Memo To Modi On Omicron: Don't Rush To Ban And Curb Movement For A Threat That Isn't Real — Yet

The tragedy with political democracy is that its leaders often do not believe they have the option of doing the right things that may not be noticed by the public. On the other hand, doing the wrong things may sometimes have lower political costs since it will look like decisive and pre-emptive action.

With the rise of the latest virus mutant, Omicron, the world has got into panic mode, and doors are being shut everywhere, especially for travellers from countries that have already recorded the presence of the Omicron. As of 1 December, there were 24 countries reporting confirmed Omicron cases.

India has dropped plans to reopen regular international air traffic from 15 December, which is a bad idea. And many states, again in panic mode, have started reimposing travel curbs even on fully vaccinated domestic passengers. There is no better way to cripple businesses that were just about recovering from the earlier restrictions than by saying you will make travel a painful affair, or curb it altogether.

Based on reasonable assumptions about the threat posed by Omicron, we can tentatively arrive at some preliminary “facts” (which can be updated later). These facts should guide what the government should do.

First, South Africa told the world about the B.1.1.529 (Omicron) virus in late November, when it found that 66 out of 97 genomes that were sequenced from infected patients were Omicron. Before November, the bulk of the variants detected were Delta, over 90 per cent in the three preceding months, according to the Network for Genomic Surveillance in South Africa (NGS-SA). It is in these months that Omicron went largely undetected, especially since South Africa was not sequencing enough genomes till then. By implication, we must assume that many carriers flying or travelling out of South Africa would have been carrying this undetected or undocumented virus. Conclusion: as far as India is concerned, Omicron is already here, and what we need to do is test more (RT-PCR) and sequence a significant proportion of all available positive cases in specific clusters from where travellers could have entered India.

Second, the early reports are that Omicron’s symptoms are benign, and some of the usual indicators are absent (loss of smell and taste, etc). Details about how infectious it is, and whether it is more lethal than the earlier variants or not, are scarce for now, and so the early panic may be unwarranted. It is time for caution, not clampdown.

Third, the scare comes largely because Omicron seems to have mutated much more than earlier variants, especially in the spike protein. Says a report in Nature: “Researchers spotted B.1.1.529 in genome-sequencing data from Botswana. The variant stood out because it contains more than 30 changes to the spike protein — the SARS-CoV-2 protein that recognises host cells and is the main target of the body’s immune responses. Many of the changes have been found in variants such as Delta and Alpha, and are linked to heightened infectivity and the ability to evade infection-blocking antibodies.”

Mutations in the spike protein may be of excess concern in the west, which has overwhelmingly used mRNA vaccines. Says a report in CNN: “What worries scientists is the number of mutations affecting the spike protein. That's because most of the leading vaccines target the spike protein. Vaccines made by Pfizer/BioNTech, Moderna, Johnson & Johnson, AstraZeneca and other companies all use just small pieces or genetic sequences of the virus and not whole virus, and all of them use bits of the spike protein to elicit immunity. So, a change in the spike protein that made it less recognizable to immune system proteins and cells stimulated by a vaccine would be a problem.”

We don’t know yet, but it will be a few weeks before we know for sure whether Omicron will actually do more damage by bypassing the vaccines that work on spike proteins. The bulk of Indian vaccinations have used the Astra-Zeneca vaccine produced by Serum Institute, but Bharat Biotech’s vaccine is based on targeting the fingerprints of a fully deactivated virus. It could conceivably, be less vulnerable to these spike protein mutations of Omicron. But we don’t know that.

Fourth, India is currently in a good place as far as dealing with any Omicron outbreak is concerned. Consider how far we have come from those bleak days of end-April and early May this year, when we were reporting over 400,000 cases daily. Today, we are averaging around 10,000 new cases daily, and active cases are the lowest ever — at under 100,000 cases as on 1 December. This is even lower than the lowest level during the first wave last year.

As for vaccinations, as of today (2 December), we have vaccinated 792 million people (nearly 85 per cent of the adult population) with at least one dose, and 48 per cent with two doses. We are also well equipped to begin booster doses for the vulnerable shortly. We might have vaccinated all adults with at least one dose by end-December or early-January, which is when we can expect any Omicron outbreak to show up in substantial numbers in India.

And, after the horrifying experience of April and May 2021, we now know how to cope with massive spikes in infections.

Conclusion: we can cope with a 10-20x spike in daily infections from current levels with ease, and the time for caution and restrictions on movements should come after we cross, say, 100,000 cases daily.

The SUTRA consortium, which correctly suggested that the third wave may be muted unless a new and more dangerous variant comes up, will probably wait awhile before updating its projections for Omicron, since details on this mutant are still sketchy.

M Vidyasagar, professor at IIT, Hyderabad and a member of SUTRA, has this to say at this stage, subject to updation when more information is available.

“We in the SUTRA Consortium have done some preliminary analysis, and here is what we believe: (i) Going by case history, the variant has been around in South Africa for at least two months. It is likely to have spread all over the world; as a result, blanket travel bans would be pointless. We also believe that South Africa, which has had a high level of exposure to the virus in the recent past, has not seen an increase in hospitalisation load commensurate with the increase in case load, despite the emergence of the new virus a few months ago. By extrapolation, the same should apply to India as well, as and when the variant is discovered in India. So knee-jerk reactions are totally unwarranted. In contrast, countries where the level of natural infection has been low, which includes most of Europe, will be vulnerable. But to repeat: This is preliminary and subject to revision.”

Quite. We should hasten slowly in curbing an economic revival that has just started taking off in India. My own conclusion: the next wave, assuming it relates to Omicron, should be about detecting, sequencing and dealing with the infections as they arise, not prevention by economically damaging travel and other movement curbs.

Memo to Narendra Modi: We know you will be blamed regardless of whether you act too soon or too slow. You have a choice of being blamed for doing the right things or the wrong things. So, don’t take a chance with another economic downturn by clamping down too hard too soon when the danger is far from clear. That would be worse than just being blamed for an incipient Omicron outbreak that no one can really predict or control at this stage.