Omnipresent Omicron starts to lose its edge

As elsewhere in the world, the Omicron-led third wave in Nepal is starting to peak, but experts say the pandemic is far from over. 

The Health Ministry had previously projected new cases to soar to 20,000 a day, and the Omicron surge to peak in mid-February. But the fact that the variant spread rapidly like wildfire right across the country giving a majority of the population milder symptoms meant that it equipped them with antibodies to fight the infection.

At Nepal’s biggest infectious diseases centre at Teku Hospital, virologist Sher Bahadur Pun predicts that the third wave will most likely peak in a few days, or by the end of next week.

“For the past week, I have observed that the number of people coming in for tests and consultation every day has decreased by a half,” Pun says. “Of course, not everyone is coming to the hospital, but this is the beginning of the end of this wave.” 

To be sure, the government’s daily Covid-19 figures are gross under-estimations. Mostly symptomatic patients are testing, thus registering a very high positivity rate. Infected people with flu-like symptoms are isolating at home without a PCR test. There are also people self-testing with kits available at pharmacies, and these infections are not in the official tally.

Even so, figures from elsewhere show the Omicron surge lasts only for a month or two. South Africa, where the variant was first detected in December, is over the hump. The UK and parts of the US have also passed their peaks. Many countries, including Australia, are now removing restrictions.

"It is too early to be sure about exactly when the high number of cases will subside completely," Andrew Pollard, of the team that developed the Astra Zeneca vaccine, told Nepali Times in an email interview from Oxford. "The main issue with rapid spread of Omicron is for the unvaccinated who may be at risk of severe disease, particularly if they are older adults and those with other health conditions."

The spread of Omicron in Kathmandu Valley is expected to reach an equilibrium soon, with a steep fall in cases, says Bangkok-based public health expert Sushil Koirala. But he warns slower-moving outbreaks may continue outside the valley where the population is thinly spread. 

“These next 10 days are critical. It will tell us if the Omicron variant is indeed a quiet pass to a pandemic end-game, or we still have a big human cost to pay,” Koirala adds. “There is still little clarity on how severe this variant will be to those who are still unvaccinated and those who had the vaccines many months ago.”

The World Health Organisation (WHO) last week issued an optimistic projection that the pandemic would probably be over during 2022 — provided inequalities in the vaccine coverage and treatment are addressed. 

Global health researcher and economist Christopher J L Murray writing for the journal Lancet also said that after the Omicron wave, ‘Covid-19 will return but the pandemic will not.’

Pollard also explains that once health systems can cope with Covid-19, the pandemic could be considered over, but that doesn’t mean that the virus will be gone.

"We have a pandemic because of pressure on health systems and deaths. With growing global immunity as a result of vaccination and previous waves of infection, both severe disease and deaths should decline during 2022," he says.

Despite this, health experts in Nepal warn that severe infections needing hospitalisation have a lag of a few weeks after the surge in infections. And despite being a milder strain that primarily only affects the upper respiratory tract, Omicron can still lead to serious diseases in the elderly and people with co-morbidities.

Indeed, ICU admissions and those needing ventilator support in hospital have tripled in one month, although nowhere near the figures in April-May. Also, the seven-day average for daily fatalities have remained below five. 

Says infectious disease specialist Anup Subedee: “It will still take some time and a few more variants before the pandemic comes to an end. So our health system should be ever ready with the management and treatment of Covid-19, isolation and contact tracing.”

Virologist Pun at Teku agrees: “We are now moving from pandemic to endemic, but this does not mean that we can sound the all clear. We must continue mass vaccinations and safety measures.”

The general consensus is that increased vaccine coverage with boosting, more testing, whole genome sequencing to detect variants, and public adherence to safety measures will determine whether there will be a new surge, or if the virus will taper off.

Nepal has 20 million doses of vaccines in stock for those waiting for first and second jabs, and has started booster shots for high risk groups. However, communication on location, eligibility and requirements for vaccination centres is confusing and inadequate.

With reports from India, Denmark and the Philippines of the even more transmissible ‘stealth Omicron’ sub-variant BA.2 that can evade PCR detection, Nepal needs to continue vigilance. This is also important to determine if the Delta variant is still circuiting and how dominant it is.

“Our Covid figures from the last four days strongly suggest that we have passed the peak,” confirms Sameer Mani Dixit of the Centre for Molecular  Dynamics. “But we must keep a close watch on next week’s numbers to know for sure if the cases are just levelling off, still peaking, or if it was just a momentary decline.”