No way to distinguish Omicron cases from Delta, US doctors in a fix

There actually is no approved test to determine the coronavirus variant each individual is infected with: a national network of state and other labs in the US use genome-sequencing tests to track variants broadly in communities.
Healthcare workers administer the Covid-19 PCR test at a free test site in Farragut Square in Washington, DC. (AFP)
Healthcare workers administer the Covid-19 PCR test at a free test site in Farragut Square in Washington, DC. (AFP)
Published on Jan 04, 2022 07:40 AM IST
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Written by Joydeep Bose | Edited by Amit Chaturvedi, Hindustan Times, New Delhi

Amid rising concerns over a fresh surge in coronavirus disease (Covid-19) cases, doctors in the United States are faced with a peculiar conundrum – they have no ready way of determining which variant of the coronavirus a person is carrying. This is especially troublesome because a high-risk patient infected with the Delta variant would greatly benefit from two particular monoclonal antibody treatments, while they would do little to nothing for a patient infected with the new, highly transmissible Omicron variant – which requires a third antibody treatment.

Faced with this issue, even federal health authorities are struggling to make decisions for the entire nation in the backdrop of uncertain estimates over the scope of each variant and the extent to which they are dominant in certain regions.

Elaborating on the matter, a report by The New York Times states that the two antibody treatments that Delta-infected patients benefit from are the drugs made by Regeneron and Eli Lilly, while patients infected predominantly with the Omicron variant would greatly benefit from the antibody drugs manufactured by GlaxoSmithKline and Vir Biotechnology.

Now, the problem arises in the fact that there actually is no approved test to determine the coronavirus variant with which each individual is infected: a national network of state and other labs in the US use genome-sequencing tests to track variants broadly in communities. Health authorities then use those “regional estimates” to decide which antibody treatments to use in clinics and hospitals.

A system that is based on frail estimates is bound to show cracks, and such is evident in the fact that federal officials on December 23 stopped shipments of the antibody treatments for Delta infections after the US Centers for Disease Control and Prevention (CDC) said that 73 per cent of all Covid-19 cases in the country were arising out of the Omicron variant.

However, it soon became clear that there were, in fact, several states in the US where Delta was still dominant, and stopping the Eli Lilly and Regeneron antibody treatments there would be a grave mistake. Later, the CDC revised its national estimate of the Omicron outbreak to 59 per cent, and on December 31, federal officials once again resumed the shipments of all antibody treatments.

According to infectious diseases experts and public health professionals quoted by NYT, the results of the genome sequencing used in most public laboratories take nearly a week to arrive – which is often too late to begin the early antibody treatments that have been found to reduce hospitalisations in patients.

It is especially difficult to keep up with the pressure in states which have an uneven mix of both variants, thus keeping doctors on the edge about which treatment to use. According to health experts, this puts the United States in a “holding pattern” during which tailoring treatments to patients is going to be “extremely difficult” and in the absence of a rapid, surefire way to identify variants in bulk samples, the issue is only expected to compound in the near future.

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