The COVID-19 pandemic began in December 2019 with the 5th wave setting in from January 2022. Every wave was due to the emergence of a new variant of the virus. The first wave was caused by the Wuhan Virus from 26th February-September 2020, second wave lasted from 28th Oct 2020 to February 2021 whereas the third wave or UK variant emerged from our neighbouring country India.
Corona first and second wave in Pakistan, and strategies
The 1st and 2nd waves were associated with a low death rate. It was well controlled due to being timely managed by the Government. It was short lived as the case and death rates began to recede rapidly after peaking. The management policies of smart and partial lockdowns proved successful by curbing the transmission of the disease. The same strategies were adopted in the second wave. The first wave claimed 6795 lives, infected 332,186, left behind 632 on ventilators. During the 2nd wave, there were 579,973 infected and 12,860 died till 28th February 2021.1,2
The Third Wave of the current Pandemic and strategies
The third wave was due to a new variant called UK variant, associated with an increased risk of death compared to other variants. On an average deaths of 100 patients were reported daily in Pakistan. Due to the spread of this new variant, ten cities of Pakistan, Bahawalpur, Faisalabad, Hyderabad, Islamabad, Lahore, Multan, Muzaffarabad, Peshawar, Rawalpindi, and Swat, were put under strict lockdown lasting till April 11, 2021, where the provincial administration was directed to observe the strict implementation of SOPs.3
The 4th wave of COVID-19 in Pakistan and strategies
The summer of 2021 saw the entry of the Delta variant which took the world by storm. It reached Pakistan in a more severe form. Fortunately, the vaccine had been approved which was effective for the Delta variant. During this wave, there were over 1,245,000 total confirmed cases; with a daily record of approximately 3,000 new cases. Smart lockdowns and restrictions were imposed on major cities as Lahore, Rawalpindi, Islamabad, Muzaffarabad, Mirpur, Faisalabad, Multan, Abbottabad, Peshawar, Karachi, Hyderabad, Gilgit and Skardu. The schools and offices were closed, to restrict the spread of the delta virus. The vaccination process was boosted by opening many vaccination centers and providing the availability of many types of vaccines.
The Current 5th wave of Omicron in Pakistan
Pakistan is now facing the 5th wave caused by the new variant; Omicron (or B.1.1.529). This is the latest coronavirus variant; which was first detected in November, 2021, from Botswana South Africa. It is now the predominant strain in Pakistan, especially in Karachi, where the positivity rate has risen beyond 40% (28th January, 2022). Not a single city has been spared by Omicron. A lot still remains to be known and discovered. Experts are following emerging data closely to learn more. Is Omicron more transmissible; double than the delta virus, but not so deadlier than previous variants. It is affecting all ages, more males, vaccinated and unvaccinated people and causing re-infection. The vaccinated persons do not require hospitalization and ICUs are being used for severe cases only. Fortunately, the mortality is low as compared to the delta virus.
What about the transmissibility of Omicron?
The Omicron may be 105% more transmissible than previous Delta variant, according to a research by French scientists.
How effective are our vaccines against Omicron?
There are many studies on mutations in other variants, also seen in Omicron. These mutations show reduction in the efficacy of the current available vaccines in terms of prevention against severe disease and death. But it does not mean that these vaccines will not work against Omicron VOC. The current COVID-19 vaccines are fantastically potent against severe disease and death. The scientists are thinking that Omicron will be the natural vaccine for a future pandemic and will result in biological control of COVID-19.
What should be done in case of exposure or infectivity with Omicron?
If symptoms are present, a RTPCR test should be done. If the result is positive, isolation is required for 3-5 days. If the test is negative, or if the person is asymptomatic but has been exposed, isolation is not required. If the symptoms are severe, hospital admission is advised in COVID Wards with the remaining protocol being similar.
Only fully vaccinated passengers coming from restricted countries will be allowed to travel to Pakistan. Passengers are advised to present a negative report of PCR within 48 hours prior to commencement of travel, otherwise they may be deported. Travellers from Category "C" countries as Botswana, Croatia, South Africa, Hungary, Ireland, Lesotho, Mozambique, Namibia, Netherland, Poland, Slovak, Salvinia, Zimbabwe and Vietnam, are restricted for unknown periods. Only people who have obtained an exemption certificate will be permitted to enter the country. Such travelers (above 6 years age) must undergo a RAT (Rapid antigen test) on arrival in Pakistan. People with negative RAT will have to observe mandatory 3 days quarantine followed by a PCR test. The traveler with a positive RAT test will have to quarantine for 10 days. There are some limited exemptions for Pakistanis travelling to these countries.
Why is the world worried about Omicron and What can you do to protect yourself from Omicron?
Omicron is a blessing in Disguise as once it passes away, COVID-19 will be more like the seasonal flu with a rapid drop in cases. It is true that Omicron is different from the Delta variant regarding its infectivity and severity. The infectivity is much less severe with a lesser mortality and morbidity especially for those who are double vaccinated, younger population and even the elderly without comorbidities.
The problem likely to be encountered is that if Omicron spreads like a tsunami, it will infect a large portion of the population. Severe infection would be encountered in a small percentage with comorbidities and the unvaccinated who would not be able to fight out the virus. These patients will require hospitalisation and intensive care treatment. This will definitely place a heavy load on hospitals and could paralyze the health care system. This can be considered the dark side of the spread of OMICRON and is being witnessed in USA and UK.
What are the Best Strategies to control the transmission of Omicron
The Rules of COVID-19 or Appropriate Behaviours should be strictly followed: Vaccination including the Booster dose is mandatory. Masks should be worn, social distancing adopted, sanitizer for hand hygiene should be used and good health and a strong immune system should be maintained by taking a balanced diet, proper eight hours sleep, and physical exercise (Figure-1).
Global leaders must unite to make an international treaty. Courtiers must prepare for all the future Pandemics for the collection and sharing of information. Vigilance is required to make new SOPs if there is any new VOC or new infection. International travel rules should be implemented to place early Lockdowns. Drugs and medical equipment for treating Covid infected people should be readily available. Every country should have the infectious disease hospitals at least in the tertiary care setup.
Let us look forward to a disease free era by saying good-bye to Omicron. The Corona virus has taught the world practical lessons for maintaining good health and preventing infections. These instructions should always be followed.
1. Abid K, Bari YA, Younas M, Tahir Javaid S, Imran A. Progress of COVID- 19 Epidemic in Pakistan. Asia Pac J Public Health. 2020; 32:154-156. doi: 10.1177/1010539520927259. Epub 2020 May 19. PMID: 32429679; PMCID: PMC7240311.
2. Government of Pakistan. Pakistan statistics. http://covid.gov.pk/. Cited on 15.1.2022
3. Kamran K, Ali A.Challenges and Strategies for Pakistan in the Third Wave of COVID-19: A Mini Review. Front. Public Health. 2021; 9:690820. doi: 10.3389/fpubh.2021.690820 available at:https://www.frontiersin.org/articles/10.3389/fpubh.2021.6908 20/full Cited on 15.1.2022
4. Bukhari MH.Recently Discovered Omicron: Fifth Wave of Pandemic in Pakistan. What Strategies Can be adopted to Control its Spread. JIIMC. 2021;16: 212-214.