The world spent 2020 huddled in shock and 2021 humbled in hope. Will 2022 bring some semblance of normalcy? Possibly yes, if we accept that coronavirus, complete with its new Omicron avatar, will be part of our new normal.
The world carries into this new normal physical and mental scars of the brutal second wave, even as a third wave, led by the Omicron variant, threatens to come calling. But our immune system is learning, say experts.
“As we live with Covid for longer, more and more people will experience its infection and hence, develop a natural immunity against it. Followed by vaccination, the chances of death and hospitalisation will be reduced severely,” vaccine expert and scientist Dr Gagandeep Kang told News18.com.
“Assume that our body is a new-born child,” the microbiologist at Christian Medical College in Vellore explained. “The child will catch more infection in the initial years as he/she is meeting more pathogens in the atmosphere. But as he/she grows up gradually, the body develops immunity and the child does not fall sick often thereafter.”
Similarly, as the human body continues to encounter different strains of coronavirus, it will widen the body’s immune response, which, at one point, will make Covid-19 as casual as “cold and flu”.
While majority of the mutations may not matter for the bulk of the population, health experts point out that challenges remain for the vulnerable population – the unvaccinated, the elderly and those who suffer from chronic diseases.
Here’s a look at the great, the good and the grim of the battle against Covid-19.
The Great: We Know More and Better Than We Did in 2020
While the first year of the pandemic was all about hit-and-trial, 2021 gave the medical fraternity more certainty in terms of designing treatment protocol. By 2022, the treatment of Covid-19 is likely to become more systematic. Clinicians, too, are more confident, unless an altogether new mutant strikes (chances of which are quite low).
In the beginning of 2020, the preferred treatment involved the usage of anti-malarial drug hydroxychloroquine (HCQ), anti-HIV drug ritonavir and plasma therapy. By mid-2020, Indian drug makers launched experimental drug Remdesivir, which was followed by Japanese flu medicine Favipiravir. Doctors started using Roche’s Actemra, also known as tocilizumab and anti-parasitic medicine Ivermectin.
In 2021, Remdesivir, plasma and HCQ proved futile in the treatment of Covid-19 and steroids became essential in severe cases. The medical fraternity understood the correct time to introduce the use of ventilators, blood thinners and tocilizumab alongside the perfect time for prescribing Ivermectin and Favipiravir.
“We started with the symptomatic management of Covid-19 where dehydration and blood thinning were key. Later, we learnt the use of steroids in severe cases and by when the patient should be put on a ventilator,” said Sumit Ray, Head of Department, Critical Care Medicine, Holy Family Hospital in Delhi.
“Many medicines, including Remdesivir, didn’t work here. We knew that antiviral pills, especially in diseases where viruses are fast multiplying, hardly work but looking at the sheer volume of the pandemic, the medical system tried a few drugs that claimed to work like a magic bullet. Finally, we learned the lesson – don’t jump onto new medicines, rather stick to the basics.”
According to Dr Kamna Kakkar, MD Anaesthesia at Safdarjung Hospital in New Delhi, “It is imperative to note that management of co-morbidities, apart from tackling inflammation and administration of oxygen as a drug when required, remains the cornerstone of therapy in Covid-19 so far.”
The Good: Precautionary Doses, Shots for Teens and and Even Pills
Going into 2022, India is expanding its Covid-19 vaccine drive with vaccines for teenagers aged 15 to 18 and precautionary shots for healthcare and frontline workers, and those above 60 with comorbidities.
To begin with, Bharat Biotech’s Covaxin will be administered to those born before 2007 as per Health Ministry guidelines beginning January 3. The precautionary shots, which are different from booster doses as per government officials, will be administered to vulnerable segments from January 10.
2022 also holds the promise of second-generation vaccines and anti-Covid pills. Bharat Biotech’s nasal vaccine, Biological E’s Corbevax and Serum Institute of India’s Covovax have been granted emergency use authorization. Corbevax and Covovax have shown efficacy of around 90% in clinical trials which is higher than the efficacy of the vaccines currently available.
“In the coming year, we can expect specified vaccines which are more advanced in terms of immunogenic response,” said Dr Sushant Meshram, Professor and Head, Pulmonology, Government Medical College, Nagpur.
“To launch a drug against HIV or tuberculosis, it took decades of research. The vaccines against Covid-19 were launched in a duration of some months. However, they will keep updating to sharpen the response and safety profile.”
Plethora of companies across the globe are working on a range of novel technologies to improve the immune response of the already available Covid-19 vaccines. These are known as second-generation vaccines. Generating better quality antibodies that may last forever is one of the main expectations from the second-generation vaccines.
For instance, French biotech company Valneva’s vaccine contains an adjuvant to boost the immune response aiming to elicit better protection in the elderly.
Another game-changer could be American firm Vaxart’s under-development vaccine-in-a-pill which will help tackle the issue of needle phobia.
Experts say anti-Covid pills could be the next big thing in 2022. In December, Pfizer’s new Covid-19 treatment pill Paxlovid and Merck’s Molnupiravir were granted emergency use authorization by the American drug regulator.
India too approved Molnupiravir on December 28 with Health Minister Mansukh Mandaviya saying it will be manufactured in the country by 13 companies for restricted use under emergency situation.
The treatment, if successful in real-world settings, could play a significant role in reducing hospitalisations and deaths among the unvaccinated and medically vulnerable population.
For now, precautionary doses announced by Prime Minister Narendra Modi on December 25 are likely to be the same shots given during the first and second dose. But with calls for booster doses growing louder with the spread of the Omicron variant, experts believe that India can use Novavax’s Indian version Covovax and Biological E’s Corbevax as booster doses apart from Gennova Bio’s mRNA platform.
In terms of Covid-19 testing, home testing kits and saliva tests are expected to flood the market. Also, the time taken to generate reports is likely to come down.
“We foresee the hub-and-spoke model to give way to more decentralised diagnostics, which will enable patients to get their test results faster, without their samples being sent to labs located afar,” said the spokesperson at Pune-based diagnostic firm MyLabs Solutions.
The capacity and manpower for molecular testing increased significantly during 2021, even higher than the previous year.
The Grim: Virus Could Be Tamed But May Not be Trounced
India has so far recorded more than 4 lakh deaths due to Covid-19, according to the official data on the website of the Ministry of Health and Family Welfare.
With the advent of Omicron, experts believe that the war is far from over.
In January, scientific journal Nature had asked more than 100 immunologists, infectious-disease researchers and virologists working on coronavirus whether it could be eradicated.
It found that “almost 90% of respondents think that the coronavirus will become endemic — meaning that it will continue to circulate in pockets of the global population for years to come.”
Indian scientists echo similar understanding. According to Dr Vishal Rao, member of Karnataka’s genomic surveillance committee, there will be an obvious race of vaccines and variants in the coming years till the coronavirus reaches endemicity.
“At this juncture, the virus seems to be treating this entire ecosystem like a global village and the vaccine inequality will keep the world vulnerable against Covid-19,” he said.
“Three for me, none for you won’t work,” he said, while explaining the vaccine inequality between the United States and Nigeria. “While some countries have vaccinated just 3% of their population, some countries have vaccinated 100% of their population and launched booster doses too.”
Dr Rao believes that with Omicron coming, the concept of herd immunity is fading. “The world needs to learn that a combination of a full dose of vaccine is required with appropriate masking, social distancing, open ventilation and hand hygiene.”
According to former ICMR scientist and epidemiologist Raman Gangakhedkar, generally, as the virus progresses, it becomes more infectious but its virulence (characteristic to kill) decreases.
“The virus has to keep the host alive, hence its virulence goes down but infectivity goes up. Till now, on Omicron, we have been groping in the dark,” he said, adding that one thing we must continue to do during the pandemic is to “accept what we don’t know”.
If by 2022, cases go up due to Omicron or any other strain, he said the government should only look at “calibrated lockdowns to avoid the economic impact” as health impact may not be as much considering that “as virus progresses, its virulence goes down”.
If we want a happy 2022, ownership lies on individuals, experts said.
“With this scenario, it is the ownership of every individual to ensure that while remaining economically productive, we take care of health eco-system by following appropriate behaviour and getting vaccinated,” Rao concluded.
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