Precautions and measures: What we should do to keep Omicron variant at bay 

Everybody perhaps now thinks that the mass vaccinations will protect them from any further Covid-19 infection. Yet the World Health Organisation (WHO) has, again, sounded the alarm for more trouble ahead

Since the Covid-19 infection rates started to fall amid inoculation across Bangladesh, ordinary people, especially the hard earners and youngsters, have thrown away their masks and overcame their fear of contagion. 

Evidently, normalcy has returned to people's life although the Covid-19 health guidelines were not officially withdrawn. 

Concerned and responsible people, however, still wear masks when they step out for outdoor activities. Yet, gatherings at wedding or birthday parties and Union Parishad election campaigns have become as lively as they used to be before the pandemic. 

Everybody, whether inoculated or not, perhaps now thinks that the mass vaccinations will protect them from any further infection. Yet the World Health Organisation (WHO) has again sounded the alarm for more trouble ahead. 

Omicron — a more transmissible or immune-system evading variant of Covid-19 is spreading rapidly. The WHO has labelled Omicron as the 'Variant of Concern (VOC).' This variant now poses the next major threat in the course of the pandemic. 

Omicron was first reported to the WHO from South Africa on 24 November. This variant has a large number of mutations, some of which are worrying. These include mutations in the spike proteins of the virus that could result in the development of 'immune escape mechanisms,' which could reduce the efficacy of existing vaccines.

According to news reports, Omicron-infection cases have been reported in travellers in Belgium, Israel, Hong Kong, Netherlands, Denmark, Australia, United Kingdom and probably in Germany. 

Several countries, including the United States, Australia, Brazil, Canada, Iran, Morocco, Israel, Japan, Philippines and Thailand, the European Union and the UK have imposed restrictions on air travel from southern African countries.

Professor Be-Nazir Ahmed, a former director (Disease Control) at the Directorate General of Health Services, strongly recommends that the Bangladesh government take strict precautionary measures like foolproof screenings at the air and land ports so that the Omicron-infected passengers cannot enter the country. 

"This precautionary measure may irritate the individual passengers, but this will benefit the nation as a whole," he said. 

The outbreak of Covid-19 was evidently caused by the arrivals of migrant returnees when the deadly virus compelled employers to shut down job opportunities in European and Middle Eastern countries. Amid serious concerns, the Bangladesh government failed to check the influx and manage quarantine facilities for the passengers from abroad. 

As a consequence, the country witnessed more than 1.5 million Covid-19 cases and 27,978 deaths till 28 November as the virus spread primarily through the weak screenings at the airport. 

Institute of Epidemiology, Disease Control and Research (IEDCR) advisor M Mushtuq Husain, however, said that the migrants' access to Bangladeshi airport is their birthright. If the migrants are again compelled to return from their host countries, there will be no option but to open the airports for them. 

A positive thing to note in this situation is that Bangladesh does not have any direct air routes with the Omicron hotspot countries. 

"Bangladeshi migrants in those countries will need to travel via third countries where they may face Covid-19 restrictions. Any Bangladeshi arriving at our airports, must get an immigration pass after proper screening and be quarantined for at least two weeks. The government should bear the cost of such 'institutional' quarantine for the Bangladeshi migrant workers. 

Otherwise, they will try to escape from the restriction," Husain said.  

According to the WHO's statement, the existing SARS-CoV-2 PCR diagnostic tests continue to detect the variant Omicron. Several labs in South Africa have indicated that for one widely used PCR test - one of the three target genes is not detected, meaning an S gene dropout or S gene target failure. 

This test can therefore be used as a marker for this variant, pending sequencing confirmation. Using this approach, Omicron is being detected at faster rates than previous variants, suggesting that this variant may have a growth advantage.

Currently, in Bangladesh, only the IEDCR operates the RT PCR machine that can detect new variants like Omicron. Hence, the IEDCR advisor requested that all the medical hospitals and general hospitals change or modify their RT PCR machines as per the requirement to identify Omicron-infected patients.  

Sharper genomic surveillance is key   

Both Husain and Ahmed strongly recommended that the Bangladesh government strengthen genomic surveillance to trace the virus's origin at an earlier stage in the country. 

"Bangladesh still lags in standard genomic surveillance. Currently, we conduct genome sequencing only on those who are asymptomatic. But the Omicron carriers may roam around without any symptoms," Ahmed said. 

If genomic surveillance at the airports is not possible, Ahmed suggests genome sequencing in the areas where migrants arrive the most and the localities where the Covid-19 infection rates seem to be rising. 

He added, "If the first Omicron-infected one is identified, the entire locality must be brought under lockdown with immediate effect. The government can issue a standing order to enforce the restriction."  

His recommendations follow common wisdom which says that early action is far better than late response. 

Amid the threats posed by the Omicron variant, public health experts have advised the government to ramp up the mass vaccination campaign. 

Although more laboratory investigation and continued surveillance is required to determine whether the Omicron-variant increases the severity of disease or resistance to the available vaccines, scientists have warned that the variant's full impact will be felt in countries where fewer people are vaccinated. 

According to news reports, around 40 percent of the country's eligible population received at least the first dose of the Covid-19 vaccines, while 25 percent received two doses in Bangladesh since last week.

Husain believes that the more people are brought under the vaccination campaign the more Covid-19 management gains effectiveness.

Several studies have found that Covid-19 spread mostly during the spring or March in a year around the subcontinent. "Hence, Bangladesh needs to inoculate more than 80 percent of its population before the next March," Ahmed added. 

He further stated that the government needs to review the Covid-19 management in the last one and half years. An inventory of emergency medical equipment including ventilators should be prepared and all the trained physicians and other medical staff are enlisted so that they are made available in an emergency. The national health guidelines need to be updated so that it brands omicron as a serious concern, he said. 

"We should already start thinking about what we can do if the Covid-19 patients increases in the hospital. Our medical hospitals and health facilities at the district level should take necessary preparations. The authorities should especially ensure an uninterrupted oxygen supply so that no patient suffers from oxygen shortage," Ahmed said. 

He also recommended that the government formulates a usage policy to operate intensive care units (ICUs). The policy would determine the priority of oxygen supply to the Covid-19 patients. 

The public health expert found that designating the Deputy Commissioners at the district level and Upazila Nirbahi Officers at upazila level in charge of Covid-19 management was 'problematic.' 

"Rather, District Civil Surgeons and Upazila Health Officers are more compatible as focal persons. I told the public administration secretary that the right professionals need to be deployed at the right positions. It would be like assigning Shakib Al Hasan to play as a footballer," Ahmed said.  

Finally, the importance of health guidelines comes to the fore because the virus, despite being mutated over and over, is contagious. 

Hussain thought that the risk of infection is comparatively lower in open spaces. Even if passengers ride an open window bus or passerby walk on a footpath, the risk is very low relative to the risk faced by those who congregate at restaurants, community centres, or indoor public rallies. 

He recommended that authorities must ensure that visitors at indoor events maintain the health guidelines.