Covid Update 315
Early Omicron Trends & FAQ

Timeline
India witnessed the first case of Omicron on 2 December 21. Since then, cases have risen rapidly, especially in the last 7 to 8 days.

Short Doubling Period
As of 4 January 22, there were 1892 cases of Omicron across 23 states and UTs. Out of which, 766 have recovered or mitigated. Maharashtra is the leading contributor, followed by Delhi, Gujarat, Tamil Nadu, and Kerala.

Rapidly Rising Positivity Rate
The positivity rate in Delhi has jumped from 0.6% on 27 December to 8.5% as of 4 January 2021 see Fig

27 December can be said to be the beginning of the 3rd wave in India. Since then the graph has been rising continuously.

Frequently Asked Questions about Omicron.

1. Clinical Features of Disease?
   The Transmission Rate is fast, but the so-called Silver lining maintains hence cases are not turning serious.
   So far, the cases have been mild in Delhi. Most patients present with only mild fever lasting one day and a slightly scratchy throat.

As per previous studies from Guetang province of South Africa, about 4.7%cases of Omicron required hospitalization, out of which 1/3 (1.6%of total cases) needed ICU care.

A small early study data from Maulana Azad Medical College confirms mild nature of disease 92%cases turning negative within 7 days, another 5% becoming RT-PCR negative on 8th days and 3% on 9th day.
Cases with Co-morbidities like Diabetes hypertension seem to be taking more time to recover. So far, no cases have required a ventilator. No deaths have been reported. However, accurate picture will take time to emerge.

2. Who are vulnerable to Omicron?
   All. Omicron cases are being reported in fully vaccinated and even in those who had Covid in the past and also got vaccinated later, indicating that Omicron will spare none. So pull up your Masks rather Double Mask, Face shield, PPE kits; follow hand hygiene and maintain physical distance.
3. Any of past vaccines providing any immunity against Omicron?
   No, cases of Omicron being seen in both fully vaccinated by Covaxin as well as Covishield
4. Is it in stage of Community Transmission? Omicron is affecting even those who had not recently travelled so the disease is already in the phase of community transmission. Covid Appropriate Behavior could be the only savior.
5. Is there any effect of past vaccination and immunity?
   Past vaccination seems to be protecting from severe disease so let there be no controversy on vaccination. Cell-mediated immunity, once triggered/stimulated by new antigen, may take about seven days to make fresh antibodies, so cases are improving seventh day onwards.
6. Why is Omicron Mild?
   As per a study done in Hong Kong University, the new variant Omicron replicated 70 times faster( than Delta) in the upper respiratory tract than in the alveoli of Lung tissue paralyzing its capability to cause severe pneumonia.
7. How do I know if it were Omicron in RT PCR positive report?
   Labs are reporting just RTPCR Positive or otherwise. Labs detect a set of two genes from N, E, S genes and orf, Rdrp genes. Omicron classically has no S gene. Thermofisher kit can diagnose S gene dropout indicating possible Omicron infection. ICMR has recently approved Omisure Kit By TATA to detect probable Omicron infection by RTPCR report preliminarily. These Kit are not yet widely available. Actual confirmation is done by Genomic sequencing.
   However, seeing more than 81% prevalence of Omicron in Delhi, one may presume and move accordingly.

8.Can One order Genomic studies to confirm Omicron?
All positive samples in Delhi are being subjected to genomic study for Omicron since 22 December. But the report takes five to seven days. The test is totally under govt control for surveillance purposes. So one may not be able to order and get the report as per will.

9. How to treat suspected case of Omicron?
   ●No Role of Azithromycin, Doxycycline Ivermectin.
   ● Role of Molnupiravir: The drug is given within five days of symptom onset, only to those with associated co-morbidities like DM HT COPD CKD CAD Hf, etc. It has been shown to reduce chances of hospitalization in ABOUT 30% of cases. Note: The above study was done on Non-Omicron cases.

● Role Of Monoclonal Antibodies: Regeneron Ronapreve®️ is said to be ineffective against Omicron. But pending reports of genomic studies, it may be the only choice for high-risk cases associated with co-morbidity like DM HT COPD CKD CAD Hf, and elderly. The drug is given in two doses and requires medical supervision. It is useful only in patients who are spike protein antibody negative. So antibody testing might be a wise step before embarking on expensive therapy.

● Sotrovimab by GSK is reported effective Mab but not yet FDA approved nor available.

● Role of Remdesivir: OPD based trial of three doses of Remdesivir in mild cases showed some benefit, but it was a company-sponsored trial. Here, the drug did not show even any reduction in viral load. Moreover, IV administration in homebound isolation patients may have logistic issues.

So the treatment of mild cases mainly remains symptomatic using paracetamol, steam inhalation, bed rest, hydration, antihistaminics, NSAIDS etc.
for details, please read our update no 312/313 posted on 31 December2021.

Previous Covid updates can be read at
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