knllkkkAbstract: Aim: The current SARS-CoV2 mutation occurs due to the opportunity provided by human animals for the replication of this pathogenic microbe. With the available data on the exponential spread of this pathogen, and the limited information on clinical manifestations severity, this systematic qualitative review (QSR) aimed to examine the exponential transmission of SARS-CoV2 omicron variant, disease severity, hospitalization and prognosis relative to previous variant mainly delta. Materials/Methods: This QSR was applied for literature review, implying study of studies in the assessment of evidence on transmission and disease severity associated with this novel variant, omicron, as well as recommended transmission mitigation measures. Results: The current data are indicative of the exponential spread of this variant due to several mutations relative to the delta variant as well as limited data on omicron disease severity, as well as clinical and public health measures in transmission mitigation and healthcare providers available in addressing acute, chronic and surgical conditions during this inter-season in the US.Conclusions: While the absence of evidence does not imply evidence of absence, this QRS clearly observed the exponential spread of the omicron variant globally, as well as limited data on clinical manifestations severity relative to the delta variant, as inconclusive. The omicron variant exponential spread is highly suggestive of implementing control and preventive measures in transmission mitigation and enhanced community herd immunity.
Introduction: Viral pathogens remain genetic materials and not living organisms, requiring host factors before replication and survival. The pathway to viral survival requires careful adaptability in the host, agent and environment interaction. Suppose the host in any viral infection is protected. In that case, exposure to such a
Pathogen results in no transmission, implying no clinical manifestations, as observed in the natural course of a disease - pre-clinical, sub-clinical and clinical. In effect, if the herd immunity is not achieved (>80% vaccination) and the control and preventive measures are not effectively utilized, any viral pathogen remains opportunistic, resulting in several mutants and antigenic serotypes. This viral pathogenic opportunity exposes the viral host of SARS-CoV2, human animals exponential transmission with novel variants, namely delta and omicron. With the exponential transmission of the omicron variant, this systematic qualitative review (QSR) sought to (a) assess the scientific data on this exponential transmission and disease severity. (b) examine disease as clinical manifestations severity relative to delta variant Additionally, with the limited information on the current omicron disease severity, this QSR recommended pathways for omicron variant transmission mitigation.
Materials & Methods: A systematic qualitative review (QSR) was used to examine non-peer-reviewed and scientific reports on omicron genomic sequencing, transmission dynamics, and severity of clinical features. This approach involved assessing the study and scientific report objectives, study or sample size, outcome/s, analysis, sub-population analysis and inference.
Results: While studying studies allows for evidence synthesis, all findings remain uncertain, implying sampling variability with random error quantification. The conclusions of this QRS observed the following:
(a) Omicron variant reflects an alternation in the genetic code of SARS-CoV2 delta variant, with the primary viral intent, is to enhance its survival in the host cell over time. These genetic codes serve as the source for the viral building, including the spike protein for SARS-CoV2. . The current geographic locale data reflects 2 to 3 times infection frequency, compared to two days retrospective infection frequency. Specifically, if the infection frequency of individuals in a specific setting within a geographic locale was (n=100) on Monday, on Wednesday, an estimated 300 were infected, indicative of exponential transmission of omicron. Omicron mutations had been observed to be more than 30, supporting this exponential transmission among vaccinated individuals. Typically, there is a doubling rate of the omicron variant every two to three days. However, increased mutations in any viral pathogen does not necessarily imply disease severity but viral survival.
(b) With several observed alterations in the SARS-CoV2 delta variant resulting in the omicron variant, the transmission rate is exponential due to these mutations in the Spike protein, which provides SARS-CoV2 with the opportunity to replicate in the host cell. The Omicron variant is highly transmissible due to the spike protein mutation and remains opportunistic in escaping the natural antibodies among individuals infected with the delta variant. Additionally, vaccinated individuals experience transmission due to antibodies limited cross-reactivity in inhibiting omicron replication - immune system escape.
(c) Omicron clinical manifestations with the current data reflect less severity than the delta variant. With more data on hospitalization, ICU admissions and mortality becoming available, more observations on the severity will emerge.
Conclusions and Recommendations: The global assessment of the SARS-CoV2 omicron variant is indicative of its exponential transmission relative to the delta variant; however reliable data are pending on comparable severity, hospitalization and mortality. Since all conclusions in scientific evidence discovery remain inconclusive, dynamic and not, static data application is required in clinical and public health decision making. This QSR recommends :
- Testing, tracking and testing during this holiday season before the family reunion. This initiative allows for marginalized omicron transmission during Christmas and the new year gatherings. Regardless of fully vaccine uptake, indoor meeting requires reliable and appropriate face mask-wearing.
- All vaccine eligible Americans and the entire human population must be fully vaccinated, implying the initial vaccine and the recommended bootees for the immune system potentiation, amplification and enhancement. As the omicron variant escapes the immune responsiveness with the current vaccine, booster uptake will enhance antibodies durability stimulating the helper T cells activation and the NKC integration for enhanced and balanced immune responsiveness in marginalizing the clinical manifestations and severity.
- Reliable face mask-wearing such as N-95
- Sub-population and granular data availability on omicron variant - age, sex, pregnancy, ICU admissions, hospitalization, mortality, prognosis, survival.
- Ventilation and healthy indoor air quality
- CO2 indoor air monitoring with reliable device for enhanced healthy air quality.
- Physical and social distancing
- Allocate a safe and effective vaccine to the undeveloped nations (Africa, Caribbean, India, Bangladesh, Nepal, etc.) by the industrialized and developed countries, namely the USA, UK, France, Germany, China, etc.
- Healthcare system adaptability to the omicron variant, given inadequate cancer screening, surgical procedures, ICU admission and hospitalization for morbidity etc. The failure to address the healthcare system incapacitation currently will imply an epidemiologic re-transition from chronic disease to infectious disease a century ago.
With the observed healthcare system incapacitation nationally and globally, if we as a human society fail to adhere to these viral disease control and preventive measures recommendations, including although not limited to fully vaccine uptake, sooner or later, the entire world as a human population will pre-transition to infectious disease as the leading cause of mortality. Realistically, based on this limited knowledge on SARS-CoV2 (COVID-19) pandemic, we as a scientific community must act now by informing the world community on a reliable and pragmatic approach to returning the human population to the pre-pandemic period.
