The Omicron threat to Bhutan after it arrives in neighboring India

Twenty one COVID-19 cases of the Omicron variant have been detected in India so far. 

There are more suspected cases in India who are quarantined with their genome reports awaited in the coming days.

The WHO in a statement on Friday said that Omicron had been detected in 38 countries up from 23 countries on Thursday and said that it could possibly be more infectious than Delta though actual data is awaited.

In an interview last week Technical Advisory Group (TAG) member Dr Sonam Wangchuk had once the neighboring country (India) detects the new variant then it highly possible that Bhutan is expected to detect the new variant in Bhutan too.

He had said if the new variant is detected in the country, it will likely be in the southern borders. However, he had also said there will not be huge outbreak since the country still has a strong surveillance system and another point of entry is in Paro Airport, where a strict quarantine protocol is being followed.

A matter of concern for Bhutan is that it continues to get people from outside who are coming in either from Paro airport or the Southern border who are testing positive. Bhutan has just established a genome testing facility at the Royal Center of Diseases Control and so far no Omicron cases have been detected. 

If any of them coming in brings the Omicron strain, then it will likely be much more infectious than the highly infectious Delta which caused a lot of havoc in Bhutan, especially with long lockdowns in Phuentsholing and partly in Thimphu and Paro.

This follows a new report on CNBC in Friday which says that as more cases of the new omicron Covid variant emerge around the world, experts say it’s likely that the variant, first identified in South Africa last week, had already been circulating for some time.

The report talked of increasing signs of community transmission, with cases emerging with no travel links to southern Africa.

In Scotland in the U.K., for example, 9 cases have been detected that have been traced back to a “single private event” held on Nov. 20 and none of the individuals involved are believed to have any recent travel history to southern Africa.

Then, on Tuesday, the Netherlands said it had identified the omicron variant in two test samples taken in the country between Nov. 19 and 23 — before the variant was first reported by South Africa and travel bans came into place.

On Tuesday, Germany also reported an omicron case in a man in Liepzig who had not been abroad, nor had contact with anyone who had been.

Meanwhile Botswana, said last Friday that it first detected the variant on four foreign nationals who entered the country on a diplomatic mission on Nov. 7 far earlier than it was reported by South Africa as part of its regular Covid surveillance.

AFP reported that a preliminary study by South African scientists published on Thursday suggests the Omicron variant is three times more likely to cause reinfections compared to the Delta or Beta strains.

The findings, based on data collected by the country’s health system, provides the first epidemiological evidence about Omicron’s ability to evade immunity from prior infection.

The paper was uploaded on a medical preprint server and has not yet been peer-reviewed.

There were 35,670 suspected reinfections among 2.8 million individuals with positive tests until November 27. Cases were considered reinfections if they tested positive 90 days apart.

“Recent reinfections have occurred in individuals whose primary infections occurred across all three waves, with the most having their primary infection in the Delta wave,” tweeted Juliet Pulliam, director of the South African DSI-NRF Centre of Excellence in Epidemiological Modelling and Analysis.

Pulliam cautioned that the authors did not have information about the individuals’ vaccination status and therefore could not assess to what extent Omicron evades vaccine-induced immunity. The researchers plan to study this next.

Michael Head, a scientist at the University of Southampton, praised the research as “high quality.”

As Omicron has been designated a ‘Variant of Concern’, there are several actions the World Health Organization (WHO) recommends that countries undertake, including enhancing surveillance, implement the effective public health measures to reduce COVID-19 circulation overall, keep a physical distance of at least 1 meter from others, wear a well-fitting mask, open windows to improve ventilation, avoid poorly ventilated or crowded spaces, keep hands clean, cough or sneeze into a bent elbow or tissue, and get vaccinated.

Dr Poonam Khetrapal Singh, Regional Director, WHO South-East Asia, stated the response measures for all variants, including Omicron, is the same as that for SARs CoV2. Omicron variant has a large number of mutations, some of which are concerning. Researchers around the world are conducting studies to better understand transmissibility, severity and immune escape capabilities of Omicron.

During a live discussion TAG member Dr Tshokey said before Omicron, the Delta Variant had only eight mutation points in the spike protein, but the Omicron has more than 32 points of mutations, that is more than four times than the Delta Variant.

So far, all the characters of Omicron are based on assumptions, such as that the new variant evades vaccines, the new variant is more infectious, it evades test kits. There is one thing that is confirmed, so far, is that it is highly transmissible which has been seen in South Africa. To confirm all the characteristics of the Omicron, CDC will have more evidence in a few weeks’ of time.

Dr Sonam Wangchuk, said when a new variant is detected, it needs to fulfill three criteria, on the transmissibility, severity and deaths. Till date, Delta Variant is highly transmissible and more information is awaited.

They said they will have to wait for more information on the new variant on whether the test kits can be used or it needs to be changed. The treatment is more or less the same. If there is evidence that the new variant evades the immune system, then the antibody may not be effective compared to other variants.

The concern is whether Omicron evades the immune system, and based on the mutation, it is likely to evade, but it does not really mean that the current vaccine will not help. The current vaccine will definitely help in cross protection. However, TAG is still waiting for concrete evidence, and scientists, globally, are working hard to find out the rate of transmissibility, severity, vaccine efficacy and overall impacts.

Dr Tshokey said there is no confirmation on the deaths lead by the Omicron, for now, and though it has infected people in the shortest time but still severity is still not confirmed.

Dr Tshokey said Bhutan has not gone into full relaxation except for reducing quarantine for fully vaccinated people, and a lot of COVID-19 protocols are still in place, and enhanced surveillance, security around the border and all the entry points are being strictly followed.

“We are confident that all these mechanisms in place can be relied upon to detect any incoming people with Omicron. As for the treatment side, we have quarantine facilities in the southern parts and in Paro as well, and isolation facilities if required. Presently, there is no need for additional measures,” he said.

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