It’s the season to spread love and joy. However, Omicron is lurking in the shadows. Let’s protect our loved ones from this super spreader this season. In this regard, we spoke to Family Physician and University of Colombo Faculty of Medicine Department of Family Medicine Head Dr. Ruvaiz Haniffa. He is also the past President of the Sri Lanka Medical Association (SLMA).  In a recently published article in Nature, one of the formidable science journals, it was mentioned that there are an astounding number of reported Omicron variants around the globe, “including a worrying number of infections in people who have either been vaccinated or experienced previous SARS-CoV-2 infections”. USA Today reported that Omicron has raced ahead of other variants and is now the dominant version of the coronavirus in the US, accounting for 73% of new infections last week.  Thus far the data is scarce as to how severe or life-threatening Omicron infections can be. However, it’s imperative to tread with caution, especially in countries where healthcare resources are limited.  [caption id="attachment_181020" align="alignright" width="309"] Family Physician and University of Colombo Faculty of Medicine Department of Family Medicine Head Dr. Ruvaiz Haniffa[/caption] Speaking to Brunch, Dr. Haniffa stated that he is witnessing an increase in cases of flu, and having spoken to his colleagues, he can confirm that this is the case all over Sri Lanka. He noted that we do not know if these cases are Covid-19 to begin with, let alone sequencing the suspected cases for variants of Covid-19, since there is inadequate testing for diagnosis. Both the rapid antigen test (RAT) and the PCR is not amped up in the face of rising numbers. Contrastingly, in other countries, testing is encouraged, either provided through the state or out of pocket at a reasonable price. However, according to the Presidential Secretariat website, for the past few months in Sri Lanka, the average number of daily Covid-19 tests was about 7,000 tests per day. In stark contrast, some countries which are compatible with our economic status are doing 7,000 tests every two hours. Hence, there is a gross underreporting of Covid-19 cases in Sri Lanka, reiterated Dr. Haniffa. Therefore, the estimated true numbers could range from three to five times – even 10 times – the number of reported Covid cases.  Against this backdrop where family physicians are witnessing a rise in flu cases, it’s prudent to mention some key figures known about Omicron so far. 

• It multiplies 70 times faster inside human respiratory tract tissue than the Delta variant
• It reaches higher levels in the tissue compared to Delta, 48 hours after infection
• It may be able to infect people at a lower dose than Delta or the original variant 
• In households in the UK, the risk of the Omicron variant spreading to another member is five times higher than the Delta variant 
• In the US, the percentage of cases caused by the new Omicron variant jumped seven times in just one week (from 0.4% of total cases to 2.9%)

There is a glimmer of hope in the preliminary data from South Africa and the UK which shows that those infected with Omicron as of now are demonstrating only “minor” symptoms such as runny nose, fever, headache, and fatigue. There is a consistently lower rate of hospitalisation compared to its predecessor; the Delta variant, which is the current forerunner of SARS-CoV-2 infections worldwide. Only a handful of patients infected with Omicron are showing clinical signs requiring hospital admission and care. An even smaller number as of now have required ICU care, and an even smaller number have died due to the Omicron Covid-19 infection or complications caused by it. However, due to the sheer number of persons who will get infected by Omicron due to its virology, it can be assumed that the complications from it to individuals’ families and the health system is going to be exaggerated exponentially, Dr. Haniffa acknowledged. The eventual toll will depend on several other confounding factors such as hospital capacity, age of those who are infected, and underlying comorbidities. Therefore, we as individuals and as a community need to take preventive action against this virus which has no certain cure to date. “A small fraction of a very large number is still a large number, so the population-level threat is very real,” stated the Nature article.  What does the data suggest? The available data suggests that three doses of the Covid vaccine (two initial doses plus a booster dose) will;

1. Decrease chances of getting infected with the Omicron variant 
2. Decrease the severity of the infection and mortality from the infection and its complications 

However, there is no definite evidence that these two factors will hold, cautioned Dr. Hannifa.  What precautions should we take? In addition to the obvious measures such as receiving the booster dose for those eligible (especially if you’re working in close contact with people), following the stipulated DReAM guidelines is recommended. According to the World Health Organisation (WHO), DReAM stands for: D: Distancing – maintain a physical distance of at least one metre from others; avoid public gatherings, crowded places, close-contact settings, and confined and enclosed spaces Re: Respiratory etiquette – cough/sneeze into your elbow; stay at home and contact a doctor (and/or 1999 or 1390) if you have a fever, cough, and/or sore throat A: Aseptic techniques – wash your hands frequently with soap and water for at least 20 seconds or use a hand sanitiser with at least 70% alcohol; avoid touching your eyes, nose, and mouth; regularly disinfect frequently touched surfaces M: Mask – wear a face mask, ensuring you put on, take off, and store your mask properly; clean your mask regularly and make sure it always covers both your nose and mouth Furthermore, avoiding the three Cs (crowded places, close-contact settings, and confined and enclosed spaces) and prioritising your social interactions and commitment during this festive season is highly recommended.  As we witnessed earlier this year with the hospitality industry taking a blow, there are severe economic consequences when governments impose lockdowns. We don’t need these measures imposed on us by the authorities; let us take responsibility for our own health and wellbeing, since none of us are safe until all of us are safe, Dr. Hannifa stressed. Covid variants are no longer only about the pathogen, it’s increasingly becoming more about the host and the environment.  Seasons greetings and a very merry Christmas and a happy New Year to those celebrating! Let’s learn to live with Covid more responsibly in 2022!