On March 11, 2020, the World Health Organisation (WHO) declared COVID-19 infection a pandemic. In the absence of any specific treatment, the focus of the fight against the deadly infection was largely empirical, awaiting the arrival of a specific medication or vaccination.
At the forefront of this unprecedented crisis were doctors and paramedical healthcare workers (HCWs) along with other frontline workers, who formed the bulwark of humanity’s resistance to the scourge of this disease. Doctors and healthcare workers threw themselves into the fire to save lives. Considering the highly infectious nature of this airborne virus, naturally the HCWs suffered humongous casualties. WHO estimates that 115,500 healthcare workers died due to COVID-19 between January 2020 and early 2021. Many had to be in isolation and stayed away from their already overwhelmed work stations as well as their families.
As the first wave receded, we found better measures to prevent the spread of the infection. Measures like N95 masks, more effective PPE kits as well as more stringent SOPs emerged to provide protection to HCWs from infection and disease, thus saving many lives.
When the second wave with the Delta variant riding it hit India, we were caught unawares about the mammoth need for oxygen and ICU beds, resulting in a surge in mortality numbers. Fortunately, due to better protocols, healthcare workers fared comparatively better during the second wave.
In the middle of November 2021, a new variant of SARS-CoV-2 named Omicron was reported from South Africa’s Gauteng province. It was labelled a Variant of Concern by the WHO on November 26, 2021.
Omicron was reported to be a much milder variant, infecting only the upper airways, thus resulting in far lesser morbidity and mortality. However, there was little to rejoice since this variant (reproduction number or R0 could be more than 18) turned out to be far more infectious than the Delta variant. So much so that if the earlier variants needed months to cause worldwide infection, Omicron spread its tentacles in a matter of days. The most concerning characteristic of the Omicron variant is the constellation of more than 50 mutations; of them, about 30 mutations are in the spike protein that interacts with human cells before cell entry, therefore possibly enhancing the transmissibility.
According to a study by Imperial College London, Omicron was associated with a 5.4-fold higher risk of reinfection compared to the Delta variant. Depending on the estimates used for vaccine effectiveness against symptomatic infection from the Delta variant, this translates into vaccine effectiveness of 0-20 per cent after two doses. The protection afforded by past infection against reinfection with Omicron may be as low as 19 per cent, the study added.
India reported the first case of Omicron on December 2, 2021 in Karnataka. In a matter of days, the number of daily infections in cities like Mumbai and Delhi soared to record peaks; from a few hundred in mid-December to many thousands by January 2022. On January 6, India’s new COVID-19 cases jumped 56 per cent in a day to 90,928; with biggest single-day rise of 495 Omicron cases recorded.
According to the data collected by the Association of Healthcare Providers, India (AHPI), which represents 2,500 super-specialty and 8,000 smaller hospitals across India, in the current wave, less than 0.5 per cent of the total patients hospitalised due to COVID-19 need oxygen therapy unlike the huge demand witnessed during the second wave.
Although testing has not been ramped up for Omicron specifically, considering that the numbers were on a downswing prior to Omicron making its dramatic entry, one can assume that this tsunami is being driven by the Omicron variant. And while we may be a tad less less worried on account of the milder nature of the disease requiring far lesser hospitalisation, as well as due to a much better preparation in terms of vaccination and infrastructure, there is one sinister weapon up Omicron’s sleeve.
Omicron Impact on Healthcare Workers
Come January 2022, the Omicron had spread like wildfire among healthcare workers. On January 2, Kolkata reported an outbreak among the medical community with more than 100 doctors and HCWs testing positive for COVID-19. Mumbai followed suit with more than 300 resident doctors testing positive in just the last three days. Delhi reported more than 100 doctors testing positive in a single day. Naturally, all these HCWs had to be isolated immediately.
As the Omicron wave hit us, we were slowly but surely falling short of professional hands to manage not just the rising number of COVID-19 patients but also those with non-COVID — both emergency and non-emergency — conditions. Hospital administrations were suddenly faced with an acute shortage of skilled hands to manage their services. Fortunately, there has been zero mortality among HCWs, but their isolation has caused a huge crisis in managing and delivering quality care to patients.
While the medical community has put new algorithms and protocols in place, hospitals and the administration — government as well as the private sector — should provide necessary care and cover to their staff. Assured, prompt and excellent treatment facilities for HCWs, giving them time to recuperate, assisting them with physical and mental care are ethical responsibilities of the institution and necessary for wholehearted compliance by the staff. Ensuring HCWs have medical insurance is another vital component of this safety net and again the institutions should be providing the same. In addition, certain non-governmental welfare and fellowship organisations like the Indian Academy of Pediatrics have made additional insurance cover available to its members at competitive rates.
However, prevention always remains the primary method of dealing with a crisis. On one hand, doctors and HCWs are supposed to practice far more diligence in terms of contact with patients as well as colleagues and family who may be symptomatic, on the other hand, we need to avoid panic among people — especially those below 60 and without comorbidities — to stop them from rushing to hospitals with milder symptoms and conditions, which can be managed at home or by telemedicine. This will help contain the extremely rapid spread of the virus and ensure our healthcare workers are protected and available for essential healthcare services.
Avoid panicking when children show COVID symptoms — morbidity rates for COVID-19 in children are extremely low and in most cases, infection can be managed at home. The Indian Academy of Pediatrics has helped digitalise practice for thousands of member pediatricians across India and parents may connect with their pediatrician for online consultations, at least as a primary precaution. In fact, even those physicians who are in isolation but not symptomatic can offer online consultations, thus decreasing the load on offline services. Because every time a COVID-infected person comes in contact with a healthcare worker, there is a possibility of infecting her and putting her out of action for a few days. And, that can be disastrous in a crisis situation.
Of course, masks, ideally N95, safe distancing and avoiding crowded places are the most effective measures we all need to continue to practice. Governments need to take strict action and clamp down on rallies and public meetings. Undoubtedly, democracy needs to have its due process, but how will it serve any purpose if life itself is threatened.
Dr Samir H. Dalwai is a consultant developmental behavioural pediatrician from Mumbai and National Treasurer of the Indian Academy of Pediatrics. Dr Anshuman Verma is a Neonatologist and Pediatrician from Jalandhar. The views expressed in this article are those of the authors and do not represent the stand of this publication.
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