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'We haven't heard the last about Omicron'

By VAIHAYASI PANDE DANIEL
Last updated on: December 31, 2021 13:51 IST
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'Your body will be able to deal with Omicron at any time, but it depends (on when) if you are vaccinated.'

IMAGE: A healthcare worker collects a nasal sample from Special Task Force personnel for the RT-PCR test in Patna, December 30, 2021. Photograph: ANI Photo
 

Dr Gagandeep Kang, one of our country's most experienced vaccine scientists and a top COVID-19 expert, in her third interview to Vaihayasi Pande Daniel/Rediff.com, assesses the Indian COVID-19 landscape post the advent of Omicron.

She also very carefully and methodically explains how boosters will work in India in the context of the vaccines we Indians have received.

Dr Kang, the first Indian woman to be nominated a fellow to the eminent Royal Society (of London), is the professor of microbiology, Wellcome Trust Research Laboratory, a division of gastrointestinal sciences at the Christian Medical College, Vellore, Tamil Nadu, and pre-COVID-19 has worked in public health for several decades, especially in the area of rotavirus and typhoid.

IMAGE: A crowd of passengers at the Hatia railway station in Ranchi, December 30, 2021, amid concern over rising Omicron cases. Photograph: PTI Photo

Boosters for COVID-19 vaccines will be available in India from January for those who have taken two shots of Covishield and are over 60 and in the high-risk category.
But what happens to the people who have taken Covaxin and need a booster from January too?

That's not the case.

Boosters, according to the announcement from the government, is for everybody that has received the first vaccine (any kind for COVID-19), more than nine months ago, and fall in a priority category.

People over 60, with comorbidities, and healthcare workers -- whether you received the Covishield or the Covaxin vaccine -- you are eligible for a booster.

What's not clear is: What should you boost with.

Do you boost with the same vaccine? Or do you boost with a different vaccine?

And now that we've got another two vaccines that are under EUA (emergency use authorisation) in India (Hyderabad-based Biological E's Corbevax and Covovax), we can boost with those also.

That's the data that's not available.

(Between) Covishield and Covaxin, in terms of looking at boosters, Covishield has some advantage because Covishield has been evaluated in the COV-Boost study in the UK*.

There at least we know that if you give one more dose of Covishield after (getting two doses of) Covishield, you will see a boosting in antibody responses.

We also know that receiving a shot of Covovax** following (two doses of) Covishield will give you an even greater increase in antibodies.

IMAGE: A queue to receive the Covid vaccine at the Civil Hospital in Jalandhar, December 30, 2021. Photograph: PTI Photo

Sorry, I didn't understand what you mean by Covovax following Covishield?

There is a study called COV-Boost, that was done in the UK, that looked at if you have received two doses of many different kinds of vaccines -- mostly mRNA, and the viral-vectored vaccines -- and you boost with the same or a different vaccine, how much of an increase in the antibody response (against COVID-19) do you see.

That study was published in The Lancet earlier this month. Because the UK has the AstraZeneca vaccine, which is the same as Covishield, there are data for Covishield. It shows that if you give one additional dose of Covishield following (two doses of the) Covishield vaccine, you see an increase in the antibody response.

But you see a greater increase in the antibody response if you use the Covovax equivalent vaccine (after two doses of Covishield).

But if you have received two doses of Covaxin it's not clear yet whether you can get a booster?

Yes. There is no data or anything for a booster following two doses of Covaxin.

A tweet by Los Angeles-based Dr Afshine Emrani said Omicron, being so mild, is like a vaccine and could even be the ideal variant for a vaccine and wondered why people were panicking.
What are your thoughts on that?

(Laughs) Omicron would be a great booster if you could predictably say that you will not develop severe infection.

IMAGE: A healthcare worker inoculates a beneficiary with a dose of the COVID-19 vaccine in New Delhi, December 30, 2021. Photograph: ANI Photo

Which we cannot?

The distribution of severity (of illness for COVID-19) is always a curve.

Only a small proportion of people might develop severe disease. But it's not like nobody will develop severe disease, particularly for people with comorbidities.

So, should we make a new vaccine that is based on Omicron? Yes, certainly, we could consider that.

But just letting Omicron run wild as a natural vaccine, as he seems to imply, I think that is a very unsafe thing to do.

In Mumbai, cases are rising rather quickly. From your point of view, is that alarming? Or that was bound to happen? And we have to mask, hunker down and not party.

This was expected.

I mean, this is what everybody has been saying.

You need to continue to be careful until the risk for you, your age group and your conditions falls to a level where you're willing to take that risk.

The only forever safe way is not to see anybody.

But in general, if you're younger, and you have been vaccinated, and you take precautions, wear a mask and stay in ventilated spaces, then you're preventing the bulk of infections.

If we continue to try to keep ourselves as safe as possible, and let's say we get Omicron six months down the line, then our body will be able to deal with it much better. Is that correct?

No, that's not the case.

Your body will be able to deal with Omicron at any time, but it depends (on when) if you are vaccinated. The best time to have exposure is when your protection is highest, which is shortly after vaccination.

But can't be shortly after vaccination for the whole of your life. Right? So...

There is that logic that has been stated over and over again about the COVID-19 virus: That the virus wants to stay alive as well, and therefore, at some point the virulence of the newer variants are going to decrease because the virus wants to live too etc.
But Omicron is not that stage yet, right?

So, we don't know -- RNA viruses continue to evolve.

For example, I work with rotavirus (a highly contagious virus that causes diarrhea and can be lethal in young children), which is a double-stranded RNA virus.

We keep seeing mutations, new viruses (of rotavirus) circulating all the time. And for adults, it doesn't really matter. Even if you have constant exposure, you've had so many exposures, that you've built up immunity (to rotavirus), and you never develop disease.

It's not only about the virus (be it rotavirus or the COVID-19 virus). It's also about the people that get infected with the virus. Ie what has your experience with the virus been?

If you've never seen the virus before, then you're not in a good place.

If you have seen the virus many times, then you're in a very good place.

IMAGE: A view of the intensive care unit ward at the Government Omandurar hospital in Chennai for COVID-19 patients, December 30, 2021. Photograph: ANI Photo

What in our country with respect to COVID-19 -- either Omicron, or Delta -- needs to be rectified?

I think we need better protocols for managing (COVID-19 ill) people.

This thing of admitting people, who are healthy, to hospitals, and all kinds of other facilities, just because they've tested positive, even if they have no symptoms, just doesn't make sense.

It becomes very expensive. And you're on an hospitalisation escalator which you cannot control?

Yes.

It's very disruptive.

I really like that the Delhi government has (instituted) this predicted kind of pathway for amber, orange, red categories -- this is what will happen if we reach this stage etc.

Now, the question in my mind is, should we be revising those categorisations, which were developed in a pre-vaccine period, to reflect more clearly what the drivers are post-vaccination.

For example, a test positivity rate in a completely naive (unexposed) population -- where a lot of people will wind up in hospital, if they get infected -- is not the same as the same test positivity rate in a vaccinated population, where there will be a huge reduction in severe disease and mortality.

IMAGE: Dr Gagandeep Kang

Based on what you have said so far, the present Omicron situation in our country is not that worrying, all in all, because it's still a mild variant, but we must be very careful.

Yes.

It's just been a little over a month since we heard about Omicron.

The amount of data that we have managed to get for Omicron was much faster than anything that we got for Delta.

But we have to remember that the Delta data is still evolving in many places too -- that's seven-nine months after Delta became widespread.

We should definitely not think that we have the last word on Omicron, but we are reasonably informed. And the reasonable amount of information available has given us much more reassurance than we had a month ago.

A month ago, everything was unpredictable. Right?

Here was a virus with a huge amount of mutations (in its structure). And it looked like it (the Omicron situation) was going to be incredibly worrying.

Now we are in a situation where we have seen countries experience this virus, and it hasn't been that bad.

Will that hold all over the world? I think a lot is going to depend on age structure of the population, prior exposure and vaccination rates.


*COV-Boost is a vaccine trial being conducted by University Hospital Southampton NHS Foundation Trust, Britain to study the use of seven different COVID-19 vaccines if administered as a third dose.
**The ninth WHO-approved COVID-19 vaccine, produced by the Serum Institute of India, under licence from Novavax, which was developed by the Coalition for Epidemic Preparedness Innovations and Novavax, a pharmaceutical company based in Gaithersburg, Maryland.
***mRNA vaccines are a new kind of vaccine that inject into the human body a harmless part of a certain bacteria or virus and trigger an immune response. mRNA vaccines introduce some genetically engineered mRNA or messenger RNA, often a tiny small piece of a protein from the virus's outer membrane.
In viral vector vaccines, genetic material of the actual COVID-19 virus is inserted into an adapted version of another virus (viral vector).
According to Indian Express (Explained: Delhi govt’s colour-coded action plan to fight Covid-19 (external link)): Delhi government's new COVID-19 action plan 'states that restrictions will be based on three parameters: positivity rate, cumulative active cases and occupancy of oxygen beds in hospitals. And the restrictions have been classified under Yellow, Amber, Orange and Red alerts'.

Feature Presentation: Ashish Narsale/Rediff.com

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