Two years of COVID-19: It has been two years since the coronavirus emerged, and since then, the way the world functions has been changed. Masks, sanitisers and gloves have become a part of the attire, while vaccinations have comfortably replaced weather as general conversational topics. During this time, not only have the countries seen different types of and various stages of lockdowns, but also a sort of isolation that had previously existed in a pre-globalised world. Yet, here we are, two years later, with the virus not only still existing but also mutating into a new variant that has the scientists scrambling for answers all over again.
To understand where we stand in our fight against coronavirus and Omicron two years on, Financial Express Online spoke to several doctors.
COVID-19 vaccination and the way forward
The vaccination drive started in India at the beginning of the year, and a year on, 144.54 crore doses of vaccines have been administered across the country.
According to Dr Jinendra Jain of Wockhardt Hospitals, Mira Road, “Covid-19 vaccination is the best way to protect yourself and the people around you from the virus. The vaccination can help to curb the spread of the virus. Whoever is eligible for vaccination need to get the jab on an immediate basis without worrying about the side-effects of the vaccine. The side-effects range from pain and swelling at the injection site, body ache, and fever for 2 days. Do not panic at all. These vaccines will work wonders when it comes to new variants like Delta and Omicron and reduce the hospitality, morbidity, and mortality rates.”
“In real-life circumstances, Covid vaccinations have demonstrated a good response and effectiveness in reducing the severity of the pandemic. Over the last few months, definitive results have been seen worldwide of preventing moderate to severe Covid illness with vaccination. It is something that everyone should take.” said Dr Pruthu Narendra Dhekane, Consultant- Infectious Diseases, Fortis Hospitals Bannerghatta Road, Bengaluru.
Dr Sanket Mankad, Infectious Diseases Specialist at Ahmedabad-based Shalby Multispecialty Hospitals said, “Early signs indicate that current vaccines might not work quite as well against Omicron. Researchers in South Africa have detected a surge in the number of people catching COVID-19 multiple times. It is postulated that the variant might be better at escaping some of the protection offered by vaccines, or past infection. However, there is no evidence yet that it causes more serious illness. According to preliminary data it might even be milder, based on the cases that have occurred so far, although it is too soon to know for sure. In my view, with other COVID variants, the risk remains highest for people who are senior citizens or are immunosuppressed like HIV, patients with bone marrow transplant and solid organ transplants, patients on steroids etc. Studies are underway to ascertain the complete efficacy of the vaccine against new variants.”
The way to protein-based vaccines
So far, most of the vaccines in use are based on mRNA and viral vector. However, now, many firms are going back to developing vaccines based on the old protein-based technology.
“Protein-based vaccines are directed against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that could be an alternative to the mRNA-based vaccines currently approved for minimizing the risk of coronavirus disease 2019 (COVID-19). But, protein-based vaccines are reportedly safe and effective,” said Dr Jain.
Dr Dhekane said, “When the pandemic hit, all clinical scientists and molecular biologists were unaware of this new viral infection. But with great efforts, we were able to decode the genetic sequence of the new virus. We don’t have good antiviral treatments as we do have antibacterial drugs, which makes treating a viral infection more challenging and uncertain outcomes. Alongside treatment options for Covid, scientists began working on a vaccination for the disease. We were driven into a corner because the mortality and morbidity were so high, and we needed to develop a vaccine as soon as possible to reduce the burden of the disease. However, because of time constraint, scientists modified conventional vaccine production technologies to fasttrack vaccine development.”
“Diverse virus particles, such as mRNA, Spike protein components, and viral vector-based vaccines, were employed to develop various vaccines. Because covid, like other viruses, changes its molecular structure rapidly as part of evolution, vaccinations based on past variants may not be effective with time. Vaccine development and manufacturing typically takes 8-10 years before being released onto the market but because of the pandemic crisis, Covid vaccines were developed on war footing and hit the market within a year. Protein-based platforms have been used for creating vaccines for many decades. To mention a few, Hepatitis B, herpes, and influence vaccines have all been developed on the same platform. The virual protein rather than tiny pieces of RNA or viral components are used in these protein-based platforms of vaccine manufacturing. The theory is that if the virus has a little genetic alteration, having a vaccine that targets the entire protein could overcome these changes and continue to offer protection. The development of these protein-based vaccines for covid were also started two years ago are now entering clinical phase studies at the normal production speed. They have demonstrated promising outcomes, good efficacy, and relatively minimal side effects despite variations in covid variants. These are, of course, the results of phase 3 clinical trials that have not yet been approved by regulatory authorities, so more time is needed to confirm them,” he added.
Breakthrough cases explained
“An infection of a fully vaccinated person is referred to as a ‘vaccine breakthrough infection’. Vaccine breakthrough infections are expected. COVID-19 vaccines are effective at preventing most infections. However, like other vaccines, they are not 100% effective. Fully vaccinated people with a vaccine breakthrough infection are less likely to develop serious illness than those who are unvaccinated and get COVID-19. Even when fully vaccinated people develop symptoms, they tend to be less severe than unvaccinated people. This means they are much less likely to be hospitalized or die than people who are not vaccinated. People who get vaccine breakthrough infections can be contagious,” Dr Mankad said.
“The Delta variant is more contagious than previous variants of the virus that causes COVID-19. However, studies so far indicate that the vaccines used work well against the Delta variant, particularly in preventing severe disease and hospitalization. The Omicron variant is twice more infectious and transmissible than the Delta variant and further studies are underway to assess the vaccine efficacy against the new variant. In October 2021, Merck released promising study results about an oral antiviral drug to treat COVID-19. Compared to placebo, the antiviral drug, called Molnupiravir, significantly reduced the risk of hospitalization and death in people with mild or moderate COVID-19 who were at high risk for severe COVID. Interim study results released by Pfizer in a press release in November 2021 showed that its oral antiviral treatment, called Paxlovid, significantly reduced the risk of COVID-related hospitalization and death compared to a placebo. Patients who had taken Paxlovid within three days of symptom onset had an 89% reduced risk of COVID-related hospitalization or death compared to those who took a placebo,” he added.
Therapeutic treatment for COVID vaccine
“As far as the treatment of Covid is concerned, the antibody cocktail is really proving itself a game changer and getting proven well in preventing mortality and complications of Covid. The beneficial effects of Ramdesivir are still doubtful. The use of steroids really makes the difference if they are used judiciously,” Dr Jain said.
Dr Dhekane added, “Unfortunately, there have been no major definitive treatment options of covid so far and the use of steroids and blood thinners are still the most tried and tested and successful modalities for mild, moderate and severe covid treatment. Antiviral medications, monoclonal antibodies, and antibody cocktail combinations have all been developed and have demonstrated significant effectiveness against various stages of covid illness. There are few tablet-based medications in the pipeline which prevent worsening of covid illness, morbidity and mortality on which high hopes of the entire community lay upon.”
Meanwhile, Dr Mankad said, “Some treatment options available for COVID-19 are Dexamethasone, Tocilizumab, Remdesivir, or Anticoagulation drugs (“blood thinners”). Three monoclonal antibody treatments for COVID-19 have been granted emergency use authorization (EUA) by the FDA. The treatments may be used to treat non-hospitalized adults and children over age 12 with mild to moderate symptoms who have recently tested positive for COVID-19, and who are at risk for developing severe COVID-19 or being hospitalized for it. This includes people over 65, people with obesity, and those with certain chronic medical conditions. Newer research suggests that monoclonal antibody treatment may also help to save lives in a specific subgroup of hospitalized COVID-19 patients. Monoclonal antibodies are manmade versions of the antibodies that our bodies naturally make to fight invaders, such as the SARS-CoV-2 virus.”
Omicron and things to keep in mind
“Omicron variant was first identified in South Africa and is designated as a ‘variant of concern,’ by the World Health Organization (WHO). There are around 32 mutations that are seen in this variant which is highly transmissible. As per initial clinical evidence, this variant may not lead to severe illness or mortality. The symptoms of this variant can be a sore throat, weakness, and body ache. As per the information available, there is no drop in oxygen levels or hospitalization. A loss of smell and taste has not been reported due to this variant which was seen during the Delta variant. The variant is not completely understood yet. But, a few cases of it have been detected in the country,” Dr Jain said.
According to Dr Mankad, “The Omicron variant likely will spread more easily than the original SARS-CoV-2 virus and how easily Omicron spreads compared to the Delta variant remains unknown. Omicron infected patients can spread the virus to others, even if they are vaccinated or don’t have symptoms. More data is needed to know if Omicron infections, and especially reinfections and breakthrough infections in people who are fully vaccinated, cause more severe illness or death than infection with other variants. Current vaccines are expected to protect against severe illness, hospitalizations, and deaths due to infection with the Omicron variant. However, breakthrough infections in people who are fully vaccinated are likely to occur. With other variants, like Delta, vaccines have remained effective at preventing severe illness, hospitalizations, and death. The recent emergence of Omicron further emphasizes the importance of vaccination and boosters. Scientists are working to determine how well existing treatments for COVID-19 work. Based on the changed genetic make-up of Omicron, some treatments are likely to remain effective while others may be less effective.”
Dr Dhekane, “Viruses are constantly changing and mutating. The omicron virus is a variant of concern, according to WHO, because it has a lot of genetic structural changes compared to the wild or ancestral variant, which could lead to more transmissible and possible severe disease, as evidenced by data from South Africa and other countries. Also, the ability of this variant for causing breakthrough infections after full vaccination and/ or prior illness is a cause of major concern. Despite different variants, treatment options, vaccination coming up daily, the one thing which has not changed since the advent of covid pandemic for protection from covid infection is following social norms. Universal masking, physical distancing and hand hygiene will offer protection from covid despite any variation, mutation and from Omicron variant as well.”