On 3 December 2021, Sri Lanka confirmed its first case of Omicron-infected patients, and at the time of writing, the number of confirmed patients had increased up to four.
According to the World Health Organisation (WHO), as of 16 December, the Omicron variant has been identified in 89 countries across the six WHO regions. In the countries where the community transmission of the Omicron variant is documented, the doubling time of the virus is known to be around 1.5 to three days, which shows a faster spread than the Delta variant. Most recently, a team of researchers from the UK have identified that the Covid vaccine booster dose could provide around 85% of protection against severe illness with Omicron.
In this context, Health Promotion Bureau (HPB) Director Dr. Ranjith Batuwanthudawa is steering a series of media briefings to update the public on this new variant. This article is based on a few discussions of the experts who shared their views in these programmes.
What is Omicron?
Medical Research Institute (MRI) Consultant Virologist Dr. Nadeeka Janage explained about the Omicron variant. The Omicron variant has been detected by a team of scientists in South Africa. In their gene sequencing studies, they have identified significant changes in the s-protein (spike protein) of the SARS-COV2 virus. Subsequently, the WHO has announced this as a variant of concern, since they have identified these mutations as significant.
“These changes to the s-protein are significant as it is the protein the virus uses to enter into the human body. Further, when manufacturing vaccines, scientists use these s-proteins. Hence, any significant mutations to these s-proteins may affect the rate of the disease transmission and also the effectiveness of the vaccines. However, still data is not so conclusive to comment on any of these factors and it will take another few weeks to show that,” he said.
He further elaborated on the availability of testing facilities to identify new variants, stating that a laboratory network is operationalised with all laboratories conducting PCR testing and that samples are received at the MRI for genetic sequencing.
Act responsibly during festive season
Colombo Municipal Council (CMC) Chief Medical Officer of Health (MOH) Dr. Ruwan Wijayamuni shared his experiences regarding the spread of Covid-19 in the city of Colombo.
“During these days, we detect only about 10-15 cases per day within the CMC area. The main reason for this reduction is probably due to the vaccination coverage. Out of the permanent residents of the CMC area, about 95% have received at least one dose of the vaccine and 78% of that population has received both doses. Currently, the inoculation of the booster vaccine is also underway,” Dr. Wijemuni noted.
Further, he emphasised the importance of obtaining the vaccine as they have seen a marked reduction in the number of deaths after the successful implementation of the vaccination programme.
Dr. Wijayamuni also emphasised on the importance of adhering to health measures during the festive season, while strict regulations are imposed on the health measures, in order to prevent any disaster situation as it happened during the April Sinhala and Tamil New Year season.
Pregnant mothers should be cautious
Family Health Bureau (FHB) Director Dr. Chithramalee de Silva mentioned that about 10,500 pregnant mothers have been affected with Covid-19 since the first wave, and 60 Covid-19-related maternal deaths were reported, all of which had occurred as a result of the third wave.
She requested all pregnant mothers to get the two vaccine doses. As for mothers who are over 30 years of age and have been vaccinated with two doses, she advised them to obtain their booster dose from the MOH. “Vaccination does not provide you 100% protection from the virus. Hence, it is important to continue adhering to basic measures such as wearing facemasks, washing hands, avoiding crowded places, avoiding concealed air-conditioned rooms and halls, maintaining distance, and staying at home at all possible times,” explained Dr. de Silva.
Meanwhile during the pandemic, 89 Covid-19-related deaths had been reported in children less than 18 years of age. Currently, vaccination drives at schools are being conducted successfully and the schools are adapting to the “new normal” situation to ensure the safety of the children and their family members. Dr. de Silva requested parents to educate their children regarding good hygienic practices.
Lifesaving 10 minutes
Consultant paediatrician Dr. Kalyani Guruge shared her experience of working with the Sri Lanka Medical Association’s (SLMA) Doc Call 247 hotline. Dr. Guruge is a pioneer member in this service from its inception. According to Dr. Guruge, the system has catered to more than 60,000 callers, and each household had about three to four patients. Thus, the system has provided services for about 300,000 patients over the last four months. They have noticed a reduction in the number of calls in the month of October, but the numbers had again increased in November. Currently the hotline receives about 200-300 calls per day.
During this lifesaving 10 minutes, the SLMA Doc Call 247 system provides immense relief to patients managed at homes, whose access to healthcare is limited due to isolation. According to Dr. Guruge, most of these patients just need some reassurance from a medical professional and a few patients required hospitalisation, where the system directly approached the 1990 Suwa Seriya ambulance service to transport these patients to the nearest hospitals.
Dr. Guruge further mentioned that many of the patients do not have adequate knowledge about the signs and symptoms of the disease and generally tend to ignore these symptoms and get tested only after about seven to eight days from the onset of symptoms. By that time, most of the family members also get infected, as these patients do not adhere to hygienic measures at home, since they attribute their symptoms to a common cold or a viral flu.
“We have noticed that many households tend to send their children to their grandparents’ whenever they find a family member has tested positive. However, at the time of the diagnosis, the children also would have caught the infection. It is very much risky to send these children to grandparents who are obviously the most vulnerable group to develop severe disease. If any family member tests positive, all members of that household should quarantine in the same house,” explained Dr. Guruge.
She stated that it is not necessary to take medicines for Covid-19, other than paracetamol for fever and headache, and chlorpheniramine for mild respiratory symptoms. However, they have noticed that many patients have taken various medicines and do not know the medicines they are on. “About 85% of our population are not aware about the medicines they are taking and it is the responsibility of all healthcare professionals to make them aware about these medicines,” she added.
Adding to the experiences of the Doc Call 247 service, University of Colombo Professor in Medical Education Indika Karunathilaka, the trailblazer of this system, stated that only about 1,500 out of 65,000 patients who called 247 service needed immediate hospitalisation through their system – that is less than 2% of the patients. “This data clearly demonstrates that for the vast majority of patients, what is mainly required is to facilitate the immune response of the body with proper nutrition, hydration, and rest. This immune response can be further strengthened by the vaccines,” mentioned Prof. Karunathilake.
However, there is a demand by patients for different types of medications and a tendency among many health professionals to recommend them. This results in irrational use of medicines. He explained: “Steroids are indicated only at a severe stage of disease and can be detrimental when given during early stages. It is commonly seen that antibiotics such as azithromycin and co-amoxiclav are irrationally prescribed for Covid-19 patients. These kinds of misuse of antibiotics is detrimental for patients, as it will necessitate administration of much stronger antibiotics when an actual need arises.”
Discussing further about the Doc Call 247 experience, Prof. Karunathilake mentioned that the service was able to correct a lot of misconceptions. “Many patients inquire whether it is okay to have a bath when they get positive, as it is a general norm that it is harmful to bathe when you have fever or cough. This is a myth that prevails through generations. We have found patients having skin rashes since they have not had a bath throughout the entire quarantine period. It is important to maintain cleanliness and hygiene during this period, and there is no scientific basis to avoid bathing,” Prof. Karunathilake clarified.
–
The impact of Omicron depends on its transmissibility, virulence, and the response for vaccines. According to currently available data, we see that Omicron is spreading faster than the Delta variant that has been attributed to the surge in the number of cases across the globe in the last several months. Since the world is still uncertain about the clinical severity of this new variant, it should not be dismissed as mild and we should always bear in mind that even a sheer increase in numbers could overwhelm the capacity of the healthcare system. Hence, we should not drop our guards down so as to ensure the protection of each other.
(The writer is a Medical Officer at the Directorate of Healthcare Quality and Safety, Ministry of Health)
The views and opinions expressed in this column are those of the author, and do not necessarily reflect those of this publication.