Dr. Rajesh M. Parikh, Director of Medical Research and Hon. Neuropsychiatrist, Jaslok Hospital and Research Centre on Omicron and lessons from Covid
In today’s discussion, I am going to talk about Omicron but also focus on developing resilience because the past two years have taxed our inner resources considerably and many of us have developed pandemic fatigue. I hear people saying ‘what is the point? I can’t go on like this, I might as well face the virus.’
So, quickly, to cover certain terms – we know what a pandemic is; endemic is one in which the illness is present in a certain population in a low-grade manner like malaria, TB and then when that illness suddenly surfaces for a short period in large number it is called an epidemic. So, endemic is chronic stage and epidemic is acute and sudden. When an epidemic spreads to two continents or more, like Covid-19, it is termed as pandemic. But over the last hundred years we have learnt that almost all pandemics have ended up as being endemic and that seems to be the direction in Covid-19 is heading.
If we look at previous pandemics, we see that they typically appeared in waves. The most classic example is the one that occurred hundred years ago known as the Spanish flu influenza pandemic that appeared in three waves. The second was far greater in amplitude and severity than the first. The third was also bigger than the first though it was slightly smaller to the first. This seems to be, in some ways, similar to what we are experiencing currently. And then there have been other waves that typically lasted for a year or over a year. What stands out in the Covid-19 pandemic is that we are at two years and we are not sure when it is going to end.
We all are familiar with the structure of the virus. The virus is an entity which just wants to reproduce, there is DNA or RNA material inside and then it is surrounded by a membrane which is a liquid membrane – an oily substance. And that is why detergents work because it is all oil; if we have oil on our hands, we can wash it off with soap. So, the coronavirus has a lipid coating, it has the RNA inside and the spike protein acts like a key that enables the virus an easy entry into the human cells because our cells have ace 2 receptors which are like locks, the proteins fit in almost perfectly to enter the cells. Once it is in, all it wants to do is reproduce; it hijacks part of the cells. When the cell is filled with the virus, the cell wall bursts and the virus goes on to infect other cells.
The Omicron variant is more infective than the previous variant because it has numerous mutations on the spike protein which makes it more efficient in entering the cell. That is the one thing the distinguishes omicron. It has an easier and faster entry into the cells. The characteristics of the omicron variant are
- 36 mutations in spike protein
- Higher transmissibility
- Higher infectivity
- Reduced lethality (a laboratory study conducted by Cambridge where they took vaccine-induced antibodies from the blood of people who had received vaccines found that the omicron variant was able to dodge these anti-bodies and that explains its high infectivity. In another study they took the lung cells and they found that it doesn’t penetrate the lungs and hence the pre-dominant symptoms are solved through.)
- Escapes vaccine-induced immunity
- Risk of reinfection 3x compared to Delta & Beta variants
- USA – 50% increase in paediatric admissions for Covid-19 in December 2021
In Mumbai, of patients who required oxygen, 96% were unvaccinated. When we look at the mortality data, 94% of Covid deaths were of unvaccinated. So, what can we do to stay safe?
- Mask up correctly (N95 or double masks)
- Physical distancing
- Hand and respiratory Hygiene
- Avoid enclosed spaces with poor ventilation
- Exercise, nutrition and sleep
- Get vaccinated
- Avoid consuming or spreading misinformation
It is important to dispel vaccine hesitancy. Sometime ago when I was on prime time, a thought just occurred to me and I described people who refuse to get vaccinated and refuse to wear mask, perhaps a bit harshly, as bioterrorists. I made the analogy that just as a terrorist sprays AK47 bullets around, bio-terrorists endanger themselves and people around by spraying viruses which can be as lethal as bullets. I said it and wondered whether I was extreme. But extreme times call for extreme words. A few people are endangering themselves, their immediate families and all of us. There is clear data that indicates that boosters work and help.
For five weeks I was working on data to get boosters through. Some of us were delighted that the boosters are available. Any booster is better than not taking the boosters at all. There are new variants and mutations, we don’t know what comes next. There is pandemic fatigue. You all are well-versed with economics, there is a struggle to balance home and work and some of us have to deal with grief and loss as well.
Social isolation in many countries has been linked to heart disease, diabetes, psychiatric disorders, increased early deaths and it also costs US$6.7 billion in the US alone. When WFH started, most were thrilled as it seemed easy but although 50% have continued to do so, 57% disliked it and 75% of people are experiencing burnout. People are working harder, the line between personal and professional is becoming blur. 44% report decline in mental health, it has also impacted on job and company satisfaction, job motivation. Statistics on impact of mental health show that in India, half the population reported symptoms of depression and anxiety, 80% people have expressed need of some professional help from experts. Perhaps the silver lining is that seeking mental health is de-stigmatised, people are talking about it openly.
How do we ride the pandemic waves? Look at surfers, when they see a big waves, they are thrilled because they have trained themselves in the art of negotiating these waves and we too can enable ourselves by building resilience. When it comes to coping, there are emotional and behavioural strategies. The most important thing is to ask ourselves are we responding or are we reacting to a situation. We often react emotionally and regret. It escalates the problem; it is important to step back and understand what the other person is going through and then it is a more measured response. This is something we can train ourselves. Then breathing and relaxation exercises deal with stress. The relationship is reciprocal. Being here and now is of great help in dealing with stress. The distraction strategies are for short term to give us a time for measured response and to approach the problem with a renewed thinking.
Cognitive strategies are next, it is important to know that knowledge is power. A lot of angst is due to the incorrect information. If we are armed with right knowledge, they act like an extra layer of protection. In January 2020, we emphasised on the difference between physical and social distancing. The correct term is physical distancing because we can be socially connected while physically being distant – technology has enabled us to do so. There is a robust link between social connectivity and good health, the ability to put ourselves in other people’s shoes, to experience the world through their eyes is a good cognitive strategy because we realise how fortunate we are. It is also important to discuss and understand the concerns of people, to see if thoughts are based on facts or beliefs and most important, in chatting with friends, we focus on the solution than the problem. Talking to someone helps to get to the solution.
Behavioural strategies include staying connected to everyone, never forget self-care, exercise, sleep and nutrition. It is important in coping with the uncertainty of the pandemic. Altruism, getting involved in problems of others, helps us to look away from our stress. The pandemic has given us time to think about ourselves, society, friends and family.
Now there were people like Shakespeare and Newton who did extraordinary and important work in the pandemic times. Shakespeare wrote three books: Macbeth, King Lear and Antony & Cleopatra. Newton came up with ideas like gravity, calculus, optics and laws of motion. So, here are people who have used the time given by pandemic to do something which is important. I have been able to harness the time and write a few books. For a long time, I have had the idea of teaching mental health in school curriculums to help diminish increasing rates of anxiety, depression and suicide in kids. We were able to put together a primary school curriculum and make our contribution to help mental health of our students.
Lessons of covid-19
We are only as safe as the weakest among us. Omicron is up because of low vaccination in Africa and if some of us are unsafe, all are unsafe.
Hunger crisis has a collateral damage. The situation of migrant worker crisis was one of the most catastrophic stories in our country since Partition. I think we also learned that politics and power can’t save us in the pandemic, but science and research can. There have been more than 1,80,000 deaths of health care workers; we need good science and technology to help us get through. I used to be a technophobe; I didn’t have a mobile phone till six months before pandemic. It has been such a boon. Finally, we need to ask ourselves what is truly essential? The titles, the stocks or the ability to connect, the family, peace and love? So, pandemic has allowed us to be grateful and prioritise our lives. If something good has to emerge from this pandemic, we should emerge stronger and wiser.
What is your take on natural vs engineered virus?
We had a debate on same lines; I believe it is not natural. I did all the research and the director of infectious data at Jaslok who spoke on the other side called me two days before the debate and asked me if I could switch sides. That is when I knew I was on the right side.
Would you advise somebody to mix the vaccine or take same?
A hybrid confirms higher immunity. A logistic issue is that 90% are vaccinated with Covishield and 10-11% with Covaxin. So, we can do the other way round, but any vaccine booster is better than no booster at all. The incremental benefit from taking any booster is higher than the incremental benefit you get from taking a hybrid booster.
What about natural immunity from having high delta or omicron?
Almost everyone has natural immunity by now, but I don’t think it is a substitute to booster. Herd immunity in Sweden and UK has proved to be a disaster. So, yes, at a mathematical level there is a certain precision in thinking of herd immunity. The fittest will survive; hybrid immunity is clearly the best.