Omicron: tests, triage and treatment

Is the Omicron variant as lethal as Delta? How do we protect ourselves from it? Which treatment is ideal? Let's answer these questions

Protection against Omicron | Man wearing a mask while shopping for fruits

Omicron or the variant B.1.1.529 was designated a ‘Variant of Concern,’ (VOC) on November 26 by World Health Organisation. Within 40 days, the mutated virus caused the largest single week rise in COVID infections. Even in India, COVID is present across 26 states and there is hardly be an individual who is yet to personally or indirectly encounter the virus.

But is Omicron, which is high in its transmissibility, also more virulent or lethal? How do we protect ourselves from the VOC? Which treatment is ideal? These questions are natural and this article attempts to answer them.

Omicron: tests and triage

Symptoms of omicron have largely remained similar to delta. Lethargy, uncomfortable throat and cough, fever and body ache are the common symptoms. Some patients have also complained of digestive issues, diarrhoea and stomach pain.

Despite the mutations, RT-PCR has remained a reliable diagnostic tool for COVID. The test effectively detects various genes, such as Spike (S), Nucleocapsid (N), and Enveloped (E) protein. Having said that, the physician will consider the patient’s co-morbidities, duration of illness and exposure in conjunction with the RT-PCR report to decide if they will need a conservative or aggressive treatment.

The omicron wave has also witnessed a steep rise in Rapid Antigen Tests (RAT), at present used by many as the primary diagnostic tool. While a positive RAT result is most likely to indicate the presence of active infection, a negative test will require further evaluation by clinical examination and RT-PCR results. Hence, it’s important to seek professional medical advice than blindly trusting over-the-counter products to make an informed decision.

The nature of symptoms can also help to ascertain the isolation period or transmissibility of a patient. Based on our observations, patients with mild symptoms are unlikely to be contagious seven days after the last onset of symptoms. On the other hand, patients who needed ICU stay and oxygen support during the treatment, may take as many as 14-21 days to turn non-contagious.

Diagnostic tests are an ideal indicator to ascertain transmissibility;  it’s better to take your doctor’s advice before venturing out in the public.

Omicron: treatment and prevention

At present, vaccination is considered the most effective tool to ‘break the chain’ of transmission and to help end the pandemic. In case of an infection, vaccination is known to reduce the severity of the infection thereby bringing down the chances of hospitalisation as well as risk of death due to the disease. However, vaccination does not reduce the chances of infection itself. Hence, wearing masks, avoiding densely populated areas, social distancing and maintaining ventilation at office or home remain key to avoiding exposure to the virus.

Once infected, the severity of symptoms guides correct therapeutic modalities such as antivirals, antibody cocktail or immunomodulatory agents. Patients with mild or no symptoms should discuss the possibility of home care with adequate rest, fluid intake and regular consultations with the doctor to keep the symptoms in check. Also, one shouldn’t discontinue medication as soon as the symptoms are relieved; complete the course prescribed for optimum results. If the symptoms persist or health parameters deteriorate in presence of chronic co-morbidities, it’s ideal to visit the hospital.

Summing up

The nationwide spike in COVID cases cannot be blamed on the VOCs alone. Lack of COVID appropriate behaviour, COVID fatigue and COVID apathy along with the unlimited access to food and entertainment avenues, is equally responsible for the rapid spread of the infection. The society has to behave responsibly if we wish to end the pandemic soon. The emotional, financial, physical and mortal burden of the pandemic has been borne by all of us. Let us dedicate the year to the recovery, responsible behaviour and rebuilding lives.

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Dr Abdul Samad Ansari is Director, Critical Care Services at Nanavati Max Super Speciality Hospital, Mumbai, India. He has two decades of experience as a physician and has been a faculty and a guide for various Critical Care Training Programmes.


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