 11,500. The number of deaths is about 44 per day. That means, within a short span of a couple of weeks, this particular variant has overtaken the Delta and gone one step further -- created re-infections in people who have had Delta. That reiterates the fact that predictive genomics is not completely wrong. And that is why WHO has gone ahead to create this red alert globally," he said.

Warning against complacency, Dr Rao said, "We need to pay heed and not make the error that we did during the first wave to assume that India is different, the UK is different, USA is different. The patterns are going to be similar. We need to be cautious. Let us not get into the discussion that Kerala is different from Karnataka which is different from Maharashtra."

It is still too early to come to any firm conclusions about the behaviour of this variant, Dr Rao said.

"Broadly, WHO has said it has touched about 20 countries and is growing. At this juncture, what we need to wait and see, with patience and not panic, in the next coming weeks and months, is how it is going to progress in each of these countries. There is a nice note in today's Lancet. Do not go by anecdotes that this is just mild. We need to wait till it reaches more critical numbers -- thousands, ten thousand. It may change its behaviour. So please be very, very cautious. If we keep numbers low, it will be mild. But when it crosses a critical tipping point, is when you will not be able to predict what it can do," he said.

Dr Rao further said that vaccine inequity is a matter of concern, with many countries having dismally low vaccination figures. "WHO has also brought up the concern of vaccine inequalities. The countries that are currently not vaccinated - there are at least 10 countries below the world mark - where the percentage of vaccination is still at 2% to 3% and Africa is at the centre of it. Is there an argument that there is 3 for me - none for you? WHO has put a moratorium to say, let us complete 10% of the vaccinations world over to make the world a safer place. "

The two cases in Karnataka were confirmed using genomic sequencing. Samples of 5 primary and secondary contacts of the Bengaluru doctor, who tested positive, have been sent for sequencing to confirm whether they have the Omicron variant or not. But Dr Rao believes such sequencing should be done judiciously.

"INSACOG has ramped up efforts for genomic sequencing. It is labour and cost intense. We need to prioritise. Every person with cough and cold need not have genomic surveillance. But what WHO has also suggested -- we can use the surrogate or proxy way with RT-PCR. We can give an indication to say this group of patients may need genomic surveillance to reconfirm if it is Omicron. No need to panic and send every single case for genomic surveillance. Labs will have to play an important role here to screen and look at ones where CT value is very low, where there is an S gene target failure or dropout - those are cases that would have good criteria to screen for genomic sequencing."

Karnataka has been trying to expand its genomic sequencing capability, he said. "Karnataka is setting up genomic labs in state medical colleges -- also an investment for health for the future for communicable and non-communicable diseases and at the same time training. We have now been able to have the turnaround time to 3 days or less than a week. When we began one and a half years back, it would take a couple of weeks to months."

So is this the beginning of India's third wave? Dr Rao does not think so.

"South Africa is experiencing the fourth wave. As of now, no indications are there that this is the third wave (in India). But this is a signal for people to say, the war is far from over. Let us not make any premature claims of victory at this juncture," he said.

The time of the year increases the risk of infection due to social reasons. Dr Rao said, "December is a very important month - for Christmas, New Year, celebrations - social and economic activities. And I believe this is a socio-economic virus. The more you move, the more you will spread. Each economic zone should be working like a healthcare centre."

On what has been learnt from the experience of other countries, Dr Rao said, "There are key learnings from other countries. They are focusing on ramping up vaccinations as the topmost priority. For us today, it is a race between the vaccine and the variant. At this stage the vaccine would have to win. I would urge all media houses to take this campaign up - which you have consistently done - to raise awareness among people about the myths of not taking the second vaccination."

Karnataka Chief Minister Basavaraj Bommai has sought the centre's permission to give booster doses to frontline workers.

Speaking on this, Dr Rao said, "I was one of the first in line to advocate that frontline workers need the second dose. And I would be one of the first in line to take the booster. There is consensus from the UK, USA, Europe and everywhere that an immune booster dose with the vaccine will help reignite the immune system and help improve its memory. We need to understand that a booster dose is being recommended for frontline workers because they are at high risk. The third dose is going to be an important, precious milestone for everybody because of the existing crisis the world over. WHO has reiterated the fact that we need to look at the world as one entity."

"People who are planning to waste the second dose -- in Karnataka, there are 50 lakh who haven't taken -- I would urge them to please come forward, take the second dose because the war is far from over. Even the second dose gives you only a partial protection -- about 50% efficacy and 90% against hospitalisation. Do not underestimate the importance of the second dose," Dr Rao said.