new subvariants of Omicron BA4 and BA5 whose existence is quite disturbing to the public

After being quite comfortable under control for some time, now the daily upward trend of covid is happening again. Even now, it is suspected that the emergence of new subvariants of Omicron BA4 and BA5 whose existence is quite disturbing to the public.

Despite having a low level of pain compared to other variants, the Omicron BA4 and BA5 subvariants still need to be watched out for. So what do the experts say about this?

Researchers from FKKMK Universitas Gadjah Mada, dr. Gunadi, PhD, Sp.BA., admitted that there was an increase in cases after Eid. Compared to the previous wave, the increase in cases this time occurred approximately 30 days after Hari Raya and the BA.4 and BA.5 subvariants were found in Indonesia.

The Omicron BA4 and BA5 subvariants were first reported in Indonesia on June 6, 2022, with the discovery of 4 cases. All cases were men who had been vaccinated with 2 to 3 even boosters, and three of them affected by the Omicron BA5 subvariance were foreign travellers at the Global Platform Disaster Risk Reduction Meeting in Bali on 23-28 May 2022.

“On average they are asymptomatic and only one complains of sore throat and body aches,” said Gunadi, at UGM Campus, Thursday (16/6).

He explained that the Omicron BA4 and BA5 subvariants have the possibility of spreading faster than BA1 and BA2. Even this new subvariance has no indication that it causes more severe pain than other Omicron variants.

The BA4 and BA5 subvariants, assessed, have decreased ability to treat several types of monoclonal antibodies. It also has the possibility of escaping the immune protection caused by infection with the Omicron variant.

That said, the Omicron BA.4 and BA.5 subvariants have many of the same mutations as the original Omicron variant but have more in common with the BA.2 variant. Both variants contained amino acid substitutions L452R, F486V, and R493Q in the spike receptor binding domain compared to BA.2.

“The L452R mutation, which was also detected in the Delta variant, is thought to make the virus more infectious and avoid partial destruction by immune cells. The F486V mutation also helps evade immune system recognition.”

Furthermore, he explained that the characteristics of the Omicron variant on average had early signs of symptoms such as cough (89 percent), fatigue (65 percent), and nasal congestion or rhinorrhea (59 percent). Other symptoms were fever (38 percent), nausea or vomiting (22 percent), shortness of breath (16 percent), diarrhea (11 percent) and anosmia or ageusia 8 (percent).

“Currently there are a small number of BA.4 and BA.5 cases. It is therefore too early to know for sure if there are any new symptoms associated with this lineage. However, given that the lineage is still classified as Omicron, and that most of the mutations (particularly in spike proteins) are the same, it is likely that the symptoms will be similar.”

Therefore, for pharmacological management as in the handling of Covid-19 in general, if there are no symptoms, it is sufficient to give vitamin C, D, supportive treatment, treatment of comorbidities and complications. Mild given vitamin C, D, Favipiravir or Molnupiravir or Nirmatrelvir/Ritonavir, symptomatic treatment, supportive treatment, treatment of comorbidities and complications.

While for moderate symptoms, vitamin C, D, remdesivir or alternatives: Favipiravir, Molnupiravir, or Nirmatrelvir/Ritonavir, anticoagulant LMWH/UFH based on DPJP evaluation, symptomatic treatment, comorbid treatment and complications are given. For those who are severe or critical, they will be given vitamins C, B1, D, remdesivir or alternatives: Favipiravir, Molnupiravir, or Nirmatrelvir/Ritonavir, corticosteroids, anti-IL-6 (Tocilizumab/Sarilumab), antibiotics (in suspected bacterial co-infection), LMWH anticoagulants /UFH/OAC based on DPJP evaluation, management of shock (if it occurs) and treatment of comorbid and complicated.

“Whether you have to be hospitalized or self-isolated, I think for those without symptoms, it is enough with oral medication and oxygen and monitoring can be done alone or by medical personnel indirectly. It’s different from those who are moderate, severe or even critical, in addition to oral drugs, injection drugs, oxygen and others, they need to be hospitalized and monitored directly by medical personnel,” he explained.

As anticipation, he said, many parties immediately increase the booster. Keep wearing a mask indoors, on public transportation, in crowds, and if you don’t feel well. In addition, there is no rush to repeal the mask policy.

“Anyway, keep following the health protocols. Health protocols will always be updated and remain a reference in daily activities,” he added.