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Cover page of the Journal of Health Sciences

 Table of Contents  
Year : 2022  |  Volume : 15  |  Issue : 1  |  Page : 1-3

Omicron: The tsunami??

Department of Respiratory Medicine, KAHER, Jawaharlal Nehru Medical College, Belagavi, Karnataka, India

Date of Submission08-Jan-2022
Date of Decision12-Jan-2022
Date of Acceptance16-Jan-2022
Date of Web Publication24-Jan-2022

Correspondence Address:
Dr. Bhagyashri B Patil
Department of Respiratory Medicine, KAHER, Jawaharlal Nehru Medical College, Belagavi, Karnataka
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/kleuhsj.kleuhsj_76_22

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How to cite this article:
Patil BB. Omicron: The tsunami??. Indian J Health Sci Biomed Res 2022;15:1-3

How to cite this URL:
Patil BB. Omicron: The tsunami??. Indian J Health Sci Biomed Res [serial online] 2022 [cited 2022 Jul 2];15:1-3. Available from: https://www.ijournalhs.org/text.asp?2022/15/1/1/336311

The world is going through the biggest pandemic of the century of COVID-19 in almost 2 years. It has hit the world by its two biggest waves of alfa, beta, and delta. In both the waves, it has shown different presentations. The first wave was Novel to everyone, as the nature of the other viruses eventually SARS-COV2 also started mutating and the names were given as alfa, beta, and delta. In both the waves though the mortality was nearly equal, the delta wave was more severe due to its presentation which was more marked by hypoxia. Both the waves have left a big impact on the history of humankind. In the amid of all of this, the world has just begun to return to its normalancy and was cheerful to welcome 2022. Again, the month of November knocked its doors with the entry of the new variety of concern (VOC) of COVID-19. On November 24, 2021, South Africa reported the identification of the new variant of SARS-CoV2 variant B.1.1.529 in the samples from Botswana. On November 26, 2021, WHO named it as B.1.1.529 Omicron and classified it as VOC. Since then, the cases started increasing Worldwide. U.S. reported its first case on December 1, 2021. By December 16, 2021, Omicron had been detected in 87 countries, with many countries reporting community transmission. As of today, the world is experiencing Omicron to be the dominant variant which has replaced most parts with the delta variant with the numbers crossing almost over one lakh cases. India has Omicron cases over 3000. On January 6, 2022, U.S. witnessed a surge of one billion cases of COVID-19 in a single day. Like that, many countries are experiencing almost a third wave and some are reaching the peak and according to the sources, mostly expecting this to subside within 6 weeks.[1],[2],[3]

Why Omicron?

Omicron “O” is the 15 letter of the Greek alphabet. As all the other viruses SARA- COV2 has undergone several mutations and all of them are named as alpha, beta, gamma, delta, etc., These all viruses are just observed. Out of all the varieties, five of them are VOC, those are delta and Omicron.

Omicron is highly mutated, known to be highly contagious according to the available data, some of which are concerning due to predicted immune evasion and increased infectivity.

The spike protein of the Omicron variant is characterized by at least 30 amino acid substitutions, three small deletions, and one small insertion. Notably, 15 of the 30 amino acid substitutions are in the receptor-binding domain. There are also a number of changes and deletions in other genomic regions.

The Omicron VOC has a high number of mutations, while the Omicron variant shares a few common mutations with the C.1.2 (a highly mutated lineage previously identified in South Africa), beta and delta variants, it also has 22 additional substitutions (including insertions and deletions) not seen in any other VOC or variant of interest to date. Among them, the Δ69–70 amino acid deletion in the spike gene, previously observed in alpha, is known to cause S-gene target failure on the Taq Path COVID-19 polymerase chain reaction (PCR) test which is suspicious of Omicron.[4],[5]

From the available data, it is predicted that the number of cases will be exponentially high of Omicron cases because of its high transmissibility, but the cause for rapid spread is still unknown. The reason predicted to be from few of the studies, it gets attached to human cells very fast, evades immunity. It has got less incubation period of 3 days. The virus has shown to replicate in the upper respiratory tract, causing less lung damage. It is expected to create a herd immunity according to epidemiologists, bringing some hope to end this pandemic. Although Omicron is highly infectious, it is less in severity among the admitted patients compared to the delta by the earlier studies by Dr. Nicole Wolter in South Africa in early December.

The common symptoms are more of sore throat, throat pain, headache, myalgia, fatigue, and fever.

Typical “Flu-like” symptoms are seen. Loss of taste and smell is not observed.

These are all milder forms and do not require hospitalization. Few cases require hospitalization if the symptoms worsen. The reinfection is observed though patients had infection in the past. The diagnosis of Omicron requires genome sequencing, reverse transcription–PCR; rapid antigen testing remains the mainstay of the toolkit. The new kit “Omi-sure” has been approved for the confirmation of the Omicron variant. There should be more emphasis on home testing by rapid antigen testing and self-home isolation to combat the spread.

Most of the patients need symptomatic treatment and observation.

Home isolation for 7 days has been advised for mild/asymptomatic patients, moderate-to-severe group needs hospitalization

From one of the studies done by Dr. Shiekh et al. in the preprint issue of Edinburgh journal explorer, it has shown that the booster vaccination is shown some protection compared to two doses of vaccination. However definitely, vaccination will prevent hospitalization, the need for oxygen, and deaths to some extent. From many of the earlier studies, the Omicron has shown the invasion of the immune system and surpassing the vaccine immunity and natural immunity due to the past COVID infection. Furthermore, It has been observed that the cocktail regimen of monoclonal antibodies doesn't show any effect on Omicron which was earlier seen on delta variants. However, few of the monoclonal antibodies such as sotrovimab has shown efficacy against Omicron. Some of the drugs are recommended for the Omicron are molnupiravir, a pill by Pfizer Paxlovid, sotrovimab and remdesivir. Promising antiviral in the delta wave was remdesivir same has been shown some promising results in the Omicron. From one of the studies from NEJM, it has shown that early initiation in some selected cases with remdesivir on OPD patients has prevented the progression to the severity.[6],[7]

From one of the studies from South Africa, the cases were compared with the delta wave and the results were quite astonishing, it is very clear that Omicron causes severity, hospital admissions, and deaths almost 2.7% of the patient coming to the emergency. Furthermore, it is proven beyond doubt that vaccination does not prevent the disease but definitely reduces the severity and complication due to the virus. The infection was more seen in young adults. The admission rate was 41.3% from the study which is quite concerning.[1],[2],[3],[6],[7]

The delta wave has shown the post-COVID effects of lung fibrosis, cardiac involvement, long COVID symptoms, and psychological impact.

Economically, socially, also the delta wave has left its marks behind. After the wave resides what matters more is its physical, mental, and social impact on the society. Hence, from the data available, the word of caution is it may not be the end of the pandemic as the virus will go on mutating till it will become completely weak or the world will attain the herd immunity. According to the Darvin theory, the virus will mutate, but it will not kill the host as it has to survive or else it has to find the new host, so it is expected that Omicron will not be the last mutation. Eventually, it will become endemic like other viruses such as influenza and other viruses. The vaccination will definitely protect us. The general measures include use of masks, social distancing, and COVID-appropriate measures. The Omicron wave in South Africa is fading now, it has replaced the deadly delta, and there is a sense of achievement of the herd immunity. However, still, the numbers being huge, the health-care system is going to get an overwhelming number of patients.[2],[3],[6],[7],[8]

As the number of cases is very huge, the nation should be ready; health-care system should be strengthened to take care of hospitalized patients.

  References Top

Wolter N, Jassat W, Walaza S, Welch R, Moultrie H, Groome M, et al. Early assessment of the clinical severity of the SARS CoV 2 Omicron variant in South Africa. medRxiv 2021;12.21.21268116. Available from: https://www.medrxiv.org/content/10.1101/2021.12.21.21268116v1. [Last accessed on 2022 Jan 16].   Back to cited text no. 1
Sheikh A, Kerr S, Woolhouse M, McMenamin J, Robertson C. Severity of Omicron variant of concern and vaccine effectiveness against symptomatic disease: national cohort with nested test negative design study in Scotland. 2021 Dec 22. Available from: https://www.research.ed.ac.uk/en/publications/severity-of-omicron-variant-of-concern-and-vaccine-effectiveness-. [Last accessed on 2022 Jan 16].  Back to cited text no. 2
Maslo C, Friedland R, Toubkin M, Laubscher A, Akaloo T, Kama B. Characteristics and Outcomes of Hospitalized Patients in South Africa During the COVID-19 Omicron Wave Compared With Previous Waves. JAMA. Published online December 30, 2021. Available from: https://jamanetwork.com/journals/jama/fullarticle/2787776. [Last accessed on 2022 Jan 16].  Back to cited text no. 3
Centre for Disease Control and Prevention. Omicron Variant: What You Need to Know. Available from: https://www.cdc.gov/coronavirus/2019-ncov/variants/omicron-variant.html. [Last accessed on 2022 Jan 16].  Back to cited text no. 4
Meng B, Ferreira IA, Abdullahi A, Akatsuki S, Kimura I, Yamasoba D, et al. SARS CoV 2 Omicron spike mediated immune escape, infectivity and cell cell fusion. bioRxiv, 2021.2012.2017.473248, Available from: https://www.biorxiv.org/content/10.1101/2021.12.17.473248v2. [Last accessed on 2022 Jan 16].  Back to cited text no. 5
Gupta A, Gonzalez-Rojas Y. Early treatment for COVID-19 with SARS-CoV-2 Neutralizing antibody sotrovimab. N Engl J Med 2021;385:1941-50.  Back to cited text no. 6
Almeida NE, Kalil AC. Molnupiravir: Is it time to move in or move out? NEJM Evidence 2021:1-2. Available from: https://doi.org/10.1056/EVIDe2100048. [Last accessed on 2022 Jan 16].  Back to cited text no. 7
Gottlieb RL, Vaca CE, Paredes R, Mera J, Webb BJ, Perez G, et al. Early remdesivir to prevent progression to severe COVID 19 in outpatients. N Engl J Med 2021. Available from: https://pubmed.ncbi.nlm.nih.gov/34937145/. [Last accessed on 2022 Jan 16].  Back to cited text no. 8


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