One year later, the situation is eerily similar. The daily count of cases in India is at its lowest in 18 months. Five months of a continuous decline in cases after the devastating second wave has ensured a return, in most cases, to normal activities. And the general refrain, once again, seems to be that the worst is probably over for India. This, even when Europe and the US, and several other countries, are in the midst of their worst phase in the pandemic so far.

Behind those similarities, however, are key differences between the situations last year and now. Some of these, the threat from Omicron for example, point to the possibility of the events repeating themselves, while others — such as development of vaccines, and even therapeutics — are indications that 2022 could be remarkably different from 2021, for the better. The uncertainties and the experience of the pandemic until now, however, make it difficult for anyone to make predictions.

The Omicron threat

The Omicron variant has emerged at roughly the same time this year that the Delta variant, its immediate predecessor initially known as the duble mutant, had been first detected last year. But unlike Delta, Omicron was identified and flagged quickly thanks to improved genetic surveillance.

For India at least, the threat from Omicron is very different compared to that from Delta. The Delta variant had emerged in India and kept circulating in the population for over two months before being flagged. By that time, it had already infected many people, and when the surge came, with unexpected ferocity, India was caught totally unprepared.

With Omicron, India has had sufficient advance warning. And even though the actual number of Omicron infections would, in all likelihood, already be several times the 600-odd cases that have been confirmed till now, it is unlikely that this fast-spreading variant would have as free a run as Delta had.

The biggest relief is that Omicron appears to cause a milder form of disease compared to Delta. All studies so far have indicated this, and not one has produced any counter-evidence.

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That does not mean India will remain unaffected by Omicron. Several states have already started to see an uptick in new cases. Omicron spreads very fast because of its ability to evade the immune response and infect even those who have had a prior infection or been fully vaccinated. If the situation currently playing out in Europe and the US is anything to go by, a big surge in cases by mid-January cannot be ruled out. Whether this would be comparable to the second wave, or even the first, is not something anyone can predict.

The hope, based on current evidence, is that it will not be as deadly as the second wave. The fairly widespread coverage of vaccines, the beginning of booster doses, and relatively early response in the form of restrictions could keep the surge at manageable levels. The most crucial factor, as usual, would be people’s compliance with Covid-appropriate behaviour.

Vaccination

The impact of vaccination is now evident around the world. It is true that after it was initially argued that the vaccines would protect people against infection, which has not turned out to be the case. Even when Delta was the most dominant variant, a large number of breakthrough infections were taking place. With Omicron, this has only increased. In fact, there is hardly any difference between the vaccinated and the unvaccinated as far as infection with Omicron is concerned. Breakthrough infections happen because most current vaccines were developed on the virus strain that was prevalent in the early phase of the pandemic. The virus has undergone several mutations since, including at sites that are used by the immune system to prevent its entry into the human body. Omicron is the most mutated variant known so far, with over 50 significant mutations, including crucial ones that enhance its ability to escape the immune response.

Vaccines have made a very significant difference in reducing severe diseases and mortality, however. This was evident even at the time Delta was prevalent. As vaccinations increased, hospitalisations and death rates came down. This is holding true with Omicron as well. Countries such as the UK are currently detecting three to four times more cases compared to their previous peak, mainly infected with Omicron. The death rate has gone up only marginally, and most of the deaths are happening among the unvaccinated. The UK has reported about 40 deaths amongst Omicron-infected people, but it is still not clear whether Omicron was the cause of these, or just incidental.

Also, new vaccines now emerging are likely to be better and more effective, possibly providing longer periods of immunity. India has just now authorised two more vaccines, the one developed by Novavax and produced in India by Serum Institute, and the other developed by Hyderabad-based Biological E in association with the Baylor College of Medicine.

Therapeutics

Along with the vaccines, there is the possibility of treatments for Covid-19 becoming mainstream in 2022. On Tuesday, India cleared molnupiravir, an antiviral drug manufactured by Merck and Ridgeback, for emergency use. The drug is supposed to prevent the development of severe conditions in people infected with mild or no symptoms. Several other similar candidates are also available and more are in the process of development. If these prove effective, they could potentially bring an end to the fear, and the disruptions, associated with a surge of cases.

Variants

Some scientists believe that the spread of Omicron could be the beginning of the end of the pandemic. It is an optimistic scenario no doubt, but not without any basis in science. There is no clarity about what the “end” of the pandemic means though — whether the disease would disappear completely, or whether it would keep emerging off and on but would no longer remain a threat because of the availability of effective vaccines or treatments.

In the first year of the pandemic, several variants — Alpha, Beta, Gamma, Lambda, Kappa, Lambda, Mu, and more — had developed. Different variants became dominant in different population groups. Delta was the first globally dominant variant, and till date, the most deadly in all geographies. The emergence of the next significant variant, Omicron, took one full year. The fact that Omicron, despite being much more transmissible than Delta, has turned out to be milder according to the evidence so far, is offering hope against the emergence of stronger variants in the future. But the possibility of such a thing happening can never be ruled out.