3. Why do Variants occur?
• Mutation is a natural process, normal part of evolution.
• But not all variants are dangerous, and most often we don’t notice them.
• As long as the virus is able to infect, replicate and transmit, it has to continue to
evolve.
• Usually, viruses keep updating itself called Mutation, but after several
mutation(30) this variant became a concern because of its transmission rate and
severity of infectivity.
• Only when they are more infectious, can reinfect, can cause severe
disease/death etc, they gain prominence.
• To avoid generation of variants: is to reduce the number of infections.
4. • Omicron variant has shown a very large number of mutations, especially
more than 30 on the viral spike protein, which is the key target of the
immune response & have been associated with increased infectivity,
increased reinfection and immune evasion, resulted in sudden rise in
positive cases in South Africa, and WHO declared Omicron as a Variant of
Concern(VoC).
• “S gene drop out”: most accepted & widely used diagnostic method is RT-
PCR, which detect specific genes in the virus. Spike(S), Envelop(E) &
Nucleocapsid(N) to confirm the presence of virus.
• In case of Omicron S gene is heavily mutated, some of the primers may lead
to results indicating absence of the S gene(S gene drop out).
• This particular S gene drop out along with the detection of other viral genes
used as diagnostic feature of Omicron. Technically, for final confirmation of
Omicron variant, Genomic sequencing is required.
5. Brief history of Emergence of B.1.1.529
variant(Omicron)
• Specimen collected on 11 Nov 2021 at Botswana and
on 14 Nov 2021 in South Africa.
• On 24 Nov 2021: South Africa reported to WHO about new variant of SARS-
CoV-2 i.e. B.1.1.529, and there after number of cases of this variant
continues increasing to almost all provinces in South Africa.
• 26 Nov 2021: WHO named the B.1.1.529, Omicron & classified it as VOC.
• 30 Nov 2021: widely recognised & accepted & designated Omicron as a VOC
by most of the country.
6. Naming of Virus
• Viruses are named based on their genetic structure to facilitate the development
of diagnostic tests, vaccines, and medicines.
• Virologists and other wider scientific community do this work, so virus are named
by the ICTV (International Committee on Taxonomy of Viruses).
• Diseases are officially named by WHO in the ICD(International Classification of
Diseases).
• SARS-CoV-2: 11/02/2020 after SARS outbreak 2003.
• COVID-19: 11/02/2020
7. WHO also have “WHO Virus Evolution Working group” (called Technical
Advisory Group on Virus Evolution)
SARS-CoV-2 variant B.1.1.529, is named Omicron by TAG-VE(Technical
Advisory Group on Virus Evolution) of WHO, the virus that cause
COVID-19.
8. Reuter’s data of COVID-19 infection shows (2-1-22)
• Infections rising in 101 countries.
• Country reporting most new infection each day:
US 3,26,455
UK 1,49,513
France 1,21,566
Spain 82,391
Italy 79,716
India 27,553
• Data: Russia & Poland : reporting most deaths each day.
9. Indian Scenerio
• Till date 34.8 million infections and 480290
deaths so far.
• First Omicron case in India: on 2 Dec 2021, 2
Patients (66 yr. old male and 46 yr. old male)
from Karnataka, confirmed after genomic
sequencing.
• 7 Jan 2022:
Total active cases: 35,226,386(3.5 Cr)
Covid-19 new cases: 1,17,100
Total Recovered: 34,371,845 (3.4 Cr)
Total Death: 4,83,178
Total Omicron cases 1892; recovered 766.
Jharkhand: 365,222; Reco: 345814; Death: 5153
• Country is preparing to deal with the another
massive outbreak of this new heavily mutated
variant.
10. Why “OMICRON” has become VOC/VOI
• Most changes have little or no impact on the virus properties.
• However, some changes may affect the virus’s properties.
• It has also been observed and demonstrated that this variant has a significant degree of global
public health concern due to its increased transmissibility, increase in virulence, change in disease
presentation, immune escape.
• Omicron has been identified as causing significant community transmission & multiple COVID-19
cluster in multiple countries, which have increased heavily in number of cases over time, and
epidemiological impacts to suggest it as an emerging risk to global public health.
• Simultaneously decrease in public and social measures effectiveness, available diagnostics,
vaccines, therapeutics.
14. WHO plan of Action
Presently, WHO is coordinating with a large number of researchers around the
world to better understand Omicron.
Current study of concern:
1. Assessments of transmissibility.
2. Severity of infection.
3. Performance of vaccine.
4. Performance of diagnostic tests.
5. Effectiveness of treatments.
15. Further area of Study
• Effectiveness of prior SARS-CoV-2 infection: Preliminary evidence suggests there may be
increased risk of reinfection with Omicron as compared to other variants.
• Effectiveness of vaccine: with the available date, WHO is working with technical partners
to understand the potential impact of this variant on the existing vaccine, and more likely
current vaccines remain effective against it.
• Effectiveness of current tests: widely used PCR tests continue to detect infection like other
variants.
• Effectiveness of current treatments: Corticosteroids, Remdesivir & IL-6 receptor blockers is
still effective for severe COVID-19.
16. WHO recommendation to take actions for
“Country”
• Enhance genomic surveillance and sequencing of cases to better
understand circulating SARSCoV-2 Variants.
• Field investigation and Lab assessments to better understand disease
characteristics, transmission, vaccine effectiveness, therapeutics,
diagnostics, public & social health measures.
• Reporting of initial cases or clusters to WHO.
17. • Sharing & connect genomic sequences data on CDC, WHO, Public health
laboratories, commercial diagnostic laboratories publicly accessible
databases maintained by like-
• 1. GISAID(Global Initiative on Sharing Avian Influenza Data) and
• 2. NCBI(National Center for Biotechnology Information).
• Report says, if a variant is circulating at 0.1% frequency, there is a >99%
chances that it will be detected in genomic surveillance.
18. WHO recommended action for “People”
• To keep physical distance of at least 1 meter from other(2meter, 6feet, 2arm
distance), idea is to keep reasonable distance between two people.
• Wear a well fitting mask
• Open windows to improve ventilation, and Avoid poorly ventilated or crowded-
spaces.
• Keep hands clean.
• Cough or sneeze into a bent elbow or tissue.
• Get vaccinated when turn.
19. Significantly less severe disease (South Africa JAMA Dec 30-12-21)
• Some infectious ds. experts & clinical microbiologists says Omicron cause
“Significantly less” severe ds. as compared to DELTA variant.
• Study says that comparatively there were younger pts. in Omicron group and
outcome could be better due to “prior infection & induced immunity.
20. Omicron evades immunity better than Delta variant
(Danish study)
• Danish study shows that Omicron is better at circumventing vaccinated
peoples immunity than Delta variant, helping explain why Omicron is
spreading more rapidly.
• There is 2 Question, since the discovery of heavily mutated Omicron variant in
Nov., than the previously dominated Delta variant:
1. Why appear more contagious?
2. whether it comes less severe ds.?
• Study suggests that variant is more contagious due to reasons—
1. Time it lingers in the air
2. Its ability to latch onto cells.
3. Its evasion of the body’s immune system.
21. Symptoms
• 1. Most common symptoms: fever, cough, tiredness, scratchy throat,
fatigue, loss of taste or smell.
• 2. Less common symptoms: sore throat, headache, bodyache,
diarrhoea, rashes on skin, redness of eye.
• 3. Serious symptoms: SOB, Loss of speech or mobility, confusion,
chest pain/discomfort.
23. 1. Vaccines & Booster:
Tools to fight Omicron
• Best public health measure to protect from COVID-19, slow transmission, reduce
the likelihood of new variants emerging.
• Vaccines are highly effective at preventing severe illness, hospitalization and death.
Age: anyone above 5 year can take vaccine.
above 18 years should get a booster dose at least 2 month of J&J vaccine or 6
months after COVID-19 vaccination of Pfizer, BioNTech, or Moderna.
24. Vaccine development
• 548 Vaccines under trials.
• 31 Approved vaccine by at least one country.
• 196 Countries with approved vaccines.
• 62 Countries with vaccine trial.
• 10 Vaccine approved by WHO.
25. 10 WHO Approved Vaccines
Name DEVELOPED by Component Approved in
Country
Conducti
ng trials
1. COVOVAX(Novavax) SII(Serum Institute of India) Protein subunit 3 1
2. mRNA-1273 MODERNA RNA 83 9
3. BNT162b2 Pfizer/BioNTech RNA 130 23
4. Ad26.COV2.S J&J Non Replicating Viral
Vector
99 18
5. NVX-CoV2373 Novavax Protein Subunit 30 7
6. AZD1222 Oxford/AstraZeneca Non Replicating Viral
Vector
134 23
7. Covishield
(Oxford/Astra Zeneca)
SII Non Replicating Viral
Vector
47 1
8. Covaxin Bharat Biotech Inactivated 12 1
9. BBIBP-CorV(Vero Cells) Sinopharm(Beijing) Inactivated 80 10
10. Coronavac Sinovac Inactivated 48 8
26. 4 approved vaccine in
India
• 1. Covishield (90% in circulation)
• 2. Covaxin
• 3. Sputnik V
• 4. Zydus Cadila (ZyCov-D)
27. Newly Approved Vaccines in ‘India’
Government approved 2 new vaccine (both are Protein-based vaccines)
India’s bet for booster dose: phase 3 trial have been done for both vaccines,
likely to be approved.
1. Corbevax (Biological E’s, Hyderabad-based)
2. Covovax (SII)
Both are Protein-based vaccine can be produced in very large amounts &
are perfect for booster doses.
28. Booster dose & Children Vaccination (Health Ministry Guidelines)
• Vaccine for Children (15-18 yr., Birth year 2007 & before): register on Co-WIN from
1 Jan 2022, Bharat Biotech’s Covaxin would be only option for beneficiaries.
Booster dose : 1. Frontline worker,
2. People >60 yr. with comorbidities,
From 10 Jan 2022, Govt. will send SMS to eligible elderly population(>60 yr.,
comorbidity, 2 dose received, doctor advice) to remind for taking dose through their
existing Co-WIN account. Details of booster dose will be reflected in the vaccination
certificates.
Prioritization & Sequencing of dose: would be based on completion of 9 month/39
weeks from the date of second dose.
29. Concerns regarding Booster dose ( Indian Virologist & SARS CoV-2 Genomics Consortium)
1. Vaccine Manufacturer concern for booster (scientific & ethical)
2. Incomplete vaccination of major population:
• Africa: only 8% fully vaccinated of its total population.
• Europe: 59% fully vaccinated.
• North America: 56% fully vaccinated.
• India: 37% fully vaccinated of its population.
• Concern is allowing booster, means that you are taking those doses away from people
who only have one or none. Priority should be to get 2nd dose who already have one
dose & Get 2 doses for people who have no dose. Worldwide data shows that you get
protection from ds. with 2 dose of the COVID-19 vaccine doses.
• But it doesn’t mean, booster should be ignored.
30. 2. MASKS: Tools to fight Omicron
Offer protection against all variants. Adviced to wear mask in public indoor
or outdoor settings of high community transmission regardless of vaccination
status.
31.
32.
33. 3. TESTING: Tools to fight Omicron
Testing tells you if you are currently infected with COVID-19.
• 2 types of tests are used for current infection: NAATs(RT-PCR) & Ag
tests. Both tests can only tell you if you have a current infection.
• Over the counter Self-test can be used at home or anywhere are easy
and produce rapid results. If positive, stay at home or isolate for 10
days, wear a mask or call health care provider.
34. New Invention: OmiSure
• Tata Medical Diagnostic, India, developed by Dr V Ravi, HOD R&D, Tata MD.
can detect Omicron variant with 100% sensitivity (validated by ICMR).
• Test run time 85 min, total TAT 130 min.
35. • Principal: Based on two S-gene viral targets to reliably identify Omicron
1. S-gene drop out/S-gene target failure (SGTF)
2. S-gene mutation amplification (SGMA)
• S-gene target failure is indicative of Omicron, but other gene (SGMA)
detection indicates absolute sure of Omicron presence. That’s how it is
OmiSure. So it is 2 check process for Omicron detection.
• Plan is to deliver 2 lakh kits per day.
37. PREVENTION: How to protect yourself and other
• 1. Get Vaccinated: should get ASAP.
• 2. Wear a mask: everyone should wear especially in high cases zone, crowded
area or close area, during activities with close contacts, health care area,
during public transportation or travelling either for short or long distance like
planes, trains, buses or other modes, etc.
• 3. Physical distance: 2meter or 6 feet or 2 arm distance (idea is to avoid close
contacts).
• 4. Avoid crowds & poorly ventilated spaces: like station, bus stands, markets,
bars, restaurants, fitness center, movie theater or other public places.
• 5. Avoid indoor spaces that do not offer fresh air from outdoors (open the
windows and doors), all these puts on high risk for COVID-19.
38.
39. • 6. Wash your hands often: with soap and water for at least 20 seconds, especially
after have been in a public places or after blowing nose, coughing or sneezing.
Should consider hand wash-
Before eating or preparing food
Before touching face
After using washroom
After leaving public places
After blowing nose, coughing, or sneezing
After handling your mask
After caring sick
40. • 7. Coughing & Sneezing practices: If wearing mask– can cough or sneeze in your
mask then put on a new clean mask ASAP and wash your hands.
If not wearing mask: always cover your mouth and nose with tissue or use inside
of your elbow and do not spit. Throw the used tissue in the trash and wash your
hands.
• 8. Hand Sanitizer: if soap and water are not readily available, use a hand
sanitizer containing at least 60% alcohol.
• 9. Avoid touching your eyes, nose, and mouth with unwashed hands as
much as possible.
• 10. Test to prevent spread to others: testing can give information about risk
of spreading COVID-19(if positive can isolate himself and inform close
contacts or health care providers).
41. • 11. Clean and Disinfect: Clean high touch surfaces regularly or as needed
and after have visitors in your home, includes tables, doorknobs, light
switches, handles, desks, phones, keyboards, toilets, and sinks. If surfaces
are dirty, clean them using detergents or soap and water prior to
disinfection.
• 12. Monitor your health daily: watch for symptoms like fever, cough,
malaise, bodyache, headache, SOB or others.
42. SELF CARE : for Home Isolation Pts.
• Isolate yourself in well ventilated room.
• Use triple layered medical mask. And discard after 8 hr or after become wet or soiled,
discard after disinfecting it with 1% Sod. Hypochlorite.
• Take rest & drink lots of fluids to maintain adequate hydration.
• Follow coughing etiquettes & do regular exercise.
• Hand washing or use alcohol-based hand sanitizer.
• Ensure surface cleaning & most touched area with 1% Sod. Hypochlorite.
• Supportive treatment: PCM, Anti-histamine, Inhalational budesonide 600/800 mcg if
distressing cough, Avoid steroid at home.
• Monitor Temperature, Oxygen saturation & inform doctor SOS.
43. Instruction for Care givers
• 1. Mask: triple layer medical mask/N95 mask.
• 2. Hand Hygiene: by soap-water or by alcohol-based hand sanitiser.
• 3. Avoid exposure to Pt.: avoid direct contact with body fluids of patients,
particularly oral or respiratory secretions.
• 4. Use disposable Gloves while handling pts.
44. TREATMENT
• Corticosteroids: Dexamethasone used for hospitalised pts. with severe COVID-19
ds., Supplemental Oxygen requirement, Mechanical ventilation. If Dexamethasone
not available, Prednisolone, Methylprednisolone, Hydrocortisone can be used.
• Remdesivir: work better in early phase of COVID-19. Dose- 200mg IV on day 1,
followed by 100 mg IV on day 2 & 3. Can be given in pts. of >12 yrs. of age.
• Convalescent plasma with high Ab level : It is blood donated by people who have
recovered from COVID-19. It can be given to hospitalised pts. with weekend or
impaired immunity.
45. Warning signs/ Admission criteria
• Severe cough or SOB
• Persistent/High grade pyrexia >7
days
• Chest tightness/Palpitation
• Low SpO2 (<94%)
• Resp. rate >24/min
• Low BP (systolic <100mmHg)
High risk group(need monitoring)
• Age >60 yr.
• Obesity
• DM
• HTN/IHD
• COPD/Chr. Lung ds.
• CKD
• CLD
• Cancer
46. Anti-SARS-CoV-2 monoclonal Ab (mAbs) or Monoclonal Ab Cocktail therapy:
• Study shows positive results, recovering within
48 hrs.
• Efficacy: study shows 85% reduction in
hospitalisation or death.
• Line of treatment is same for both types of
COVID-19 pts. (Delta & Omicron).
• Recently also approved mAbs for children above
12 yrs. of age.
• Administration: 500mg single IV infusion, upto 4
shots.
• Single dose costing up to 56000 Rs.
• Widely used is ‘SOTROVIMAB’by
GlaxoSmithKline: combination of Bamlanivimab
+ Etesevimab.
47. New Drugs
• 1. MOLNUPIRAVIR 2. PAXLOVID
• It has been found safe & effective at reducing the risk of hospitalisation and death in people with
mild to moderate COVID-19 infection who are at an increased risk of developing severe ds.
• 1. Molnupiravir (Merck & Co.): Oral Antiviral, US FDA, DCGI (Drug Controller General of India)
approved for restricted emergency use in COVID-19 ds., Acts in early stage of ds. (within 4-5
days), reduce progression to severe ds. which might reduce hospitalisation. Dose 800mg orally BD
for 5 days. Researchers point out it may create new variant of SARSCoV-2 that escape immunity
& prolong pandemic, not included in health guidelines yet.
MOLFLU(Dr Reddy’s Lab) will be marketed in India to treat COVID-19.. Cost Rs 35/cap. 10
cap/strip, total 40 caps for 5 days would cost Rs 1400/pt.
48. • 2. Paxlovid (Pfizer): Oral antiviral, combination of active ingredient
Nirmatrelvir(PF-07321332)300mg & Ritonavir 100mg, acts by inhibiting protease
enzyme(required for viral replication) orally BD for 5 days, most effective in early
phase of ds., >12 yr., mild to moderate ds., risk factors- obesity, >60 yr. of age,
DM, Heart ds.
• 3. Ritonavir: antiviral, used in HIV as protease inhibitor since long, inhibit viral
replication.
49. Supportive care for mild COVID-19 illness
Aimed to relieve symptoms-
Pain killer/Antipyretics (Ibuprofen, Acetaminophen)
Cough syrup or similar medication
Adequate Rest
Fluid intake to maintain adequate hydration.
Antibiotics if needed.
50. How concern should be about Omicron?
• WHO declared variant as a VoC (Variant of Concern) after assessment.
1. Increased transmissibility or detrimental change in epidemiology,
2. Increased virulence,
3. Change in clinical disease presentation,
4. Decrease effectiveness in available diagnostic, therapeutics and
vaccines.(Source:WHO)
51. Will the existing vaccine work against Omicron
• No evidence that it will not work.
• Mutation reported on Spike gene may decrease the efficacy of existing vaccines.
• However, vaccine protection is also by Abs as well as Cellular immunity, which is
expected to be better preserved. So it will still offer protection against severe
disease.
• Vaccination is crucial, those eligible should get vaccinated.
(Source: WHO & MoHFW,GoI)
52. Will there be a third wave?
Omicron cases are increasing & being reported from many countries, and
given its characteristics, it is highly transmissible.
• 1. Further, given the fast pace of vaccination in India,
• 2. High exposure to Delta variant as evidenced by high seropositivity,
severity of the disease is anticipated to be low.
However, scale & magnitude of rise in cases & most importantly the severity
of disease is still not very much clear and scientific evidence is still evolving.
(Source: WHO & MoHFW, GoI)
53. Is Omicron a blessing for mankind?
• Due to its high transmissibility & less severity (less hospitalisation, very less
O2 requirement, less ICU/CCU admission, less critical cases requiring
intubation, ventilation or other support) everyone will be exposed & will get
it. It will create mass herd immunity & consequently will replace DELTA
variant.
• Researchers says, mankind will get natural immunity that will provide better
protection than vaccine & last longer.
• It can be a blessings for many underprivileged country like India, where
reasonable % of people have not fully vaccinated.
