Omicron is here. Are we prepared?

Without timely intervention, the ‘variant of concern’ could overwhelm our health infrastructure

On the day Omicron was declared as a variant of concern by the World Health Organization, the new Covid-19 strain had infected 87 individuals in five countries, with 77 of them just from South Africa.

But it took just three weeks for the new variant to spread to 91 countries, infecting more than 27,000 people. More than 12,000 patients came from the UK alone, and another 9,000 from Denmark.

Modelling studies predicted a possible deluge in Europe, while other G7 countries called it the “biggest threat to the global population.”

Is India prepared for an Omicron surge?

The states have no doubt improved their hospital beds and shored up their oxygen production since the peak of the second wave in May, when over 4.14 lakh cases were recorded in a single day, overwhelming the healthcare system.

But could India’s hypothetical third wave grow even bigger?

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The Centre’s principal advisor and NITI Aayog member V K Paul flagged such a possibility during a media interaction on Friday. Highlighting the worsening Omicron situation in Europe, he said more than 80,000 people (not all are Omicron positive) were getting infected in the UK on a daily basis, which if extrapolated to India after adjusting for population, would translate into 14 lakh daily Covid-19 infections.

Similarly, France is witnessing 65,000 daily infections, which in India would mean 13 lakh daily cases.

Reservations about such an extrapolation notwithstanding, the question is: How many of those infected will require hospital care?

To answer this, the Centre is collecting data from other nations.

A number on the higher side of 20% roughly translates to 3 lakh cases that require hospitalisation every day — enough for Indian health system to collapse.

However, the UK’s experience — daily admissions of 700-1000 compared to 3000-4000 seen in the previous peak — and the South African scenario give some hope.

“Given the experience of other countries and the evidence that it has already reached our shores, we will see an Omicron-fueled surge in cases by January. From what we’ve seen in South Africa, cases appear to be milder overall. Relatively few of them require hospitalisation, at least from evidence so far, and their health systems have not been overwhelmed,” Gautam Menon, a professor of physics and biology at the Institute of Mathematical Sciences, Chennai told DH.

To curb such a spread, Paul and other public health experts have suggested aggressive surveillance to find out the early cases and effectively prepare for a high caseload. This is easier said than done.

Missing surveillance

The states have not yet taken the crucial first step — increasing the daily tests — to pick up the early signs of a surge.

Since November 27, when Prime Minister Narendra Modi reviewed the Omicron scenario following the WHO declaration, the number of daily tests has not exceeded 13 lakh, though experts suggested a four fold jump in tests.

In Maharashtra, the state with the maximum number of Omicron cases so far, the number of tests went up from 1.08 lakh on December 1 to around 1.2 lakh on Dec 15.

In Kerala, which accounts for 43% of India’s active Covid-19 cases, the number of RTPCR tests went up from around 84,000 on Nov 25 to one lakh plus on Dec 15.

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The ICMR figures suggest an increase of around 20,000 tests for the country in the last 10 days, which could be due to the extra screening at the airports.

“Airport testing should continue but that will only delay a surge that comes from local transmission, not travelers. Everyone showing up in a hospital for anything from fevers to flu symptoms to pneumonia should also be tested. That’s how South Africa caught its first cases. Only the confirmed positive samples need to be sequenced to estimate if Omicron is spreading and replacing Delta,” said virologist Shahid Jameel, a visiting faculty at Ashoka University in Haryana.

Senior doctor A H Ahangar, director of the Sher E Kashmir Institute of Medical Sciences in Srinagar warned that the continuous surge in positive cases was an indication that the third wave of Covid is “literally at our doorstep.”

While government officials in every state exuded confidence that they would be able to manage a new wave with improved infrastructure that has been put in place in the last few months, public health experts voice a note of concern.

Oxygen audits, drills

In Tamil Nadu, public health expert K Kolandasamy told DH that the state should conduct a detailed audit on the preparedness of the health machinery. It should also check whether adequate medicines are available in the public health centres and whether pulse oximeters are working.

“The audit should find out the status of the oxygen plants under construction and whether oxygen concentrators are working and are properly stored. The government should also train more people to handle oxygen concentrators as a precautionary measure,” said the former director of the department of public health, Tamil Nadu.

The same was conveyed to the states by the Union Health Secretary Rajesh Bhushan during a review meeting earlier this week.

He asked the state administrations to ensure installation of oxygen supply related instruments at the hospitals after their delivery at district headquarters. Bhushan’s directive came after the ministry realised that the ventilators supplied by the Union government had not even been unpacked in some states.

The states have also been asked to conduct mock drills of all installed and commissioned PSA (pressure swing adsorption) plants to ensure they are fully operational so that oxygen with the required quantity, pressure and purity reaches the patients at their bedside.

These drills are to be completed by December end. Each state is also to carry out an oxygen audit.

The new challenges would be finding additional centres for genetic sequencing and devising an appropriate arrangement to keep the suspected Omicron patients segregated till the sequencing results come in. Maharashtra, Gujarat and Kerala have two centres for sequencing, but it is the second issue that is turning out to be troublesome.

Kerala now insists on institutional quarantine for Omicron patients after a patient who tested Omicron positive was found to have flouted home quarantine norms and visited shopping centres and restaurants. The wife and mother of the first Omicron patient in Kerala, who came down from the UK, were also infected.

“In Kolkata, we have made separate wards so that there is no contamination. We are prepared to accommodate any new suspect cases with Omicron in the government hospital. In case of an Omicron surge, we will increase the number of beds in the Omicron wards. We will not mix the other Covid patients with Omicron suspect patients,” said an official of the West Bengal health department.

In September, Karnataka drew up a Rs 1,472 crore plan to spruce up medical infrastructure and human resources in hospitals for dealing with the third wave. The money was meant to increase the number of beds, improve oxygen supply and pay for the additional staff.

But a large part of the expenditure has yet not been made, with experts pointing out that taluk hospitals continue to be seriously ignored in terms of any infrastructural improvements.

“The next one month is crucial to watch how Omicron plays out in India,” noted a Karnataka official.

“It is about time to ensure that routine epidemiological surveillance systems are strengthened,” added Oommen John, a senior public health researcher at the George Institute for Global Health, Delhi. “What does not get picked up through testing will eventually end up in ICUs.”

(With inputs from Akhil Kadidal in Bengaluru, Arjun Raghunath in Thiruvananthapuram, E T B Sivapriyan in Chennai, Gautam Dheer in Chandigarh, Mrityunjay Bose in Mumbai, Mohammed Safi Shamsi in Kolkata, Prasad Nichenametla in Hyderabad, Sanjay Pandey in Lucknow, Satish Jha in Ahmedabad and Zulfikar Majid in Srinagar)

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