'Everybody's going to get infected'

'In the likelihood that Omicron is circulating, you have a much greater chance of getting infected now, than you did during the Age of Delta.'

Pfizer's new COVID-19 drug Paxlovid, which received the United States' Food and Drug Administration's approval, is making headline news.

Will it be a lifesaver?

Dr Nahid Bhadelia offers her take.

The founding director of the Boston University Center for Emerging Infectious Diseases Policy and Research, Dr Bhadelia -- who is India-born, but as the daughter of a physician on a transferrable job grew up in Sweden and Saudi Arabia and the US -- has worked with Ebola in West Africa in 2014 and has been working, during the COVID-19 pandemic, to provide the most critical, fact-correct information on the disease to decision-makers, public health professionals and the public.

In Part II of her interview to Vaihayasi Pande Daniel/Rediff.com she answers questions about personal safety, safety of frontline workers and oral antiviral drugs.

• PART I: 'Omicron is a very, very obvious case for boosters'

On a personal level should we be scared?
For instance, if you are travelling on a flight, especially if you are transiting through or coming from countries that have many Omicron cases, like for example the UK, even if you are doubly vaccinated aren't you vulnerable. Do we need to be personally scared of Omicron?

Yes. But that's what I'm saying: You are safest in this scenario, if you've had a prior infection and two doses, or if you've had three doses.

If you've had two doses, it is still probably a very good protection against severe disease.

But we should all be more careful, because everybody's going to get infected. Whether or not you get severely ill or mildly ill depends on whether you are vaccinated or not (and how many doses).

I would say that you just have to be more careful because if you are travelling and in the likelihood that Omicron is circulating, you have a much greater chance of getting infected now, than you did during the Age of Delta.

That's the equation for the individual. If you (catch it), it might end up being mild infection, because you are vaccinated, but the variant seems to be highly transmissible.

Pfizer's oral COVID-19 pill Paxlovid was found to reduce the risk of hospitalisation or death by 89 per cent in high risk adults. What is your take on Paxlovid?

So, that's really promising data about Paxlovid. But I think we have to take it with a grain of salt. The data for Paxlovid is promising, but what we saw with Merck's (molnupiravir) was that the final data that was released to the public was different, right?

I always start with a caveat: Let's just wait to see what the study shows. But the final analysis of their (Paxlovid's) high-risk cohort (a longitudinal study over time that looks at a cohort or bunch of people who share a defining characteristic) was very promising.

And it showed very little difference between three days and five days (ie the patient being treated with Paxlovid within five days of symptom onset). Five days is a much more realistic sort of deadline to be able to get your hands on a pill, if you end up being positive, because you have to get tested and then find somebody who has the pills.

It's promising. The things that are limiting are, of course, timely linkage to testing, to make sure that you get tested in time to be able to take advantage of this.

But I think Pfizer said they had about 150,000 doses this year. So, there might not be enough doses globally for it to make a difference, with the winter surge and the Omicron surge, which is happening now in many countries.

If too many healthcare workers go down sick, what will happen to healthcare delivery? Is that a worry everywhere?

Yes, it is. That's the concern.

In some ways we're worse off than before, at least in the US -- I don't know the situation in India -- healthcare workers have left the field. They're burnt out.

As you said, at this point if there is another surge it is going to be hard.

We can all keep our fingers crossed, hoping that maybe it is less severe.

But, you know, you are seeing increased hospitalisations in South Africa, even if they're saying it's like 30 per cent less than before, but it's still 70 per cent more than what baseline was!

So, there is a question -- and your point is right -- what about health care workers across the world? Shouldn't they get boosters? And that's partly so that we can prevent severe disease because your protection is about 70 per cent, right now, with two doses, which is which is not bad, but I think that additional dose may help as well.

What about why Omicron arose? And that it can arise again too? Everybody has always 'opined' that the virus can only get more harmless in its future avatars, but that is only partially happening.
Unless there is more vaccine equity, could we expect yet more transmissible variants in the future that will still cause more harm than the average flu does?

I am certainly not an evolutionary virologist.

We do know that new variants can develop from uncontrolled transmission because every new infection is a chance for mutations.

Trevor Bedford* and Kristian Anderson* have proposed a few scenarios -- including spillover into animals and back into humans, infections in areas with low surveillance, evolution within an immunocompromised patient etc. Since it's not my specialty, I can't comment on it!

But vaccine equity is incredibly important.

* Trevor Bedford is an American computational virologist at Fred Hutchinson Cancer Research Center and also affiliate associate Professor in the Department of Genome Sciences and the Department of Epidemiology at the University of Washington. While Kristian Andersen, who works in the field of genomics and evolution, is a professor in the Department of Immunology and Microbiology at Scripps Research

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Feature Presentation: Ashish Narsale/Rediff.com