December 26, 2021

Covid-19: Runaway Omicron Wave Overtakes Delta

Prabir Purkayastha

OMICRON, a new SARS-CoV-2 variant of concern, has rapidly overtaken all other variants in the new waves of Covid-19 cases that are emerging in South Africa, the UK, the European Union and the US. More worrying is that Omicron is able to infect those who have received two vaccine doses or already had Covid earlier. This is supported by laboratory evidence though they are still very preliminary results. The good news, if it can be called good news, is that most of those who have been vaccinated do not seem to progress to a critical stage. This indicates that the body's immune system, primed by vaccine and possibly previous Covid infections, is still able to handle the disease from progressing to a serious stage.

Some figures are important here. While the emerging Omicron wave started from South Africa – or was first detected there – new case numbers there have started to drop from the peak of about 27,000 to now about 21,000, including in urban centres like Johannesburg and Pretoria. However, we also have the example of the UK, where the numbers of new cases are still going up. In most countries seeing a new wave, Omicron is not only emerging as the dominant variant, but their numbers have already overtaken the earlier peaks with no signs of tapering off.

While all this may sound depressing, there is some positive news as well. Our bodies now have some immunity, either from previous infections or from vaccines. Therefore, our immune systems know the virus, and even if the first line of defence –neutralising antibodies – are not as effective against Omicron. Our immune system has many other layers of defence, including the T-cells. When the virus enters our cells, it takes over the cell machinery to create a number of copies of itself. When an infection multiplies in our body by taking over our cell machinery, we then have a much more serious case. The T-cells kill the infected cells and prevent the virus's multiplication inside our body, effectively stopping the infections. This is why an earlier infection or vaccines may not prevent an Omicron infection, but it still stops the infection from spreading much further. The two doses of vaccines (or infection and vaccines) seem to prime the immune system better and more likely to prevent serious cases than an infection.

Some evidence, though very preliminary, is emerging that Omicron infections are not causing a large number of serious cases as Delta did. It is possible that Omicron itself is causing a milder form of the disease and therefore not causing as many serious cases that the earlier variants did. Or that most people in countries that are seeing a large number of cases are either already vaccinated or had earlier infections or a combination of both. As we know, a large number of infections are asymptomatic and therefore may not have been diagnosed as Covid-19 but still provide some immunity. Most people in the countries that have seen or seen the new Omicron wave are either vaccinated or have passed through earlier Covid-19 waves, therefore, have some existing immunity. They are falling ill but not seriously so, with their immune system kicking in even if a little late. On vaccines, the experts have always clarified that vaccines may not prevent infections but will stop serious disease: it prevents or lowers hospitalisation and critical care.

The other possibility is that Omicron itself causes a less severe form of the disease. From the preliminary reports emerging from the hospitals in London, it appears that the bulk of serious cases in London hospitals is from the non-vaccinated population. As London has 70 per cent of its population fully vaccinated, this would show that it is not that Omicron creates a milder form of Covid-19 but that if vaccinated, people are less likely to progress to a more serious form of the disease. Vaccination prevents serious illness and hospitals collapsing, as we saw in the earlier waves. That is why vaccination is still critical in combating the Covid-19 pandemic.

While vaccination is the critical difference between a new wave overwhelming the hospitals and their critical care systems, what about other drugs that have been used against Covid-19 infections? Ivermectin, hydroxychloroquine and convalescent plasma have already been found to be ineffective in Covid-19 treatment. Apart from the corticosteroids that reduce lung inflammation, remdesivir and monoclonal antibodies have been found useful in reducing the virus spread in the body. The bad news is that the new monoclonal antibody treatments specifically developed for Covid-19 do not seem to work.

The good news is that new drugs like molupiravir and Paxlovid – a combination of two antivirals, nirmatrelvir and ritonavir – will still work. These drugs, like remdesivir, reduce the virus multiplication allowing the body's defence mechanism the required breathing space to step in and stop the infection. The new antivirals are more effective than remdesivir and can have a significant impact on cutting down on hospitalisation or hospital stay.

All the three antivirals – remdesivir, molupiravir and Paxlovid –are small molecules that can be manufactured easily by any pharmaceutical company; and manufactured in large quantities. Unlike vaccine manufacture, which deals with large molecules or biologics, there is no such barrier to their transfer of know-how and rapid manufacture in quantities to even the less developed countries.

That brings us to why is it that in spite of science, or more correctly scientists, having developed Covid-19 vaccines and drugs so rapidly, we are still unable to vaccinate the world or make available medicines and vaccines to people who desperately need them? Why is it that the number of booster doses of vaccines in the rich countries far outstrips the total number of vaccine shots given to the low-income countries? Why can we not make a concerted effort to ask that patents on antivirals be either lifted? Or break these patents as the WTO rules allow countries to do during pandemics? Why is it that rich countries are unwilling to stop the worldwide pandemic and concentrate on saving their population while letting the pandemic continue in the rest of the world?

The answer is simple: they are far more interested in the huge profits that their pharma companies will make if the pandemic continues. The best course for big pharma is a continuation of the epidemic evolving to an endemic state in the rich countries protected by vaccines and antivirals, while the poor countries continue to get a "natural" herd immunity through infections. This will protect the huge runaway profits that they are making. For the future as well, the rich in the poor countries will be somewhere in between, living with a continuing pandemic while having access to medicines and vaccines that may be priced too high for the bulk of their population.

Omicron has shown that such an equilibrium where the rich are protected while the poor are not, is unlikely to hold for long. We either stop infections everywhere if we want everybody to be safe; or no one will be safe. An apartheid vaccine regime – where some are protected while the bulk of the world's population is not – will not work. It will only give rise to new variants. This is the lesson that the public health practitioners learned a century back, and it still holds. It is incompatible with the hyper-capitalist vision that brought in the neoliberal reforms of dismantling the public health system and the new TRIPS patent regime. This is what we need to fight.

In India, we need to ask our government why India, which prided itself on being the pharmacy of the world, failed to deliver vaccines to its own people as promised? We have failed to provide two doses of vaccines to the target population. Only 56 per cent of India's adult population has received two doses. And unlike the West, we have very little anti-vaccine opinion in the country, so this is not the reason for not being able to vaccinate our people. We have the scientific know-how and the vaccine manufacturing capacity. We could have scaled these capacities to not only meet our needs but also become a vaccine supplier to the world. As China has done.

Why did the Indian government fail? Is it because it believed in the myth that capitalism and markets by themselves solve all problems? The answer and this is what big pharma has shown time and again: profits for companies do not equal health for the people. The Covid-19 pandemic confirms this once again; unless we are held in the thrall of capitalist mythology of benevolent markets.