Omicron is coming

Dr Nadeem Niyaz jan
“WHO has designated the variant B.1.1.529 a variant of concern, named Omicron, on the basis of advice from WHO’s Technical Advisory Group on Virus Evolution.
This variant is of concern because it has some mutations that may have an impact on how it behaves.
Countries should enhance surveillance and sequencing, share genome sequences with public databases, and report initial cases/clusters to WHO, while also continuing to implement effective public health measures.
The more COVID-19 circulates, the more opportunities the virus has to change, the more mutations we will see. The most important thing people can do is reduce their risk of exposure to the virus.
South Africa first reported cases of Omicron to WHO on 24 November 2021, with both South Africa and Botswana having submitted sequences to GISAID on 23 November with sample collection dates of 11 November 2021. During the meeting of the Technical Advisory Group on Virus Evolution on 26 November, South African researchers mentioned a confirmed case in a sample collected on 9 November. Hong Kong SAR was the first to upload sequences to GISAID on 22 November 2021. The earliest date and even country may change as more analysis is done by countries.
It is expected more countries will identify cases as they increase surveillance and analysis.“These are the countries that have reported to WHO, uploaded sequences in GISAID or officially announced cases as of 28 November. Many of the cases below were reported in travellers, though it’s expected this may change in coming days as more information becomes available. Australia“ Belgium Botswana“ China: Hong Kong SAR Czech Republic“ Denmark Israel Italy South Africa United Kingdom.
Several other countries have reported either suspected or confirmed cases for which we await official notification and GISAID submission, which WHO encourages countries to do.
Researchers in South Africa and around the world are conducting studies to better understand many aspects of Omicron and will continue to share the findings of these studies as they become available.
Transmissibility: It is not yet clear whether Omicron is more transmissible (e.g., more easily spread from person to person) compared to other variants, including Delta. The number of people testing positive has risen in areas of South Africa affected by this variant, but epidemiologic studies are underway to understand if it is because of Omicron or other factors.
Severity of disease:
It is not yet clear whether infection with Omicron causes more severe disease compared to infections with other variants, including Delta.  Preliminary data suggests that there are increasing rates of hospitalization in South Africa, but this may be due to increasing overall numbers of people becoming infected, rather than a result of specific infection with Omicron.  There is currently no information to suggest that symptoms associated with Omicron are different from those from other variants.  Initial reported infections were among university studies—younger individuals who tend to have more mild disease—but understanding the level of severity of the Omicron variant will take days to several weeks.  All variants of COVID-19, including the Delta variant that is dominant worldwide, can cause severe disease or death, in particular for the most vulnerable people, and thus prevention is always key.
“Effectiveness of prior SARS-CoV-2 infection
“Preliminary evidence suggests there may be an increased risk of reinfection with Omicron (ie, people who have previously had COVID-19 could become reinfected more easily with Omicron), as compared to other variants of concern, but information is limited. More information on this will become available in the coming days and weeks.
Effectiveness of vaccines: WHO is working with technical partners to understand the potential impact of this variant on our existing countermeasures, including vaccines. Vaccines remain critical to reducing severe disease and death, including against the dominant circulating virus, Delta. Current vaccines remain effective against severe disease and death.
Effectiveness of tests: The widely used PCR tests continue to detect infection, including infection with Omicron, as we have seen with other variants as well. Studies are ongoing to determine whether there is any impact on other types of tests, including rapid antigen detection tests.
Several labs have indicated that for one widely used PCR test, one of the three target genes is not detected (this is called S gene dropout or S gene target failure). This is similar to what we saw with the Alpha variant. So, we can use this PCR test to rapidly identify the likely presence of the new variant, and help us prioritize which samples need to be sent for genome sequencing, in order to confirm the new variant.
Effectiveness of current treatments:   Corticosteroids and IL6 Receptor Blockers will still be effective for managing patients with severe COVID-19. Other treatments will be assessed to see if they are still as effective given the changes to parts of the virus in the Omicron variant.
Advice to countries, individuals
Q: What can people do to protect themselves?
• The most effective steps individuals can take to reduce the spread of the COVID-19 virus is to keep a physical distance of at least 1 metre from others; wear a well-fitting mask; open windows to improve ventilation; avoid poorly ventilated or crowded spaces; keep hands clean; cough or sneeze into a bent elbow or tissue; and get vaccinated when it’s their turn.
Q: What should countries do?
• Enhance surveillance and sequencing efforts to better understand circulating SARS-CoV-2 variants.“• Submit complete genome sequences and associated metadata to a publicly available database, such as GISAID.“• Report initial cases/clusters associated with VOC infection to WHO.“• Where capacity exists and in coordination with the international community, perform field investigations and laboratory assessments to improve understanding of the potential impacts of the variant epidemiology, severity, effectiveness of public health and social measures, diagnostic methods, immune responses, antibody neutralization, or other relevant characteristics.
Continue to implement effective public health measures to reduce COVID-19 circulation.
Q: What is WHO’s position on travel restrictions?
WHO recommends that countries apply a risk-based and scientific approach when implementing travel measures, in accordance with the IHR Temporary Recommendations issued by the WHO Director-General following the 9th Emergency Committee for COVID-19, issued on 26 October 2021.
(The author is Senior Consultant Vascular Surgery Triveni Nursing Home)