THE HEALTH | JANUARY-FEBRUARY , 2022

EMIR-SING

BY AMEEN KAMAL

Learning from dealing with uncertainties the past two years , it is worthwhile to err on the side of caution . However , based on current data , the most reasonable reaction may be somewhere in the middle , i . e ., cautious yet optimistic .

It means people should maintain high standards of hygiene and physical distancing Standard Operating Procedures ( SOPs ), ensure sign-in and sign-out on the MySejahtera application ( to assist in contact tracing ), do frequent self-testing and reporting , and make healthier lifestyle choices .

The authorities would have to keep a close tab on our borders and increase sampling and viral genetic sequencing capacity alongside other efforts to ramp up immunological studies .

In others words , aside from increased public vigilance and authorities ’ workload , the rest is the same - until and unless we have new and stronger evidence to react otherwise .

The disproportionate level of global panic has been driven by the unusually high numbers of mutations found in Omicron , with over 30 on the spike protein , while the Delta variant only has five spike mutations .

Given how much Delta has wreaked havoc globally , the fear is that these mutations could mean the virus to be more transmissible , evade the host immune system , and cause severe disease .

Because the mutations are mostly on the spike - which is the main target of antibodies generated through natural infection or vaccination – there are reasonable fears that the mutated spikes could result in the viruses not recognisable by antibodies and make the virus attach stronger to cells . So , what do we know at the moment ? Recent sources appear to point to increased transmissibility and the likelihood of immune evasion causing re-infections . Although Omicron ’ s impact on disease severity is inconclusive , some early data points to a favourable trajectory .

What kind of disease severity ?

In terms of transmissibility , a pre-print by researchers from the Michigan State University ( MSU ) estimated that Omicron could be 10 times more contagious than the original SARS- COV-2 or about 2.8 times as infectious as

the Delta variant A pre-print by South African researchers suggests that Omicron could be up to three times more likely to reinfect people , which is supported by the MSU researchers who estimated Omicron could have double the chance of escaping current vaccines than the Delta variant .

Note that these are pre-prints ( not yet peer-reviewed ), and their methodologies differ , meaning the findings , and what we can conclude from it , may change .

That said , it is plausible that many mutations in Omicron developed through intensifying selection pressures brought about by an increase in interventions such as through vaccines , naturally-induced immunity , and other drugs and biologics . If so , immunity evasion by Omicron is likely .

Thus , it would appear that sources mostly point to increased infectivity and higher chances of re-infections . But the most important question is , what kind of disease severity are we looking at ?

A threat assessment report by the European Centre for Disease Prevention and Control ( ECDC ) dated Dec 2 mentioned that “ Among the cases reported in the EU / EEA ( European Union and European Economic Area ) for which there is the available information on disease severity , half of the cases were asymptomatic and the other half presented with mild symptoms . No cases with severe disease , hospitalisations or deaths have been reported among these cases ”.

But because the number of confirmed cases reported was only 70 in the EU / EEA , the ECDC noted that more data would be needed to draw conclusions . For example , indications of severe cases ( through increased hospitalisation rates , etc .) may take a while to manifest at the population level .

Also , the cases reported by the ECDC have thus far involved more vaccinated younger age groups and travellers , which can be assumed as being generally “ healthier ” people . We know that younger age groups are less likely to show severe symptoms than older age groups .

Either way , it does sound promising , and it is not strange if Omicron is indeed causing less severe symptoms .

Many variables to consider

Firstly , more mutations do not necessarily mean a bad thing . Random mutations in viruses happen all the time , but selection pressures likely increase the chances that favourable mutations ( to the virus ’ s survival ) are retained and accumulated .

What kinds of characteristics would be favourable to the virus ? To spread better , avoid detection by host immunity , and keep the hosts alive . Becoming more infectious but less lethal to the infected person is a favourable characteristic for the virus , and thus , it has always been a potential evolutionary pathway .

As reported by Reuters , there are theories of Omicron originating through an immunocompromised ( such as a HIV patient ) individual in southern Africa , which could indicate that the virus has adapted to become less lethal to the host .

In other words , Omicron may have “ learned ” to be less severe .

If these hypotheses are true , Omicron pushing aside Delta to become the dominant variant could be a good thing . Under this scenario , more and more people would get infected , but few would get severe symptoms .

Furthermore , Omicron ’ s high number of mutations may even leapfrog our immune system to a new starting point that helps the body ’ s immune system to develop a defence against future infections and even future variants . This is why some reports have even posited how Omicron could be our “ way out ” of the pandemic , providing hope of truly “ living with the virus ” as we have always been with the common seasonal flu .

Ameen Kamal is the Head of Science & Technology at EMIR Research , an independent think tank focused on strategic policy recommendations based on rigorous research .

However , empirically answering these questions and testing these promising theories via robust tests and experiments will take some time .

As mentioned by MSU scientists , there are many variables : differences in individuals ( underlying health conditions , race , gender , age ) and vaccine types could result in varying sets of antibodies . Additionally , the inability to control all variables may limit the reliability of the populationlevel statistical analysis .

This is why the Health Director- General Tan Sri Dr Noor Hisham Abdullah mentioned that much is still unknown about this variant and advised Malaysians not to panic and continue adhering to protocols .

Need for increased postimmunisation surveillance capacities

The Centers for Disease Control and Prevention says that a VoC is “ a variant for which there is evidence of an increase in transmissibility , more severe disease ( for example , increased hospitalisations or deaths ), a significant reduction in neutralisation by antibodies generated during previous infection or vaccination , reduced effectiveness of treatments or vaccines , or diagnostic detection failures .”

According to these criteria , there isn ’ t enough evidence at the moment to conclusively check all the boxes .

Aligned with WHO recommendations , we re-emphasise again the need for increased post-immunisation surveillance capacities , including genome analysis and serological studies to be increased significantly . The previously targeted one per cent of cases is not intense enough . The public also needs to adhere to public health measures to reduce virus circulation .

As being shown now with Omicron ’ s emergence , this is important for detection , supporting global research and understanding immunological uncertainties .

For the detection of Omicron , one suggestion for the authorities to consider is the use of PCR tests kits that target both stable and less stable parts of the virus , whereby Omicron is likely to yield negative results for the less stable part given its highly mutated spikes . Thus , given the current prevalence of Delta ( making its positive predictive value strong ), samples sent for genetic sampling for confirmation of Omicron may have a higher chance of successful detection .

In the meantime , we again urge vaccine developers to embark urgently on redesigning vaccines beyond inducing systemic immunity and mucosal immunity . This is a respiratory virus with highly mutational spikes . It makes sense to focus immunity on the respiratory system and counter the high mutation rate .

As for other researchers , we urge the study to understand not only what genetic sequences of the virus contribute to the severity of disease , but more importantly , what genetic sequences , markers , and predispositions of the individual would confer higher chances of severe disease .

If indeed Omicron is our way out , then the next step should be tailored interventions to address the relatively few people that do get the severe disease . — The Health