National and International Issues

Omicron is a Reminder that No One is Safe Until Everyone is Safe

Despite having found solutions and vaccines for COVID-19, the rise of  another unprecedented variant is placing the entire international community in front of another unknown risk.


Once again, we are all worried. It was hoped that the worst of the pandemic was over, celebrating a return to quasi-normality despite warnings that this year could witness another surge. Now, COVID cases are increasing across the UK, Europe, and South Africa. R Rates are rising in the UK again after a half-term dip, and the new Omicron variant detected in South Africa is ringing alarm bells across the world. 



This genetic sequence does not appear in any earlier versions of the Coronavirus, called SARS-CoV-2, but is ubiquitous in many other viruses including those that cause the common cold and also in the human genome. This could mean the virus transmits more easily, while only causing mild or asymptomatic disease. It is not clear whether Omicron is more infectious than other variants, whether it causes more severe disease or whether it will overtake Delta as the most prevalent variant. It may take several weeks to get answers to these questions
The Omicron variant of the virus that causes COVID-19 likely acquired at least one of its mutations by picking up a snippet of genetic material from another virus, possibly one that causes the common cold present in the same infected cells. Omicron, the SARS-CoV-2 variant responsible for a cluster of cases in South Africa, that is now spreading around rapidly, is the most heavily mutated variant to emerge so far and carries mutations similar to changes seen in the previous variants of concern associated with enhanced transmissibility and partial resistance to vaccine induced immunity.
Currently, there is a limited understanding of how much of a threat this variant poses, though the World Health Organization has classified it “of concern”. The fear is that its multiple mutations, 32 on its spike protein, the key it uses to unlock our body’s cells, could mean antibodies from previous infections or vaccination may not counter it so well. Scientists are also looking at its interaction with another aspect of the immune system: T-cells.


Scientists in Botswana and South Africa alerted the world to a fast-spreading SARS-CoV-2 variant now known as Omicron and researchers worldwide are racing to understand the threat that the variant now confirmed in more than 20 countries poses to the world.


Indeed, scientists in Botswana and South Africa alerted the world to a fast-spreading SARS-CoV-2 variant now known as Omicron and researchers worldwide are racing to understand the threat that the variant now confirmed in more than 20 countries poses to the world. Yet it might take scientists more months to complete the picture of Omicron, and to gain an understanding of its transmissibility and severity, as well as its potential to evade vaccines and cause reinfections.
The Omicron variant of the SARS-CoV-2 virus is seeing an unprecedented surge in cases, lending weight to concerns that this variant may prove to be the most transmissible yet seen. This new variant of the COVID-19 virus is very worrying. This variant carries some changes seen previously in other variants but never altogether in one virus. It also has novel mutations that have not been seen before. In total, the variant’s genome has around 50 mutations including more than 30 in the spike protein, the part that interacts with human cells before cell entry and that has been the primary target for current vaccines. There is also the risk that the variant might be better at spreading than the Delta variant, particularly in the unvaccinated, which makes it harder and harder for any healthcare system to cope.


Although genome sequencing is needed to confirm Omicron cases, some PCR tests can pick up a hallmark of the variant that distinguishes it from Delta. On the basis of this signal, there are preliminary indications that the virus – although the cases are extremely low in number – has the potential to spread much faster and infect vastly more people than Delta.


Omicron’s rapid rise is what worries scientists the most because it suggests the variant could spark an explosive increase in COVID-19 cases elsewhere. Since this pattern is getting repeated in other countries, it suggests a very strong evidence that Omicron has a transmission advantage. On December 1, South Africa recorded 8,561 cases, up from the 3,402 reported on November 26. Although genome sequencing is needed to confirm Omicron cases, some PCR tests can pick up a hallmark of the variant that distinguishes it from Delta. On the basis of this signal, there are preliminary indications that the virus – although the cases are extremely low in number – has the potential to spread much faster and infect vastly more people than Delta.
The variant’s swift rise in Europe and UK hints that it has some capacity to evade immunity. In this context, Omicron’s surge in Southern Africa might be largely due to its capacity to infect people who recovered from COVID-19 caused by Delta and other variants, as well as those who have been vaccinated. 
How well the variant spreads elsewhere might depend on factors such as vaccination and previous infection rates and an important question remains whether Omicron can overcome immunity from vaccines or infection? The problem is that if you throw it into the mix in a highly vaccinated population that has given up on other control measures, it might have an edge there. However, even if Omicron can evade neutralizing antibodies, it does not mean that immune responses triggered by vaccination and prior infections will offer no protection against the variant because modest levels of neutralizing antibodies may protect people from the severe forms of COVID-19. 
The threat of Omicron has prompted some rich countries, such as the United Kingdom, to speed up and enlarge the roll-out of COVID vaccine booster doses. But it is not yet clear how effective these doses will be against this variant. Third doses supercharge neutralizing-antibody levels, and it is likely that this will provide a protection against Omicron’s ability to evade these antibodies. If this finding is borne out elsewhere, Omicron would pose a particular danger in countries with high rates of natural immunity but relatively low rates of vaccination, such as South Africa, Russia, and the United States. 
Cases have been reported in Botswana, Hong Kong, Canada, and Australia, which has had extremely tight border controls throughout the pandemic. Some countries, including Japan and Israel, were quick to close their borders to all foreign travellers, while others, such as the UK and EU countries, enforced quarantine for travellers from South Africa and neighboring countries after the World Health Organization designated Omicron an official variant of concern on November 26. Data on Omicron infections in other countries will show the extent of the geographical spread as a larger sample of cases accrue a better idea of how generalizable the early reports of mild disease might be possible.
There is still no data on the vaccination status of people infected with Omicron. On the basis of its known mutations, vaccine makers have expressed optimism that immunisation will continue to protect against the worst outcomes of COVID-19 brought on by the new variant.
The world has experienced three previous waves, driven by the original virus, the beta variant, and the delta variant. The rapidly building Omicron surge has yet to be officially declared as a fourth wave. Sadly, the proportion of new cases involving people who have already experienced COVID-19 has been more than three times higher than in the second and third waves.
This is the case for swift action, even if it ultimately proves unnecessary. We have repeatedly seen that precautionary actions have relatively low economic and social costs and can easily be scaled back, while a delayed reaction costs lives and increases the risk that severe restrictions will be needed similar to last time. The question is, which measures are appropriate? 
To slow the spread of the variant the government may consider that masks are again to become compulsory on public transport and in shops and schools, all contacts of people with a case of Omicron should be required to isolate for 10 days and all travellers entering the country will have to take a PCR test two days later and to self-isolate until they receive a negative result. But while suspending travel cannot stop the variant’s spread, some believe it may buy precious time to get more doses into arms, improve public awareness and introduce stronger disease control measures. That time should be used wisely. Mandatory masking should never have been a plan B, the government should reintroduce it now along with vaccine passports for large events and adequate financial support if possible, for the sick or isolating. Pakistan needs to start the booster dose initiative in its vaccination programme as a prophylactic preventive strategy.
In our country, people will be additionally susceptible due to malnourishment, existing health problems, overcrowded conditions and healthcare systems that already fail to meet their basic needs. This variant is a powerful reminder that failing to distribute vaccines equitably is a failure not only of ethics but of self-protection; the more the virus circulates, the greater the risk of new variants. 


Only 3% of the people in low-income countries are fully vaccinated, compared with more than 60% in high-income countries. This gap is not only ethically wrong, but it also increases the likelihood of a vaccine-resistant strain’s development. 


Omicron is a reminder that no one is safe until everyone is safe. By the end of the year, enough vaccines will have been manufactured to have vaccinated the whole world against COVID. Yet, too many countries are facing this winter with low vaccination rates as a result of wealthier nations hoarding unused supplies. Only 3% of the people in low-income countries are fully vaccinated, compared with more than 60% in high-income countries. This gap is not only ethically wrong, but it also increases the likelihood of a vaccine-resistant strain’s development. High-income countries need to develop far more efficient and timely systems for delivering unused vaccinations to developing countries well in advance of their expiry date.


Though the pandemic is far from over, it will end one day, and though humans cannot determine its course, our actions do have an impact upon it. The emergence of Omicron should serve as a reminder of some key lessons in this pandemic.


Though the pandemic is far from over, it will end one day, and though humans cannot determine its course, our actions do have an impact upon it. The emergence of Omicron should serve as a reminder of some key lessons in this pandemic. The first is the importance of genomic sequencing, which tracks the genetic structure of the virus. 
Secondly, the importance of the precautionary principle has been proved over and over again in this pandemic. With a virus that spreads so rapidly, less restrictive action sooner can prevent the need for more restrictive action for longer later. Pakistan’s vaccination programme has been a success and means that unless we see another more vaccine-resistant variant, whether that is Omicron or another, we should be able to avoid the sorts of invasive lockdowns that were required in the first and second waves.


Pakistan’s vaccination programme has been a success and means that unless we see another more vaccine-resistant variant, whether that is Omicron or another, we should be able to avoid the sorts of invasive lockdowns that were required in the first and second waves.


The government may like to consider introducing stricter requirements around travel, self-isolation for those who have been in contact with Omicron and compulsory mask wearing in shops. Hopefully, Omicron will prove to be less of a risk than some fear. But if it is so, we should treat it as a lucky escape. It is a warning that this pandemic is far from over and that Pakistan and other countries should be doing more to combat the spread of the virus.


The writer is a professor, Fellow of the Royal College of Psychiatrists London, Fellow and Diplomate of the American Board of Psychotherapy, and Certified Counterintelligence Threat Analyst. He is currently a consultant forensic psychiatrist in the UK and Shifa International Hospital Islamabad.
E-mail: [email protected]
 

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