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The Oncoming Omicron Surge

May 31 | 9:30 AM

Gujarat, India, reported a case of Omicron subvariant BA.5 on Tuesday. This variant is derived from the highly transmissible Omicron coronavirus variant. These BA.4 and BA.5 variants are the sub-variants of the globally circulating Omicron variant. These sub-variants were initially discovered in South Africa earlier this year, and they have now been discovered in a number of other nations as well. Will these sub-variants lead to a new wave of COVID cases or the country's fourth COVID wave? Join us LIVE as we find out all there is to this latest surge of COVID with Medflix Select faculty Dr. Tushar Shah.

[Music] so good afternoon everyone i am dr rishali and on behalf of netflix i welcome you all we welcome you all for the q and a sort of a session on the oncoming omicron search we have with us dr tushar shah who's the consulting physician at the advanced multi speciality hospital mumbai so with that i think i'll hand it over to you thank you so much thank you so much thank you uh first of all i would request all of you because the your max will be on frequently to be in a room which is quieter especially don't be near the kitchen or near the children's room if you can okay uh why am i doing this topic because i requested netflix to organize this just yesterday and i'm grateful that they could do it on a short notice why am i talking about this we are probably looking at a small but significant surge in omicron cases that started about a week back and which will uh probably go on for at least one more month so the month of june we may see a few new peaks occurring within mumbai city all within india of omicron cases why is this important and why do i want to just refresh what we already know about omicron first of all just an introduction and then i'll make it fully interactive omikron the original omicron is called ba1 ba1 is the variant of omicron then there were some variants the first sub-variant that came into being was ba2 and within ba2 then there were multiple sub-lineages there also one of the important subliners was ba 2.12.1 for example then there was ba 3 which was inconsequential and then there have been now ba4 and ba5 so why is it important for us to know these sub lineages or sub variants of the original variant omega first of all ba1 was more transmissible than delta that you know ba2 was about 1.4 times more transmissible than ba1 and ba 2.121 was about 1.25 more times transmissible than ba2 and ba3 and ba4 are less transmissible than ba2 so transmissibility has gradually increased much more than delta at the same time all these sub variants within the omicron lineage are not showing increased virulence they are showing decreased virulence than deltas and the virulence has not changed from ba1 to ba2 to ba 4 to ba 5. one thing that has changed at least on paper is that the immune escape has increased in ba4 and ba5 for that just one brief explanation what is immune escape omicron has immune escape that means that omicron can occur symptomatic omicron can occur in people who have been vaccinated with two doses in people who have been vaccinated with three doses and in the west in people who are vaccinated with four doses omicron symptomatic can still occur in fully boosted vaccinated people that is the first aspect of immune escape the second aspect of immune escape is that omicron can occur in those who have had a first wave infection with wuhan strain second wave infection with delta strain or the other waves that occurred in south africa or uk with beta etc so omicron escapes previous infections from in the previous waves one immune escape that omega has not yet demonstrated and it might is if somebody has had omicron in ba1 phase which was in say january in india then those people are not getting omega 1 yet even with ba 4 and ba 5 but it seems that at least in vitro ba 4 and ba 5 can escape the immunity provided by ba1 so we might just might and i think it is unlikely but it might happen that ba 4 and bf5 will cause a surge in infections such that even those infected in january or so will get infection again that might happen so just this is a brief introduction and now i will open uh the session for questions and answers because there'll be many and i'll try to try to give more information gradually as to what should we do okay so let me ask myself a question and then i answer it myself why which time you should prepare your questions many people have asked me and sometimes i asked myself what will define a fourth wave in india first we have the one strain ancestral strain we call it the second wave delta strain the third wave omicron string will there be a fourth wave or is this the fourth wave the oncoming search to define a wave a new wave one must have a new virus a completely new virus which will be labeled as variant of concern and which will be given a greek letter for example after omicron the next letter would be pi so if a new virus comes with greater virulence or greater transmissibility one of the two then we will have a fourth wave also i think if ba4 and ba5 the current sublineages of omicron if they start causing infection in the ba1 affected people meaning ba1 does not provide immunity to ba 4bf5 and there is a reinfection occurring within omicron then we will look at another wave and that i think will be defined as the fourth wave and then probably the ba four bfi will be given a new nomenclature by the who say hi so i think we should wait for that to happen if it happens then we might be going for a fourth wave so far no fourth wave as of today there is a question by shazada irish what would be quarantine period from omicron yeah so uh five days is still the quarantine period we call it isolation period rather than quarantine isolation period is still five days and uh i think we should stick to that the first day should be counted as the first day of any symptom for example if the symptom is off on the first day viewer comes on the second day the first day of cough should be counted if there is diarrhea some people get diarrhea as you know if the idea is there on the first day and fewer cough on the second day then diarrhea first day should be counted now why five days and why not ten days why not can omicron spread after five days yes it can spread after five days but the viral load becomes significantly less so i think five days is a reasonable time i do suspect that if uh the ba4 bf5 remain mild viruses or even the future sub-variance of whom we can't remain mild i do think that gradually the whole concept of isolation will go away and masking will all be uh will be all that is will be necessary in affected households and i wish that happens why i wish that happens is that omicron transmission with a low iron load within the family might be a good thing to happen the more people get omicron the more immunity becomes widespread and they will not get omicron in the future also omicron infection might give great great immunity against future variants better than the immunity provided by vaccines so that i think isolation should now be gradually limited so if you have a very elderly person in the house unimpunized unvaccinated person in the house uh immuno compromised most person house then isolate well so yeah okay uh well dr i think that question was answered dr another question what would be the alarming symptoms or signs for admitting the patient [Music] okay this is a good question and this is very important to know this every patient omicron who comes to you first good question to ask is are they vaccinated we have now enough proof that vaccination protects against severe omega boosters protect against severe omicron even better so if vaccination has been not done in a patient this patient had to monitor very carefully with six minute walk test for hypoxia etc and these patients may require hospitalization as you know the reasons for hospitalization remains standard the number one reason for hospitality for me in omicron because hypoxia will probably not occur because it doesn't affect lung so much the number one reason would be prolonged fever with debility dehydration so if the fever goes beyond three days then you have to start working on um on investigations and admit the patient it will very commonly happen during omegran season that patient will have fever will test positive for omicron and the fever may be due to some other reason and not omigrant because coincidentally rtb share can be positive such is a prevalence of omicron so you have to any patient who has fever more than three days you become more careful so standard uh reasons stability dehydration and of course hypoxia will be reasons for hospitalization okay uh thank you so much uh dr rashmi agrawal has a question is the entire family still quarantine or is it only that individual who's isolated only the symptomatic and will be isolated and here again there is a paradox because it is so transmissible that if there is one infected and symptomatic person it is very likely that there will be one more or more people who are asymptomatic and infected and they may transmit to others but i see no reason why we should push for stricter isolation policy in this very mild infection we don't do it in influenza we should not do it in omicron so i am saying even the infected person with symptoms should now probably not be isolated and just masked so i think with good masking if you are going to a crowded place and there is an infected person in the house and you're going to a clinic as a doctor then you will mask as a precaution to protect others and remember one way masking is enough okay okay uh dr rashmi has another question that vitamin d is given in what dose so vitamin d my standard prescription of omicron because i give omicron treatment as symptomatic treatment paracetamol no antibiotics or no nsaids and of course no antiviral drugs no mole nuclear with nothing else i just keep my small vitamins and i give active vitamin d either alpha d3 brand or caltrol brand as 0.25 micrograms bd for five days this might be just placebo but we have to give something to the patient that will be a placebo because otherwise the patient will take azeroth myosin or from somewhere else so give rocaltrol or alpha calcium in this dose it is slightly expensive but it's a good look for giving immediate vitamin d level rise otherwise normally i give vitamin d 60 k once a month to everybody almost everybody uh for life so that you can use omega 1 as an excuse to start monthly vitamin d if they're not taking right uh thank you the next question by dr girish mysurvala that what is the level of preparedness of the entire health care system oh i think sometimes the healthcare system overreacts for example in mumbai i'm talking about mumbai because i live in mumbai uh we have heard now that uh at least one private hospital has started a nice icu dedicated to kohit because of the oncoming search there is one bmc setup which is now again kind of reopened for a micron i think overreaction because umicron will not need significant ico admissions so our preparedness the most important preparedness should not be from the bmc or the government the most important preparedness preparedness should be from the family physician if the family physician does uh their job well there is no need for any other person to take responsibility so let us take responsibility treat correctly inappropriately stop and demand i still see antibiotic prescriptions and i am ashamed that i still see antibiotic prescriptions by pediatricians to children with omicron by adult physicians to adults with micron and we we must talk whatever your excuse of giving antibiotics there is no secondary infection no reason to give antibiotics yeah right uh dr himani pandey has a question that the one who has got omicron infection and has not taken the booster how much of the severity can be expected in such cases nothing if you have taken two doses you're not unless you're immunocompromised i'm not seeing uh severity at all i'm seeing 85 year olds 90 year olds who have taken two doses and they get their micron one day fewer two days year maximum three days fewer and they are fine so i think we we should be we should be fairly relaxed in in this unvaccinated i would say yes and remember one first wave or second wave infection even after two years is better than two doses of vaccine that is my very strong belief without any documentation but we see this happen every day do not worry in those patients also who have got any wave infection they will be protected against severe infection not against omicron symptomatic infection but again severe infection so dr rashmi has another question that government is still insisting on 10 10 days isolation so what is the justification behind that i don't know this recommendation i thought the recommendation gone down to four or five days we should check but if the government is saying 10 days we may disobey the government is there any vaccination for neonates or for kids below 10 years is asparagus i think a vaccination in india has i'm not a pediatrician but vaccine has been approved some sort of vaccine is approved of about two years of age i wish i do you think you know that two years plus i think the trials were going on i think for cydus scheduler their vaccines had trials and they had it for them but not yet in the market still in the process i think two plus years somebody happening vaccines have been approved but i have this very strong belief which is against the advice of pediatricians that i do not think children should be vaccinated unless they are immunocompromised i would not vaccinate anybody under the age of 30 unless they are immunocompromised or if there is mandate by their school colleges by travel universities abroad unless that is there please refrain from vaccination because the risk benefit ratio is not great what is the risk severe covalent how many children get civil code very rarely what is the uh what is the uh risk of giving the vaccine the risk of ringing action is as you know in kobe shield we get venus thrombosis so coefficient which is approved above the age of 18 i think we should i think we should avoid in children and of course remember this that most youngsters have had omicrons and you will be giving acceleration to people who had omicron and that is not fair so that brings me one to one more important thing somebody is asking do we get covered antibodies done dr poor key doctor is asking important thing here if you have a kid who is 25 years old and if you think that you don't want to give take the risk of severe covet at the same time you don't want the risk of the vaccine you can do antibodies or igg antibodies to nuclear capsule antigen of sars cov2 antibodies to nuclear capsule antigen if positive that means the child has had infection in any one of the three waves first we have second third we cannot then if these antibodies do not differentiate between waves or even adults for that matter you as a doctor if you think that okay i don't want to take the booster uh but i am i want to be sure that i have antibodies two previous infection these are not spiked protein antibodies these are nucleocapsid antigen antibodies so do those antibody tests for example i have done my antibody to nuclear capsule antigen i am positive for the antibody i never had any symptom never had symptomatic omicron never had symptomatic delta or a previous wave so i have antibodies and uh that helps me decide that i should not take the booster i'm below 60 so i should not take the booster if if possible uh another thing to remember here is for every omicron case which is symptomatic there are 50 omicron cases which are asymptomatic so the ratio of symptomatic equation is as high as 1 is to 50. so so many people have had omicron and then you will be giving vaccine to them unnecessarily our government has approved now boosters for all ages all adult ages at least and i i think there is an overreaction of course there is a lot of vaccine in the market where which should be wasted and that might be one motivation for vaccination to be pushed but i think we should not succumb to that dr purity has a question that like you recommended that masking is important so which mask to use a simple surgical one would do or you require the n95 so uh yeah there was another question should we mask in the clinic as doctors if you have had omicron meaning infection after december 25th or so or if your antibodies to nuclear capsid antigen are positive don't mask no need to mask absolutely if you have not had omicron and uh you want to protect yourself against omicron which is very difficult almost impossible because you won't be masking in every place let alone clinics you will be going to functions parties joggers park chapati beach you will get your omicron whenever you have to get you will get you can't escape omicron easily but if you want to escape it in the clinic where an n95 mask nothing else will do omicron is just does not just have immune escape it has escaped to surgical masks it has escaped two cloth masks it has only n94 995 if at all will protect you a genuine and 95 be protected so yes okay great uh dr is asking does omicron also involve all systems or only throat and the gi symptoms no only throat and gi syndrome predominantly so omega that is the great thing about um omicron is a smart virus it knows that it does not it should not kill the host and omicron therefore keeps the host alive so that the host can give it to other people and etcetera etcetera so no only upper resolution slightly gi tract less common much less commonly gi tract lung pneumonia has been seen especially in those unvaccinated or those who are very old but uncommon or rare that's rare there have been debts this is a good case study because north korea which was a closed country has significant surge of omicron and multiple deaths thousands of deaths probably going on there because in omicron because they are unvaccinated so north korea is almost completely unvaccinated and so this is another reason why we know that vaccination prevents deaths prevents hospitalization right yeah yeah so there's one question yeah so you've already answered that dr rashmi had asked that after omicron infection vaccination can be taken after how many days but i think you already answered that after omicron you don't need a vaccine so i'll tell you explain this a little bit more after omicron no actually no booster and even if you've never taken vaccine after micron don't take any vaccine is my unless mandated of course i do believe that if a new variant comes say pi let's call it pi for the moment then the vaccine which has been ineffective against omicron mild infection will be even more ineffective against that that new variant and we will have to have newer vaccines that will become mandatory the reason why the companies now there's already work going on in the u.s on new york vaccines which are omicron based but i think it'll be too late for them to come out now because they won't be useful you know so i don't think you should vaccinate yourself before omicron is the best currently available vaccine i know that uh i should not encourage people to get omicron as a vaccine but omicron is the best currently available vaccine okay so would there be any changes in the cbc report for omicron patients like what to watch out for is so lymphocyte count as as usual you should watch for but we are not seeing significant lymphopenia in omicron so i'm not worried i don't even do cbc i don't do any blood tests in omicron i do rtp somebody asked should we do articulation in all suspected cases or rapid antigen testing you must do rapid antigen test on day one if negative repeat on day two if suspicion is strong for example rather my family members have do rt pcr it is a very good idea to prove omega to prove that this patient had coveted because future actions will depend for example if the patient has fever now and the fever turns out to be omicron if the patient gets fever again next month with coffin cold now you know this cannot be omicron and you may be able to treat correctly as influencer or if the patient is dengue with incidental cough and cold you will be able to investigate it you must investigate the person with artificial or appetite test all patients in between in january we had stopped doing rtbcr and even rapidly but i think in this particular surge and remember this surge will last maximum one month why am i saying is because the we are following south africa pattern more or less south africa had its first omicron in mid-november and that surged uh in november december jan there we started in end december and we searched in jan and lasted till february or so now they have searched so since last one months and their surge is now declining we will start we have started surging and we will take one month to start declining and since the surge in south africa due to ba-4ba5 south africa is ba 4bf5 currently predominantly the surge is pa 4bf5 and yet despite the surge they have not seen significant reinfections within omicron meaning ba1 people which were so many in south africa have not got ba4 bfi and that surge is now declining so i do hope that this surge will also be short-lived this will not be a fourth day okay so after omicron infection how long does the immunity remain in our body uh we now this is an area which i am a little upset about most people when when they promote boosters they say that the third dose increases antibodies neutralizing antibodies fourth dose has increase in utilizing antibodies even more nobody can test for or is testing t cell immunity we i think for example if you get you know that your dengue has four subtypes and if dengue one subtype occurs once for life time your t-cell immunity protects you against that sub type of degree similarly i believe that if you had delta once your life is protected from delta by that is celebrity forever similarly omicron forever so i do think that we should not say how long it lasts based on antibody levels t cell t cell immunity is a huge uh arm of the immunity and we should rely on that okay yeah yeah thank you doctor shawnak has a question that are there any investigations required like crp or ddimer or any yeah so as i said i don't even do any blood tests uh we should not we should discourage crpd diameter not only we should not do we should discourage the patient from even thinking of doing crbd hammer because what happens often is crp will be normal level is five maybe nine ten elevated crp panic inducing d diver often we get false reports and drama may be high if normal is below 500 800 800 900 people have started anti-coagulants based on 800-900 ridiculous decisions happen because of investigation so we must not do even cbc in omicron unless the fever goes beyond 72 hours one reason to do blood tests is if the patient has co-morbidities like diabetes blood pressure coronary artery disease and if the patient is not done routine testing for some time make omicron an excuse to do blood tests so in a diabetic patient you will do random blood sugar or fasting pp hva1c etc so make this as an excuse to do blood tests but otherwise don't do practice okay thank you dr nirisha is asking that are there any new precautions implemented in south africa and what's the mortality rate there i mean is there anything that india can be prepared for [Music] um yeah is it clear now okay uh can you hear me can you not yeah yeah yeah yeah your voice is not audible to me at least you can ask somebody else who was with you can you hear me now okay hello [Music] are you able to hear me now sir i can can you mean yeah yeah yeah yeah i can uh so dr nirisha was asking that what is south africa's mortality rate and have there any new precautions or any uh symptoms seen over there no so uh we have had papers from south africa we have had papers from south africa recently uh only recently and no new symptoms increase in mortality there have been hospitalizations there have been deaths but most deaths probably i believe are they have not released that but i believe are in unvaccinated or immunocompromised people so yeah and already they are seeing a decline in their in their this way if you call it away in this search so yeah south africa is comfortable okay great uh dr deepak is asking in present time should we ask for rtpcr in patients with urti yeah so this is again a good question and i'll repeat myself any patient with fever and cough cold must ask for rapid antigen or artificial and current times also you must presume that this is only omicron till the month of june at least presume all urti with fewer to be coveted again great those were the questions sir so one more question from my side would be like during the last main pandemic when we had there were there was a rampant use of remdesv and oscillosumab and everything so with this if there's an unvaccinated individual so would omicron respond to those medicines so uh in the west america especially the medicine that they use in unvaccinated people is backslow weed and uh they have been disappointing reports with pax love it also if i have an unvaccinated person with omicron and if the fever remains beyond three days remember this is very important for me fever has to stay beyond three days for me to consider antiviral therapy in omicron fear goes beyond three days i investigate the patient and i will give rem decision rem decibel is the only drug i will use as an antiviral if hypoxia occurs which is extremely rare i use steroids otherwise early remedies were as early as possible no monopoly no i will make it they waste time and just straight away admit the patient and you this is only in unvaccinated people or those who are significantly immunocompromised such that vaccines may not have taken effect okay great so like you said that the further mutation would be even less severe than what is happening so dr is asking that should we now not be not in fear that the future mutation would not be much harmful is there a chance that even severe mutation would come up of course of course there's a chance that severe mutation will come up so mutations are unpredictable that's why they are called mutations and mutations can be burst so what will have to happen for the new mutant for the new variant of concern that variant of concern will have to be more transmissible than current ba4 bfi or ba2 also if it is more vigilant but less transmissible then it may not survive so even if it is more virulent it will infect you in pockets but omicron pa2 bf4 bfi will conquer that new variant and let it not just like delta which was more virulent was suppressed by the less virulent but more transmissible omicron we will not allow a more brilliant organism to occur unless it is water so it has to be more transmissible it has to be more virulent to become threatening to us if it is just more transmissible say it is two times more transvisible than ba2 then everybody will get infected now that that cycle will continue again we will have surges but they will not be bad and they will not be enough to cause lockdowns or economic instability all right okay uh dr rashmi's asking that 99 year old male uh recent covert admitted and discharged crp90 so how many days would it take for the crp to settle down if the patient is asymptomatic stop doing crp don't do crb investigations are a double-edged sword if you do investigations in an asymptomatic individual you are going to cause panic in yourself and the patient so just stop see ignore the cr most important ignore the crp if you don't find any clinical features so yeah that is very very important we give too much importance to investigations and too little importance to absence of symptoms let's start doing that yeah so uh any suggestions for a good rit kit and bio is what i usually recommend and but i have not used an rd kit in my home yet in some time and bio i think is abbott's p-a-n-b-i-o and there are more if you uh if you permit me i will send you some names i don't easily remember brand names okay all right so uh i think there's one more question on which day should we do the rtpcr test in case it's a symptomatic patient with fever good question again i believe that rapid antigen test takes one day of symptoms to come positive meanings do the rapid antigen test 24 hours after onset of symptoms or at the onset and on the second day again of course you have to isolate the patient uh uh before you before you get the confirmation the rtbcr you do it on the first day so you must do whatever and uh another question would be should we do artificial of all family members no meaning uh this is debatable as i said i would like to know whether i have omicron or not if my wife has omicron and therefore i might do artificial but it is not mandatory do it in symptomatic people okay wait uh those were the questions audience if you have any more questions please put it up in the comments and we would really love to see you on stage so you can just click on raise and this other than we have already yeah one last thing that i would like to uh before i go uh there is a principle in diagnostic medicine called he comes dictum he comes h-i-c-k-a-m becomes victim he comes victim says that one of the parts of ecom victim is that if two symptoms are temporarily disconnected then they both should be considered as due to different causes why i'm saying is this in in dengue uh season which is now coming uh and with the omicron season already there we will see sometimes coffin cold due to omicron which started five days back with one day of fever then the fever went away and on the fifth day now the patient had dengue fever with high grade fuel with a body now since the on the first fever had come with rtpcr positivity you will start you know your mind will be geared towards only that fact that this patient is omicron and now this current infection is probably a micron uh biphasic fever or secondary bacteria etc do remember that if coffin cold and fever are different times onset temporally disconnected then he comes dictum states that both these are due to separate causes so always when you ask is history ask the origin of each symptom separately if diarrhea has occurred four days back and a fever is today then that diary and this fever should not be connected that is a yeah that's a clinical dictum now yes i think if any any other question or we can even close here yes no no more questions sir thank you so much for this much needed session and for clearing all the myths and the doubts that are surviving the surrounding omicron right now so thank you so much and thank you to our audience thank you so much for showing up in such great numbers at this new time slot and the entire team of medflix thanks you all thank you so much bye thank you

BEING ATTENDED BY

Dr. Darius Justus & 458 others

SPEAKERS

dr. Tushar Shah

Dr. Tushar Shah

Consulting Physician at Advanced Multispecialty Hospital, Mumbai

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dr. Tushar Shah

Dr. Tushar Shah

Consulting Physician at Advanced Multispecial...

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