Dr Rana Jawad Asghar is the chief executive officer of Global Health Strategists and Implementers (GHSI), a consulting company in Pakistan. He is also an adjunct professor of epidemiology at the University of Nebraska, USA, and a member of the WHO Roster of Experts in Epidemiology and Surveillance. He is one of only six Pakistanis in the seventy-year history of US CDC in its Epidemic Intelligence Service. He has spoken and written extensively on the Covid-19 situation in Pakistan and the strategy to dealing with it. The News on Sunday spoke to Dr Asghar on the current pandemic situation in the country in the context of arrival of a new variant of the coronavirus.

The News on Sunday (TNS): How do you see the emergence of the Omicron variant and its impact on the pandemic in Pakistan?

Dr Rana Jawad Asghar (Dr RJA): I think Pakistan could not have stopped the Omicron variant from entering the country. Travel restrictions in today’s connected world are no more than political symbolism. And that is what we saw. Within four to five weeks we had a surge in cases, probably due to Omicron. As per some data available from Sindh, 80 percent of the new cases are of Omicron infection. In other countries too, within weeks of its arrival, Omicron has accounted for 80 to 90 percent of all new infections. That is what I expect to happen in Pakistan, too. So, I the coming weeks we are going to see a quick surge. We will probably reach the peak by end of January or early February. After that we will likely see the number of new cases coming down.

TNS: Is the new variant more harmful than the previous ones? How do you think people’s perception of the variant’s capacity for harm impacts its spread?

Dr RJA: We don’t know yet whether the new variant is more harmful or not. We need at least 10 weeks of good quality data to understand the mortality rate due to this variant. If we look at South Africa, from where this variant emerged, it has been just seven weeks. So, it is early to say anything. But definitely, the number of deaths following the infection has been less than that witnessed during previous waves and hospitalisations, which is a good sign. This is true globally except for the United States, where hospitalisation is at a record high. At all other places, we see a pattern of a lower ratio of deaths and hospitalisations. This has not been confirmed yet, but many people believe that the Omicron variant is less harmful and less lethal than the Delta variant. But because it is highly infectious – four times more infectious – the number of cases is high, and there are chances of increased burden on hospitals. And if it hits healthcare workers, it will affect services too. So, the impact of Omicron, even though it may be mild, could be higher in terms of affecting the health care system. Hence, we need to make sure we follow all precautions and standard operating procedures (SOPs).

TNS: Should we expect more variants of Covid-19 to arise in the near future?

Dr RJA: Yes. Even this moment, there may be new variants developing in different parts of the world. And remember, it is not that the Alpha variant gave birth to the Delta variant or Delta to Omicron. These variants can evolve independently in different parts of the world, and sometimes even in the same patient who may have a depressed immune system. This is a complex process. We can stop new variants by controlling the pandemic. We cannot control or stop the emergence of [new] variants unless we work together at the global level and bring the transmission down. This can be done by ensuring equitable vaccination. It does not make sense that in some countries, a majority of the population is getting four jabs while a majority of African people do not even get a single dose. We have to come up with a plan that is truly global and not national. If new variants develop in less vaccinated countries, we simply cannot protect other populations by erecting vaccination walls. Eventually, some variant will break through these walls and make these countries vulnerable again. Secondly, we need to understand that transmission is airborne. To date, we have not taken this threat seriously. Studies show that keeping windows and doors open is an intervention that reduces transmission by 18 times. Nearly all of the transmission is through indoor air. We need to focus on ventilation.

TNS: Data indicates that many people in Pakistan are either not getting the second dose or the vaccine at all. What is the reason behind this, and how can this impact Pakistan in the long run?

Dr RJA: All vaccine doses are important. To start with, the vaccines used in Pakistan require three doses. Inactivated virus vaccines, which we use in Pakistan, traditionally requires three doses like tetanus and hepatitis. Some experts say that even the mRNA vaccines used in the US and Europe are three dose-vaccines. So, when you get a single dose, it hardly gives you protection. It only prepares your body for the second dose. The second and third doses provide much better protection. Also, vaccines are a part of a larger system of safety measures. On their own, they do not provide 100 percent protection against a new infection. Even if you are vaccinated, you need to take precautions – wear a mask, avoid crowds and open windows.

TNS: How can we create a greater realisation of the importance of vaccines and safety precautions among the public in Pakistan, where many have not yet received vaccines? How can we address this when people appear to not care?

Dr RJA: Disinformation regarding vaccines spread through social media has affected the opinion of many, including some of the educated and well-to-do people. But remember, in the current wave with the Omicron variant, most of those dying are the unvaccinated people. So, people should ensure that they are fully vaccinated. In Pakistan, a majority of the population is young. So far, all variants have predominantly affected older people more adversely. This is why, the ratio of deaths is higher in Europe and the US where older people constitute higher proportion of the populations.

But what if a new variant affects the young as strongly? For that, we need to be well prepared and vaccinate a large part of the population. We need to prepare a good public health strategy and disease surveillance. We need to improve health intelligence without which we cannot fight any virus in a satisfactory way.

The author is a staff reporter. He can be reached at vaqargillani@gmail.com. He tweets at @waqargillani