Topic: Omicron Covid-19 Update

 Speaker: Dr Soumya Swaminathan, Chief Scientist, World Health Organization

 22^nd January, 2022, Saturday; 1.30-2.45pm

• Last week, there have been more than 18 million new cases and more than 45k deaths globally. Cumulative cases are more than 323 million and more than 5.5 million deaths.
• The peak of deaths occurred during the delta wave; since then deaths have remained fairly constant but are not beginning to climb.
• Different WHO regions have behaved differently. In Africa, cases reduced last week, but all other areas showed an increase.
• The prevalence of variants of concern (VOCs) depends upon the amount of sequencing done and type of sequencing done.
• Over the last few months, delta was the predominant VOC, but in the last two months, Omicron has rapidly taken over and is now present in almost all countries.
• Contact tracing studies show that there is a decrease in serial interval (the time between one case to the next case).
• Omicron is about 3-4 times more transmissible, this is largely driven by its ability to evade natural immunity and vaccine-induced immunity. It prefers the upper respiratory tract so that it is easy to transmit. Although it causes less severe disease and hospitalizations have reduced, but still there are significant numbers of hospitalized patients. Many healthcare workers are infected.
• Public health and social measures both at the individual level (like masks) and societal level (like reducing movement) have proven critical to limiting the spread of Covid-19 and reducing deaths. The degree of these measures has to be continuously adjusted to the intensity of transmission and the capacity of health system of a country. These have to be balanced with the livelihood of people and economic impact.
• Community should be consulted and engaged before changes are made. They should be explained why such measures are being adopted.
• Masks are very effective but their use alone is not sufficient to provide adequate protection. Layers of intervention are more likely to be effective: physical distancing, well ventilated rooms, avoiding crowds and close contact, regularly cleaning hands and self-isolation, if sick.
• Appropriate use and disposal of masks is essential.
• There are multiple modes of transmission: Through droplets (more than 5 micron in size), which fall to the ground rapidly, hence physical distancing is recommended; aerosols, which are smaller particles and remain suspended in air. They are produced after singing, talking, laughing. How long do they remain afloat depends on the ventilation and humidity of the room. Hence, the importance of wearing masks and good ventilation in indoor setting. The third mode of transmission is surface transmission by touching contaminated surfaces.
• More attention has to be paid to ventilation in hospital settings; there should be at least six air exchanges per hour in air-conditioned settings.
• The WHO recommends the Covid-19 CARE pathway at local, regional and national levels. Confirm SARS CoV-2 infection, Assess symptoms, risk factors and severity, Respond with appropriate care and treatment and Evaluate clinical response and recovery.
• Besides host factors and virus factors, the baseline risk of death in severe and critical patients can be affected by access to resources and care.
• Severe cases (SpO2 <90% on room air) are usually treated with oxygen. Critical cases are usually treated in high care or ICU areas and are usually treated with invasive mechanical ventilation (IMV), non-invasive ventilation (NIV), high flow nasal oxygen (HFNO).
• WHO regularly updates its living guidelines for management of Covid-19 based not only on efficacy and safety data but also ethics and costs.
• WHO has recommended two new drugs for COVID-19. It has strongly recommended the use of baricitinib in severe and critical cases and has made a conditional recommendation for use of sotrovimab in mild to moderate high-risk cases.
• WHO will also be coming out with recommendations on molnupiravir as there are lot of concerns around how it is to be used such as toxicity and emergence of resistance. There has to be a monitoring system in place before it is widely available.
• WHO is also looking at drugs like nirmaltrelvir/Ritonavir and fluvoxamine.
• Ivermectin has to be used only in the context of clinical trials.
• Children are at low risk of severe disease. The proportion of deaths in children is low versus global deaths. However, those with underlying conditions are at high risk of severe illness. Therefore those with underlying health conditions should be vaccinated at the same time as high-risk adults.
• Around 60.3% of the world population has received at least one dose of a Covid-19 vaccine. While only 9.4% of people in the low-income countries have received at least one dose. 9.82 billion doses have been administered globally; 28.77 million are now administered each day.
• After two doses, the vaccine effectiveness against Omicron (symptomatic infection) is very low. But with a booster, the vaccine effectiveness goes up for both delta and Omicron, though the duration of protection is not known.
• WHO recommends that countries with low rates of primary vaccination should first achieve high primary vaccine coverage rates among the higher risk priority use groups.
• Countries with moderate to high primary series coverage rates in higher risk priority use groups should first achieve booster dose coverage in higher risk groups before offering it to low-risk groups.
• The goals of vaccination are to minimise deaths, protect healthcare workers, protect hospitals from being overwhelmed, opening up of economic activity and control the infection.
• Factors like time since vaccination, type of vaccine, age, underlying disease, variant play a role in protection.
• Persons at highest risk are older adults (>60 years), immunocompromised persons and health workers. High risk groups include adults with comorbid conditions, pregnant, teachers and other essential workers and other disadvantaged sociodemographic subpopulations at higher risk of severe infection.
• Remaining adults, children and adolescents with comorbid conditions are at medium risk, while health children and adolescents are at lowest risk.
• When those at highest risk are covered move to higher risk group and then to medium risk and to lowest risk.
• If there are limited vaccine stocks, the focus should be on as high as possible vaccine coverage in high-risk groups. Start booster if 6 months have passed in high-risk groups.
• Way forward: Focus on reducing deaths and severe disease by increasing vaccination coverage and public health measures and reduce transmission by avoiding lockdowns which affect the economy of countries.
• A collective response – national and global – response is needed with sharing of data, supporting research on vaccines and therapeutics.
• Prioritise opening up of schools and educational institutes.
• We have to be watchful and keep transmission low to prevent future waves. With enough immunity at population level (natural and vaccine-induced), we can withstand future waves and move onto the stage of endemicity.
• It is very hard to predict but the severity of pandemic should reduce in 2022, but we are not coming out of the pandemic yet.
• Vaccine mandates are a subject of debate. Public health considerations vs individual rights have to be balanced.
• WHO offsets the misinformation by anti-vaxxers by providing credible information and work with big companies like social media to reduce misinformation on social media platforms.
• There has been lot of speculation that omicron will be like a natural vaccine. But it cannot be said so definitely. This virus has surprised us all many times. Omicron too came out of the blue. It is important that we continue with surveillance and public health measures. Keeps masks on, limit transmission, work from home for those who can, stay at home if sick.
• This pandemic has brought out the inequities and its impact on nutrition and diseases like TB, NCDs, is yet to be estimated.
• We are on the path of moving from pandemic to endemic. But it is unpredictable and we have to have a plan ready.
• There are no criteria for definition of endemicity for this virus. It is difficult to establish criteria – at what level do you accept the amount of mortality that we can live with.
• Many parents are apprehensive about vaccination for their children. But benefits vs risk has to be considered.
• Countries should share vaccines to those who have not received any vaccination, if they have vaccinated their high-risk population or boosting their high-risk groups. But global solidarity is needed for equity.

Participants

Member National Medical Associations

Dr Yeh Woei Chong, Singapore, Chair CMAAO

Dr Wasiq Qazi, Pakistan, President-elect CMAAO

Dr Heidi Stensmyren, Sweden, President World Medical Association

Dr Marthanda Pillai, India Member World Medical Council, Advisor CMAAO

Dr Alvin Yee-Shing Chan, Hong Kong, Treasurer, CMAAO

Dr Ravi Naidu, Malaysia

Dr Akhtar Hussain, South Africa

Dr Angelique Coetzee, South Africa

Dr Md Jamaluddin Chowdhury, Bangladesh

Dr Salma Kundi, Pakistan

Dr Marie Uzawa Urabe, Japan

Dr Prakash Budhakoti, Nepal

Dr Maria Enedina Scuarcialupi, Brazil

Invitees

Dr Veena Aggarwal, India, Trustee HCFI

Mr Nilesh Aggarwal, India, CEO IJCP Group

Ms Diane Campbell

Dr Shashank Joshi, India

Dr Mulazim Hussain Bukhari, Pakistan

Prof Arun Jamkar, India

Dr Anil Kumar, India

Dr Y Wong

Dr Tony Ng

Dr Nidhi Dhawan, India

Dr Ramesh Ruia

Dr Chong Chia Yin

Dr Wong Yueh-ti

Dr Rajender Reddy

Dr MK Bhatnagar

Dr Sangram Biradar

Dr Nagaraj Kamat

Dr Zeeshan Arif

Dr Tammy Chan

Dr Brij Bajaj

Dr S Sharma, Editor IJCP Group

Moderator

Mr Saurabh Aggarwal