The Indian Express | 1 month ago | 21-04-2023 | 11:45 am
What does the new “wave” of the SARS-CoV-2 virus mean? The recent surge in the number of persons testing positive for Covid-19 (“infected cases”) has led to public and media concerns, even though the rise in numbers of severely-ill persons (“sick cases”) has been far less. This has raised questions: (a) Is Omicron here to stay (b) Are recent variants of concern, (c) is there a need to mask up, (d) are boosters of previously developed vaccines or newly-developed customised vaccines needed and (e) will travel restrictions be reimposed?There is little doubt that the SARS-CoV 2 virus will be a continuing part of our ecosystem, as a permanent member of the clan of respiratory viruses that causes periodic surges of infections, often following seasonal calendars. This is the pattern followed by “novel” respiratory viruses, which appear unannounced, cause consternation and concern, but over time become “naturalised members” of our ecosystem. Over the past one-and-half years, Omicron has provided evidence of dominance and durability to establish itself as the enduring image of the SARS-CoV-2 virus.However, omnipresence is not omnipotence. While presenting evidence of higher infectivity and greater ability for escape from previously acquired immunity, recent sub-variants such as Arcturus (previously labelled XBB 1.16) are not exhibiting high virulence. The fraction of infected cases requiring hospitalisation, especially intensive care, remains low. The WHO regards Arcturus as a “variant under watch”, not as a variant of concern (VOC). Indeed, the actual proportion of infected cases having serious outcomes is likely to be much lower than reported as many asymptomatic or mildly unwell persons infected by the virus would not have been tested. From a public health point of view, this is reassuring.Even if there is comfort at the community level that there will be no Delta-like onslaught in terms of severity of illness, should some individuals be concerned about the possibility of serious disease if infected? Respiratory viruses, whether of the coronavirus clan or the flu family, have a predilection for causing serious illness in immunodeficient and immunocompromised persons. So, even the “milder” forms of the SARS-CoV-2 can cause complications in elderly persons whose previously acquired immunity may be waning, in immunocompromised persons and in persons with severe co-morbidities. Such persons should use masks in public when an outbreak is actively spiking and also avoid crowds in ill-ventilated spaces. Any person with symptoms of an active respiratory infection should also mask up, indoors or outdoors, to protect vulnerable persons from getting infected.Despite some initial claims that systemically administered vaccines prevent infection, it is now clearly recognised that those vaccines protect against severe illness but do not block the virus from entering the upper respiratory tract. Hence, infection counts will periodically rise even in vaccinated populations. Recently available mucosal vaccines, which are nasally administered, can offer some protection against infection. However, their usefulness in significantly reducing the incidence of severe disease is yet to be demonstrated in the Omicron era where that risk is low. There is presently no evidence to suggest that additional boosters are needed in persons who have already received three doses. High levels of hybrid immunity, acquired by the Indian population over the past two years, is likely to confer some protection against severe illness. Even as antibody levels wane, cellular immunity is likely to retain the residual capacity to mount a defence. If more virulent variants emerge, this perspective on vaccines may change.Can we fully resume normal life, in terms of travel, work, education and socialisation? At present, there are no danger signals to deter us from doing so, while following sensible precautions. Crowded events are best avoided when the count of viral infections is sharply rising. Ventilated areas should be preferred for gatherings, wherever possible. It is safer to wear a mask when participating in crowded events, especially if in the elderly age group. Hand washing offers protection against viruses which spread through droplet infection. Remember the traffic rules. Even if the traffic light is green, drive on sensibly while sticking to your lane, observing speed limits and wearing a seat belt. Similar discipline is needed during the active outbreak, even as we get on with life.How will we know if a dangerous new variant is emerging? We need to do genomic identification of all hospitalised cases of Covid-19. At the community level, wastewater surveillance would be useful. Some countries have started to do wastewater surveillance on the toilet waste of incoming international flights. The surveillance modes too are adapting to the change of scene brought by Omicron. We are learning to live with it while taking care not to die from it.
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