India is better prepared to face the Omicron wave, if it comes, but people should always wear double face masks as these continue to be the best protection against any variant and take vaccines while regulatory authorities should authorise emergency use of two oral drugs for treatment of Covid-19, said a health systems expert.

Dr Krishna Reddy Nallamalla said while it has become clearly evident that Omicron is more infectious than Delta variant, the ongoing debate is by how much. Preprint research publication from South Africa has convincing evidence that it evades immunity acquired after natural infection.

"Everyone has kept their fingers crossed as to its virulence (ability to cause more serious illness, hospitalisations and deaths). Initial reports that the cases are generally mild may be giving a false hope as Covid illness generally worsens during 2nd to 3rd week after the onset of infection as the immune system becomes hyperactive in response to the multiplying virus. Secondly, dominantly younger African population with stronger innate immunity may not develop severe illness. We have to closely watch its behaviour in elderly and population with other comorbidities," says Dr Reddy, President (South Asia), InOrder, a nonprofit institute working to strengthen systems to secure health

Most of the vaccines, in general, have demonstrated their effectiveness against new variants including Delta in preventing hospitalisations and deaths. However, their effectiveness seems to be waning rapidly over time (6 to 9 months after 2nd dose), necessitating booster doses to those at high risk and to all adults if sufficient vaccine supplies are available.

Whether Omicron evades immunity from existing vaccines is yet to be ascertained as the percentage of people who have been fully vaccinated is still low in Africa.

A hint from the CEO of Moderna (that makes mRNA-based vaccines) that they may need to develop a new vaccine to tackle Omicron is a pointer that it may evade immunity from vaccines as well. "However, we have to await data on breakthrough infections in fully vaccinated people," said Dr Reddy who is also regional director (South Asia) of global health nonprofit, ACCESS Health International

The leading cardiologist pointed out that parents are the most worried as schools and colleges have just begun to open after nearly two years of studying from home. Government is awaiting expert committee recommendations on vaccinating children and booster doses to adults. "We were fortunate that the earlier variants did not impact children and young people as they have done with elderly. It is still not clear if Omicron behaves in the same way or differently. Until new evidence comes out, it is prudent to keep children at home and follow Covid appropriate behaviour."

He believes that India has responded in a balanced way. The country did the right thing by not shutting down its borders but taking standard measures of screening, testing, quarantine, and isolation of incoming people. The government has ramped up its vaccination drive as reluctant people become more than willing to get vaccinated given the scare of the new wave.

Face mask and vaccination certificate mandates have been reintroduced to domestic travellers across state borders.

Hospitals across the country are better prepared now in terms of oxygen surplus capacity and ventilator beds. People and businesses have learnt to reinstate Covid appropriate behaviour at short notice.

"Regulatory bodies may fast track emergency use authorisation of two oral drugs (from Merck and Pfizer) that have demonstrated effectiveness against Covid virus. Fortunately, many Indian pharma companies have been licensed to manufacture and distribute Molnupiravir of Merck. Many others may be in talks with Pfizer for licensing its drug. These drugs are expected to be effective against Omicron variant as well as their site of action is not likely influenced by the numerous mutations seen over the spike protein. However, monoclonal antibodies developed against spike antigens may be less effective in view of the mutations."

According to Dr Reddy, face masks continue to be the best protection against any variant. However, correct use of these have to be repeatedly emphasised through public awareness campaigns. To be effective, these masks have to be properly fitting over nostrils to prevent virus going into the body. Double masks (cloth masks covered with surgical masks) are the most cost-effective protection and are almost comparable to N95 masks which may be expensive for many.

Airlines may stop serving or allowing eatables in planes until things become clearer. Eateries may reintroduce social distancing as people have to remove their masks during eating. Social protection (free rations, direct benefit transfers, unemployment benefits, etc) be extended until the situation settles. Governments should address growing inequity due to Covid, he added.