How to contain Omicron, future COVID-19 variants of concern

•Anxiety as two passengers from Nigeria test positive to new COVID-19 variant in Canada and more fully vaccinated people are affected
•Experts say Omicron reflects prolonged vaccine injustice, has potential to mutate, become more dangerous if more people remain unvaccinated
•Recommend temporary ban on non essential flights from South Africa, scale up genomic surveillance and watching of human traffic through borders
•Say Nigeria should strengthen her health intelligence system as virologist claims confirmed cases of COVID-19 who took MSAMS recovered within 72 hours

It is feared that the new COVID-19 variant B.1.1.529 (Omicron) might have been circulating in Nigeria since last week as two passengers from here, on Sunday, November 28, tested positive to the virus on arrival in Ottawa, Canada.

Interestingly, the two passengers and over 100 others that tested positive to Omicron were fully vaccinated, leaving scientists worried. It is believed that new variants have the potential to affect severity of disease, how effective tests pick up the disease as well as vaccine efficacy.

Director General, World Health Organisation (WHO), Dr. Tedros Adhanom Ghebreyesus, yesterday, said Omicron variant reflects the threat of prolonged vaccine injustice. “The longer we take to deliver #VaccinEquity, the more we allow the #COVID19 virus to circulate, mutate and become potentially more dangerous,” he tweeted.

On November 26, WHO designated the strain, known as B.1.1.529, as a variant of concern and named it Omicron, on the advice of scientists who are part of the WHO’s Technical Advisory Group on Severe Acute Respiratory Syndrome Coronavirus Type 2 (SARS-CoV-2) Virus Evolution. Omicron joins Delta, Alpha, Beta and Gamma on the current WHO list of variants of concern.

On what Nigeria must do immediately, Chairman, Expert Review Committee on COVID-19 and foremost virologist, Prof. Oyewale Tomori, told The Guardian yesterday that the Presidential Steering Committee (PSC) should hold an emergency meeting to evaluate the situation and provide guidance immediately for the country.

On the ban on flights from South Africa (SA) by most countries, Tomori said: “I do not think it is hasty. If you are still recovering from the effects of the Delta variants, with upsurge in number of cases, it is appropriate to temporarily ban flights from the source, while you evaluate the situation. If you wait till you know if it will spread fast or cause more severe disease or even overcome your vaccination, it may be too late. I think once the WHO had declared it a Variant of Concern (VOC), proactive countries must take precautionary steps.”

On the implication for Nigeria especially if detected in the country, the virologist said: “The possible implication is that it could start our next wave. There is very little information now so it is difficult to predict the outcome in terms of transmissibility, severity or ability to evade vaccine immunity.”

On how best way contain the new variant, he recommended: “I will suggest a temporary ban on flights from South Africa and on passengers visiting South Africa over a specified time period. There is need to tighten our porous borders, upscale laboratory testing in a coordinated effort, especially genomic sequencing and improve on contact tracing, while reemphasising adherence to non pharmaceutical interventions.

A public health physician and Chairman, Lagos State Primary Healthcare Board, Prof. Akin Osibogun, told The Guardian yesterday: “With this fact emerging, why single out South Africa for travel restriction? Why is same treatment not meted to Egypt, Turkey, and Belgium etc? Is it now a crime to be a topnotch in genome sequencing and announce detection of a novel variant? To my little mind, South Africa is undeserving of this international punishment. It is a very difficult situation. South Africa was able to detect the new variant because it has a robust surveillance system and was honest to quickly report the new variant. Which other countries already have this variant without detecting it?”

Osibogun, who is also a member of Lagos State COVID-19 team, however, said the Belgium case was a young, unvaccinated woman who developed flu-like symptoms 11 days after travelling to Egypt via Turkey. “She had no links with South Africa. This means that the virus is already circulating in communities. As of yesterday, 100 cases have been identified across the world,” he said.

The epidemiologist, who is immediate past Chief Medical Director of Lagos University Teaching Hospital (LUTH), recommended that Nigeria should strengthen her health intelligence system to be able to prevent and detect; strengthen public acceptance of public health interventions; and reduce vaccine hesitancy.

A professor of medicine and Medical Director, Medical Art Centre (MART) Maryland, Lagos, Oladapo Ashiru, told The Guardian yesterday: “Yes, it can lead to a wider spread. It is hoped that those on the entourage have been vaccinated, and need to be screened at the airport before boarding. Yesterday, it was reported that dozens of people on the South Africa to Netherlands bound flight, tested positive to COVID-19. So far in Nigeria, we have been reasonably lucky. The effect of the pandemic is not severe. We must double our efforts in observing all the safety protocols needed to prevent the spread of the virus or its variant. Such protocols must start from the border controls, the airport, mask, social distancing, hygiene, and vaccination.”

On the way forward, Ashiru, who is the President of African Fertility Society (AFS) and Joint Pioneer of Test Tube Baby/ In Vitro Fertilisation (IVF) in Nigeria, said: “Lastly, our doctors in Africa should know that there are a number of reports that points to the usefulness of Ivermectin in the treatment and prophylactic measures for SARS-COV2. In the absence of vaccine that is not yet acceptable or available. Such drugs may be helpful. It is recommended that each state should intensify their public vaccination efforts. The more people we vaccinate, the less the chances of spread or variant. Definitely vaccination has been shown not to give 100 percent protection. However, even 60 percent protection is better than zero percent.”

Ashiru said the western world must make a concerted effort to vaccinate every single individual globally without preferential distribution of vaccines. He said, previously, in the days of yellow fever, smallpox, measles, and polio vaccination was virtually 100 percent compliance. “Today the western world is hoarding vaccines thinking that those in Africa would be affected,” he said.

Ashiru said if the African countries have focused and spent more funds on health, research and development, “we should have our vaccine production in place by now.”

On what Nigeria must do immediately, Director General, Nigerian Institute for Medical Research (NIMR) Yaba, Lagos, Prof. Babatunde Salako, told The Guardian: “Scale up genomic surveillance and watch human traffic through the borders. Continue to escalate vaccination of Nigerians and ensure persistent vaccine campaign to reduce vaccine apathy.”

On ban on flights from SA, Salako said countries take decisions based on their risk perception, many more people fly to UK compare to Nigeria and the Delta experience is till with them. “For Nigeria, we have not been hard hit so we can still watch very closely for now with active boarder and genomic surveillance. Escalate campaign for COVID-19 protocol and also scale up vaccination in the country,” he said

On the implication for Nigeria especially if detected in the country, Salako said: “It may and it may not, the delta variant does not seem to have done expected damage to our population yet it was the commonest circulating variant in the third wave so this omicron may not be different but we must be prepared.”

Going forward, what are your recommendations? The NIMR DG said: “…Continue to create awareness on the virus, prevention and vaccination. Research on immunogenicity and vaccine efficacy and effectiveness in Nigerian should be on going to determine the need for booster doses in Nigeria. Efforts at local therapy should also continue and seeking opportunities to produce COVID-19 vaccine in Nigeria should be in the front burner.”

A virologist/vaccinologist and lead, COVID-19 vaccine task team of the African Vaccine Manufacturing Initiative (AVMI), Dr. Simon Agwale, told The Guardian yesterday: “Unfortunately, nearly two years into the pandemic, the world is again racing to contain yet another variant designated as ‘Omicron’ which was first identified in southern Africa but now identified in several other countries. Several countries are re-imposing measures like travel restrictions and non-pharmaceutical interventions that some hoped were a thing of the past. The actual risks of this new variant of concern are not yet known, but early evidence suggests it poses an increased risk that people who have already had COVID-19 could catch it again, the WHO said. It could however take about two weeks to know if current vaccines are less effective against it.”

Agwale, who is also founder and CEO of Innovative Biotech Keffi, Nassarawa State and United States, said since the slow uptake of vaccinations offers more opportunities for the virus to evolve into a dangerous variant, it is imperative for everyone that has access to the vaccines to take them. He said not doing so would continue to jeopardise the trajectory of the pandemic by giving the virus the opportunity to continue to mutate and eventually evade current vaccines. The vaccinologist said, if this happens, it will take the current effort to vaccinate the world backwards because vaccine manufactures will then focus their attention to manufacturing vaccines against the new variants and guess what will happen, the rich countries will buy them up.

The virologist stressed the importance of local vaccine manufacturing as the way forward for any nation that wants to be self-sufficient in vaccine supply. “I am not just talking about secondary packaging which is called fill and finish, which would not solve the current supply crunch, but full manufacturing including the production of drug substance (the vaccine). This is the focus of our company and through partnerships, we hope to deliver this to the Nigeria people,” he said.

A public health physician and Executive Secretary, Enugu State Agency for the Control of AIDS (ENSACA), Dr. Chinedu Arthur Idoko, told The Guardian that more effort should be geared towards ‘ensuring’ that the likelihood of having this variant and its subsequent spread in Nigeria is minimal.

Idoko recommended increased Port Health Services vigilance, scaled up COVID-19 safety measures/ protocols, ensuring adherence to the safety measures viz a viz strict compliance and general country alertness must be emphasised.

He added: “Sure ‘not to do anything is dangerous’. However we must continually weigh our options; we must consider the rebound effects of the actions we take which would of course guide the ultimate approach adopted.”

The public health physician said the implication if detected in Nigeria is multifaceted. “It is a cascade of pressure on the Health system, strained resources, rebound economic effects and otherwise. Having said this however, one would remain optimistic. We have had rumours of these various strains and variants but for some reason an unexplained apparent protective factor (possibly of nature and nurture) has kept the very devastating COVID-19 picture away from us here in Nigeria. That of course doesn’t mean we should rest on our oars,” he said.

Idoko called for a more robust COVID-19 safety protocols adherence/ compliance. “Our people are no longer observing protocols. There should be improved/ increased Vaccine uptake and a general sensitivity to the fact that COVID-19 remains an ever present danger,” he said.

A clinician, consultant, a fellow of the West African Postgraduate College of Pharmacists and National Chairman, Clinical Pharmacists Association of Nigeria (CPAN), Dr. Joseph Madu, told The Guardian: “The COVID-19 Omicron Variant also known as B.1.1.529 is a very high mutant of the Covid-19 virus which could be exceedingly contagious, going by the number of mutations on its spike (face) which more than double what is carried by the Delta Variant of the virus.

For this reason, the World Health Organisation has designated it as a variant of concern. It was named after the Greek alphabet Omicron. Other Greek alphabets include alpha, beta, delta, gamma, epsilon, omega etc.”

Madu said Moderna in recent News said that it would take about three months plus for their vaccine to be modified so as to be able to tackle the Omicron Variant of COVID-19 virus.

He said Astra Zeneca is yet to make any statement on this, going by information available but if the old vaccine is to be modified to combat the new variant, it probably implies that all those who have been vaccinated will have to go for another round of vaccination in order to stop the new variant.

On what Nigeria must do immediately, the pharmacist said: “Already, there is this News of two cases of the Omicron Variant discovered in Ottawa, Canada from two individuals with recent travel history from Nigeria. But since this variant is still novel, I will scientifically say that the vaccines currently available will still be very useful, but the updated vaccines will be most useful.”

Madu said Nigeria should take necessary steps to mandate point-of-arrival testing and relative quarantine for all travellers irrespective of where they are coming from into Nigeria, so as to protect Nigerians against the spread of this highly contagious variant.

He said the government should accelerate ongoing mass vaccination processes and ensure that clinical community pharmacists are engaged at a more rapid rate for use in testing and bringing the disease to its knees.

The clinical pharmacists said government should provide adequate free Personal Protective equipment (PPE) at primary healthcare and community levels.

He said vaccination should be promoted via public education and government should mobilise for all types of advocacy in every strata of the society. Madu said those individuals yet to be vaccinated should be encouraged to do so.

Madu said government should centralise international points of entry into Nigeria to one or two air and seaports immediately for a more effective monitoring.

He said a worse case scenario is that borders should be strategically monitored for possible closure in any case of uncontrollable spike in cases of this highly contagious variant

Madu said government should immediately increase funding for the National Institute of Pharmaceutical Research and Drug Development (NIPRD), to undertake further research in COVID-19 “because the solution to this pandemic could be right under our noses.”

“Non essential travels to Botswana, South Africa and other countries suspected to harbour the variant should be suspended. More stringent screening of passengers from those countries should be instituted. Junior civil/public servants should work from home for now,” he said.

On the implication of the new COVID-19 variant to Nigeria, Madu said: “For me, the implication if detected in Nigeria could be another lockdown especially in states with International Airport or other ports of entry, because of the virulence of the variant of concern. But that can have a very dangerous effect on our already very poor economy. Furthermore, schools academic calendar may be negatively affected.

“If detected in Nigeria, definitely that is a situation that could influence the spread and mortality of COVID-19 pandemic.”

Vacines not working
A professor of Virology at Michael Okpara University of Agriculture, Umudike Abia State, Maduike Ezeibe, told The Guardian yesterday: “We should stop doing things just because other countries are doing so. Reoccurrence of COVID-19 in persons who recovered from the disease within short intervals means immunity from the virus does not last long enough, and vaccination means to expose the body to a weakened or fragment of a pathogen to illicit production of immunity, which will stand as security against the same pathogen (infection).”

Ezeibe, who invented MSAMS for the ‘cure’ of HIV/AIDS, said lack of protection for recovered people means COVID-19 pandemic cannot be controlled by vaccination. He said the virus is known for fast mutation and changes to forms, vaccines can no longer inhibit, and apart from humans it has many animals as hosts. The virologists said current worldwide vaccination is not working; otherwise, the infection rate would have started declining in the advanced countries. He said what the world needs is a medicine that can achieve quick cure and such medicine must be made to inhibit a marker the virus cannot change.

Ezeibe explained: “We already have such medicine. The Medicinal synthetic Aluminum magnesium Silicate (MSAMS) attaches to electrical charges on viruses. SARS Cov 2 virus, which causes COVID-19, has positive charges while infected cells are negatively charged. The virus cannot change its charges and it is at least 60 nm in size while MSAMS, molecules are made of nanoparticles that are over sixty times smaller (0.96 nm). The nanoparticles have both positive and negative electrically charged ends and there is no tissue a pathogen of 60 nm can reach that a medicine of 0.96 nm cannot reach. So, the medicine reaches all infected-cells and uses opposite charges electrostatic attraction to mop both the virus and infected cells. We have reported that confirmed cases of COVID-19 who took the medicine recovered within 72 hours. These results were published by a journal in USA. What that means is that the journal agreed with our scientific discovery. The MSAMS is a formulation of two minerals already approved as medicines by both WHO and NAFDAC (Aluminum silicate and Magnesium silicate) and an approved food (glucose).”

The virologist said Nigeria should start using her own medicine already patented to treat her citizens and invite WHO to confirm it and adopt it for other countries. “Once the medicine is confirmed and recognised by WHO, COVID-19 will no longer be in the news. Whoever suspects that he/she has contracted the infection will treat himself/herself and move on. Those confirmed will also be treated by hospitals and quickly discharged. Let people read that our publication on quick cure of COVID-19. We are not making unsubstantiated claims that people are used to hearing,” he claimed.

Ezeibe added: “If Nigeria is not ready to listen to sound scientific arguments from her scientists why do we have universities and research institutes? Why do we have to wait for other countries to tell us what to do? Why can’t they listen to us when God reveals His secrets through us instead of through them?”

Meanwhile, WHO on November 26, 2021, designated the variant B.1.1.529 a variant of concern, named Omicron, on the advice of WHO’s Technical Advisory Group on Virus Evolution (TAG-VE). This decision was based on the evidence presented to the TAG-VE that Omicron has several mutations that may have an impact on how it behaves, for example, on how easily it spreads or the severity of illness it causes.

The WHO, in a statement, yesterday, said researchers in South Africa and around the world are conducting studies to better understand many aspects of Omicron and will continue to share the findings of these studies as they become available.

Transmissibility: It is not yet clear whether Omicron is more transmissible (example, more easily spread from person to person) compared to other variants, including Delta. The number of people testing positive has risen in areas of South Africa affected by this variant, but epidemiologic studies are underway to understand if it is because of Omicron or other factors. Severity of disease: It is not yet clear whether infection with Omicron causes more severe disease compared to infections with other variants, including Delta. Preliminary data suggests that there are increasing rates of hospitalization in South Africa, but this may be due to increasing overall numbers of people becoming infected, rather than a result of specific infection with Omicron. There is currently no information to suggest that symptoms associated with Omicron are different from those from other variants. Initial reported infections were among university students—younger individuals who tend to have more mild disease—but understanding the level of severity of the Omicron variant will take days to several weeks. All variants of COVID-19, including the Delta variant that is dominant worldwide, can cause severe disease or death, in particular for the most vulnerable people, and thus prevention is always key.

Effectiveness of prior SARS-CoV-2 infection
Preliminary evidence suggests there may be an increased risk of reinfection with Omicron (that is, people who have previously had COVID-19 could become reinfected more easily with Omicron), as compared to other variants of concern, but information is limited. More information on this will become available in the coming days and weeks.

Effectiveness of vaccines: WHO is working with technical partners to understand the potential impact of this variant on our existing countermeasures, including vaccines. Vaccines remain critical to reducing severe disease and death, including against the dominant circulating variant, Delta. Current vaccines remain effective against severe disease and death.

Effectiveness of current tests: The widely used PCR tests continue to detect infection, including infection with Omicron, as we have seen with other variants as well. Studies are ongoing to determine whether there is any impact on other types of tests, including rapid antigen detection tests.
Effectiveness of current treatments: Corticosteroids and IL6 Receptor Blockers will still be effective for managing patients with severe COVID-19. Other treatments will be assessed to see if they are still as effective given the changes to parts of the virus in the Omicron variant.

Studies underway
At the present time, WHO is coordinating with a large number of researchers around the world to better understand Omicron. Studies currently underway or underway shortly include assessments of transmissibility, severity of infection (including symptoms), performance of vaccines and diagnostic tests, and effectiveness of treatments.

WHO encourages countries to contribute the collection and sharing of hospitalized patient data through the WHO COVID-19 Clinical Data Platform to rapidly describe clinical characteristics and patient outcomes.

Recommended actions for countries
As Omicron has been designated a Variant of Concern, there are several actions WHO recommends countries to undertake, including enhancing surveillance and sequencing of cases; sharing genome sequences on publicly available databases, such as GISAID; reporting initial cases or clusters to WHO; performing field investigations and laboratory assessments to better understand if Omicron has different transmission or disease characteristics, or impacts effectiveness of vaccines, therapeutics, diagnostics or public health and social measures.

Countries should continue to implement the effective public health measures to reduce COVID-19 circulation overall, using a risk analysis and science-based approach. They should increase some public health and medical capacities to manage an increase in cases. WHO is providing countries with support and guidance for both readiness and response.

In addition, it is vitally important that inequities in access to COVID-19 vaccines are urgently addressed to ensure that vulnerable groups everywhere, including health workers and older persons, receive their first and second doses, alongside equitable access to treatment and diagnostics.

Recommended actions for people
The most effective steps individuals can take to reduce the spread of the COVID-19 virus is to keep a physical distance of at least one metre 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 when it’s their turn.

WHO will continue to provide updates as more information becomes available, including following meetings of the TAG-VE. In addition, information will be available on WHO’s digital and social media platforms.