Covid-19: 2022 starts with fear and hope

Even as we ring in the new year, its latest variant Omicron is spreading fast in India and many other countries

As 2019 was coming to an end, news about a new virus that surfaced in the Chinese province of Wuhan began circulating among the medical fraternity. Two years later, the pangs of the SARS-CoV-2 overwhelmed the entire globe, triggering a once-in-a-century pandemic, the disastrous consequences of which are being experienced by everyone. In the last two years, the Covid-19 changed the world forever. As the pages of the calendar make a fresh turn, the question everyone has in mind is whether the pandemic continue its unhindered run in 2022 too, ravaging people’s lives on its way.

India was one of the worst victims, experiencing a ferocious second wave, but experts tracking the virus say that 2022 is unlikely to be as savage as last year’s Delta driven wave. The virus, however, is not going anywhere. “My prediction is the present endemicity (seen till December) will be broken by one more wave, far less formidable than Delta wave and then we will have a long period of endemicity with Omicron as the only or the predominant variant in circulation,” T Jacob John, one of India’s senior most virologists and a former professor at the Christian Medical College in Vellore told DH.

The SARS-CoV-2 sprung many surprises. For instance, nobody thought of a variant of concern with 50 mutations when Omicron burst into the scene. The scientists nevertheless hope that even such a cunny pathogen will ultimately follow some basic rules. Two decades ago, the HIV baffled the medical researchers as it attacked the very immune system, which was thought to be invincible. Since then, the science of immunology grew by leaps and bounds eventually leading to antivirals that became the only effective biological solution against the HIV.

“The SARS-CoV-2 uses ACE-2 as a cell receptor and that makes it such a versatile pathogen. The receptor-binding ligand, namely spike protein, has been changing little by little by virus gene mutations and the variants like Alpha, Beta, Gamma, Delta and now Omicron have spread faster and dodged immunity. Yet, such a process will not go on for long – antivirals and vaccines will help, but the virus itself will cause immunity effective enough to stop further waves. I hope Omicron is the end of that line and after an Omicron wave we will get back on track of the endemic Covid that India has enjoyed since July 8, 2021 – nearly six months,” said John.

Also read: Covid: Govt asks states to set up makeshift hospitals, constitute teams to monitor patients in home isolation

Others tend to agree. They say Omicron may not be the end of the tricks that the SARS-CoV-2 has up its sleeves, but recurrence of a severe public health disaster like the Delta wave is unlikely. “Vaccinations and actual infections will eventually make most of us at least somewhat immune-capable even for variants, limiting the occurrence of severe disease to an extent. My best guess is that while there will be infection outbreaks, some more localised than others, the severity of disease in these outbreaks will decline over time in the coming months,” said immunologist Satyajit Rath, a visiting faculty at the Indian Institute of Science, Education and Research in Pune.

However, there is not going to be any abrupt end to the pandemic; it is much more likely to peter out. And before it goes, Omicron, due to its highly transmissible character, will test the agility of the healthcare system and decision-making within the government.

The last word on Omicron’s disease-causing ability is yet to be spoken despite some good news from the UK and South Africa. The variant is as bad as any other Covid-19 variant for the unvaccinated. A bigger worry is a sudden big surge, which may generate a large number of patients (though a tiny percentage) requiring hospital care. Is there a possibility of Indian hospitals getting overwhelmed?

Also read: Explained: The role of T-cells in fighting Omicron

“A third wave is likely in terms of cases but the important thing to keep track of is whether a significant fraction of those cases will be requiring hospitalisation. Whether the health system will be put under the same stress as we saw in May, 2021 is the important question,” said Gautam Menon, a professor of physics and biology at the Institute of Mathematical Sciences, Chennai.

Another key question in the new year is whether the Centre would invest more in healthcare as was done last year. This is where the experts are not very hopeful. Asked if the Centre would allocate more money on healthcare and continue with infrastructure development or forget everything once the pandemic becomes endemic, Rath said, “One hopes for the former, but the experience of the past two years during which a steadily moving pandemic has been treated mostly as a short-term crisis, makes the latter possibility sadly more likely.”

Intrinsic value

“Unfortunately, no political party has understood the intrinsic and instrumental values of investments in health management,” Jacob John said. “Politically health and disease prevention are not vote catching because culturally Indians are tolerant of misfortunes and diseases.”

The Covid-19 exposed India’s poor health systems and absence of a healthy workforce. “Investments into strengthening health delivery systems, diagnostic capacity, public health surveillance and health data systems are critical and calls for more than launch of flagship schemes and flashy mobile apps,” said Oommen John, a senior fellow at the George Institute for Global Health.

As India embarks on a new phase of the Covid-19 vaccination by inoculating the adolescents (15-18 years) and giving a third shot to the high-risk people, another question is how long the vaccination campaign would go on. New medicines like Paxlovir and Molnupiravir from Pfizer and Merck, respectively, would surely be a game changer, but there are big questions on their availability.

Also read: Pandemic is a marathon, not a hundred-metre sprint

Since such medicines are to be taken early, there has to be widespread availability of cheap or free testing to let people discover that their minor symptoms are due to Covid. This is unlikely to be realised. “Further, oral antiviral drugs need to be widely and freely/cheaply available for people who ‘test positive’ in such a scenario. It does not look like this is going to happen any time soon, either,” said Rath, who was formerly associated with the National Institute of Immunology, Delhi.

The experts, however, are unanimous that Indians would quickly forget the most effective protection against Covid-19 such as mask, social distancing, handwashing and not to spit, once the pandemic is over.

“People will soon forget all these. If we can retain such behaviours in all hospital campuses, we will reduce much of the hidden hospital-acquired infections,” said Jacob John.

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