India’s Third Wave is here, with two variants Delta and Omicron in tow: Experts

 The Centre on Wednesday issued revised guidelines for home isolation of mild and asymptomatic patients amid the surge in Covid-19 cases nationwide.

As per the new guidelines, the patient under home isolation will stand discharged and end isolation after at least seven days have passed from testing positive and no fever for three successive days, and shall continue wearing masks.

There is no need for retesting after the home isolation period is over. Asymptomatic contacts of infected individuals need not undergo Covid test and monitor health in home quarantine as per the new guidelines.

"Patients should at all times use a triple layer medical mask. They should discard the mask after eight hours of use or earlier if the mask becomes wet or is visibly soiled. In the event of a Caregiver entering the room, both Caregiver and patient may preferably consider using an N-95 mask", said the new guidelines.

The mask should be discarded after cutting them to pieces and putting in a paper bag for a minimum of 72 hours.

Elderly patients aged more than 60 years with co-morbid conditions will only be allowed home isolation after proper evaluation by the treating medical officer. The patients suffering from immunocompromised status (HIV, transplant recipients, cancer therapy etc) are not recommended for home isolation and shall only be allowed home isolation after proper evaluation by the treating Medical Officer, the guidelines said. Moneycontrol talked to three leading epidemiologists and experts on the trend ahead and what needs to be done.

Prabhat Jha, Endowed Professor in Global Health and Epidemiology at the Dalla Lana School of Public Health, Toronto

 'It appears like an early Third Wave. The size and duration will be clear in 10-14 days’

 What do you make out of the double pronged variants, Delta and Omicron, currently haunting India?

Omicron is likely the dominant variant circulating now in India, as it indeed is worldwide. Omicron is most likely to be responsible for the recent uptick in cases in Mumbai and elsewhere.

Could this be the third wave hitting India that has been discussed in the past?

It appears to be an early Third Wave. The size and duration remain to be seen and will be clear only after 10-14 days. The extent to which the earlier Delta-led wave protects against Omicron is also not yet clear. In South Africa, Omicron came and went quickly, but note that they had mostly a Beta wave, not a Delta wave prior to omicron.

 Somehow doctors in India believe that Omicron is highly infectious, but less deadly in terms of impact. Do you agree?

The worldwide evidence supports both points, but the concern is simple. Even if say Omicron causes only 1/3 or the hospitalization rate, but causes four times more cases, then India may be still worse off. If Omicron causes lung damage (as did Delta) then the shortage of oxygen and ventilators that occurred last time could again lead to many deaths. So, what I am looking for are plans by state/federal officials to detail their oxygen tanks and ventilator supply, along with hospital beds/staffing. The main challenge of Omicron in the West is the risk of flooding the hospitals even with more mildly sick patients than occurred with Delta.

 The medical staff and health workers (HW) are at their wit's end. The pandemic is nearly 22 months old. How much longer can they go on?

Third doses for HWs are a priority, along with N95 K95 masks and other PPE. The other concern is if many HWs become sickened, even mildly, they cannot go to work and look after the seriously sick. The good news might be that Omicron, by being so dominant, but relatively less lethal, may help crowd out future variants.

 What is the efficacy of the vaccines, Covishield and Covaxin, against the new variants that are arriving in the world? 

I know only Covishield evidence, which suggests a third dose protects well against Omicron, as do third doses of mRNA. ICMR would know about Covaxin.

 Are we going to have to live with Coronavirus? Should we be prepared for that?

Yes. But vaccines, masks, rapid testing, PPE and open data means that we can live with it. Schools can stay open. Life can go on.  Life is worth living, in bad or good times.

Rakesh Mishra, Director Tata Institute of Genetics and Society

'There is real threat to frontline health workers'

Is the Third Wave here now?

Yes, it is. It could mean less hospitalisation and could be more asymptomatic, but its dangers are no less. If we don’t take enough care, it can become virulent in no time. We must wear masks, keep our distance and avoid crowds at all costs. That’s the way to beat the system.

What’s the real threat of a Third Wave?

The real threat, according to me, is the safety of frontline workers. They may be asymptomatic but will have to be sent out to quarantine and that presents a serious problem. Frontline health workers are needed the most now.

Of course, we are better armed this time.

Yes, we are. There is seroprevalence and many more people have been vaccinated. Agreeably less than 50 percent people have been double vaccinated, but even a single vaccination is a better guard against not being inoculated at all. So, that way, India is better placed than before. But there can be no letting down our guard. It is also how we wear our masks. It has to be worn properly, not on the chin. The mouth and nose need to be covered.

Rajesh Chandwani, Chairperson at Centre for Management of Health Services, IIM-A; and Faculty at Human Resource Management Area, IIM-A 'Omicron can spread really fast; testing needs to go up'

So finally, the Third Wave is here.

Yes. Two Omicron deaths have been reported, both patients in their nineties. So far, cases of hospitalisations are minimal or have not been reported. We certainly need to be organised for oxygen but thus far the need for ventilators have not been felt. But let me reiterate that it is still early days, and anything can happen.

But South Africa, where Omicron is said to have originated, did not have a double variant like Delta that India has.

I have also heard about it but am not sure if that is the case. It depends upon genetic sequencing. In South Africa, within seven days of the genetic sequencing, Omicron had moved to no less than 10 countries. It is impossible to impose travel restrictions and this variant travels.

There does not seem a way out.

Apparently. No passengers were checked or tested in September-October last year, safe in the belief that the virus was gone or ebbing out. There is little doubt that the Omicron variant has traveled with them. I handled many patients during that period, with obvious signs of Dengue, that being the Dengue season. But there were no respiratory problems; now when I look back, that may well have been Omicron or the Delta variant.

Could Omicron spread fast and cause devastation in India?  

You can be rest assured it can. It can spread very fast. At this stage it looks slow, but more testing is needed. Turnouts and crowds have to be avoided at all costs. It would be premature to arrive at the conclusion that community transmission will not work in the case of Omicron, even if it is milder.