Don't underestimate Omicron

Rapid surge can still overwhelm health care system

On Thursday, the Union health ministry reported that the current surge in cases of Covid-19, driven by the highly transmissible Omicron variant of the virus, continues to set new records. Over 90,000 new cases were reported in the previous 24 hours, taking the number of active recorded cases to over 285,000. The number of new cases is half as much again as those reported the previous day, showing that the wave has some distance still to run. The earlier hotspots of Delhi and Maharashtra are once again being hit, with the former’s chief minister, Arvind Kejriwal, himself testing positive for Covid-19. Mr Kejriwal is, however, apparently showing only mild symptoms, as are most of those infected by Omicron. In a televised address earlier this week, he advised the residents of Delhi not to “panic”, arguing that there was still ample spare capacity in the city’s hospitals, particularly in intensive care units and oxygen beds.

However, it would be dangerous to underestimate the threat posed by Omicron, given the relatively brittle quality of India’s health care infrastructure and how easily it could be overwhelmed by the numbers. Even if only a small proportion of cases requires hospitalisation, the absolute number may still be enough, at the peak of a wave, to inundate hospitals in hotspots. In other parts of the world where the Omicron wave is more advanced, an additional problem has been noted: A large number of health care workers have tested positive and have to quarantine, thereby reducing capacity in hospitals. The basic aim of policy during a wave has to be to manage the availability of hospital capacity, and to avoid the dangerous tipping point that arrives as the wave peaks. If hospitals are running close to capacity at the peak, then the death rate inevitably rises. Thus, even a less virulent but more transmissible strain of the virus can nevertheless, if allowed, cause a great many deaths.

The government must, therefore, not slacken its efforts to get the wave in control. In a recent advisory, the Union health ministry argued that asymptomatic contacts of Covid-positive individuals did not need to be tested. It is not certain whether this is wise, because it would understate the scale of the problem and lead to complacency. Instead, testing should be scaled up. It is also necessary to be sensible about social distancing. Politicians must realise that a tendency to hold crowded rallies while forcing the curtailment of other activities is leading to an erosion of trust. Political campaigning must not be irresponsible. The mistakes made in the run-up to the devastating second wave in India — overconfidence and complacency —cannot be allowed to be repeated.

The government must also be flexible about the vaccination programme, now that it is increasingly clear that booster shots provide heightened protection against the Omicron variant. Earlier attempts to limit access to boosters must be re-examined in the light of the rapid spread of Omicron as well as the fact that supply is no longer a problem. At least in hotspots such as Mumbai, Delhi, and Kolkata, booster shots should be opened up to the general population. The production of alternative vaccines, including Covovax and Corbevax, which have shown considerable efficacy, should also be scaled up so they can be made available as boosters if required.