Omicron is more transmissible, but is it really milder?

The emergence of the Omicron variant has changed the course of the pandemic once again. Just as many countries were beginning to enjoy easing of restrictions and many families were planning for Christmas, the new variant arrived, forcing governments to scramble over measures to help curb its spread.

Although it is widely accepted the Omicron variant did not originate in South Africa, because it had the technology and sense of responsibility to report the new variant, it has unfairly had the most severe travel restrictions imposed upon it by other countries. South African doctors and politicians have been critical of the global response, feeling it too harsh and disproportionate to the threat posed by the Omicron variant.

Dr Angelique Coetzee, the South African doctor who first alerted authorities to the presence of the new COVID-19 variant, has described the symptoms of Omicron as both “very, very mild” compared with those of the Delta variant, and different to it. She has described muscle aches, fatigue, a scratchy throat and night sweats as common Omicron symptoms.

But Dr Mike Ryan, executive director of the World Health Organization (WHO) health emergencies programme, believes, “There’s no doubt that the rising number and the force of infection will generation more hospitalisations in the coming weeks.” Speaking at an Irish Aid webinar hosted by the Institute of International and European Affairs (IIEA), he said: “What I’m most concerned about right now today, is the fact that there are unvaccinated people in every country, who are at high risk.”

So, are we overreacting as Dr Coetzee has suggested, or is it safer to go in harder with restrictions now until we understand the variant better?

On December 14, Discovery Health, South Africa’s largest private health insurance administrator, released data looking at more than 211,000 people who tested positive for COVID-19 between November 15 and December 7, 2021, approximately 78,000 of whom were thought to have the Omicron variant. The analysis, which was carried out in conjunction with the South African Medical Research Council (SAMRC), calculated that two doses of the Pfizer-BioNTech vaccine offered 70 percent protection against hospitalisation during the recent surge in cases and 33 percent protection against infection. This is lower than the protection offered against the Delta variant which stands at 93 percent against hospitalisation and 80 percent against infection. These real-world findings corroborate what we already know about Omicron from laboratory findings – that it is able to evade part of the immune response triggered by vaccines.

The study also looked at hospital admissions in this group, concluding that the risk of hospitalisation among adults diagnosed with COVID-19 was still 29 percent lower than during the country’s first wave last year. There are reports of increasing numbers of children being infected and admitted to hospital with Omicron in South Africa, though South African scientists have said they cannot confirm a link between Omicron and the high admissions of infants, which could be due to other factors.

But a study carried out by Imperial College London casts doubts on the cautious optimism shown by South African doctors. The paper, which is yet to be peer reviewed, looked at 333,000 cases, including 122,062 of Delta and 1,846 confirmed cases of the Omicron variant, through genome sequencing between November 29 and December 11, and found no evidence of a difference in the severity of symptoms or hospitalisations when compared with Delta. However, the data included only 24 hospitalisations of patients suspected of having the Omicron variant, with researchers acknowledging that “hospitalisation data remains very limited at this time”. Worryingly, Omicron was associated with a 5.4 times higher risk of reinfection compared with Delta. The study put the protection offered by a previous infection at around 19 percent and with a booster jab at between 55 and 80 percent.

Experts are worried that the speed at which this variant transmits and the rate at which it doubles in the population will offset any reduction in severity. The United Kingdom, in particular, has seen the variant spread and become dominant in a short period, with London seeing the biggest growth in cases since January 2021. Inevitably, there will be a lag in hospital admission so the next two to three weeks will be crucial in determining whether or not further restrictions are needed to curb the spread.

One of the things the studies do not look at but which is a concern for doctors like myself is what this surge in infections will mean for long COVID. It stands to reason that with a higher number of infections, more people will end up with long COVID, with its ongoing symptoms that include extreme fatigue, breathlessness and palpitations. Long COVID not only has devastating effects on individuals and their families but can also put pressure on healthcare systems and economies as people have to take prolonged periods off work.

The sensible advice is now to be cautious as we learn more about the virus, get vaccinated – because even though there is some reduction in protection against Omicron it still offers a good level of protection – and limit social activities. We are unlikely to see the levels of hospitalisations and long-term morbidity we saw in earlier waves because many of us are vaccinated, but as good as the vaccines are, they are not perfect so any additional measures will help.

Progress report: Swiss study shows the importance of regular classroom ventilation

As Omicron cases start to increase across the world with reports from South Africa of younger people becoming infected, we must do everything we can to safeguard in-school learning. The closure of schools during the first waves of the pandemic was extremely harmful to children, and the effect is likely to last for years to come as children struggle to catch up on missed education. As with all of these things, the most disadvantaged children were worst affected, those without computers or tablets, and also those whose parents were unable to help them with homeschooling. Schools are also important places where safeguarding issues are picked up and those children who suffer from abuse or neglect are likely to suffer more if schools close again. This is why it is important to keep schools open but it is equally important to keep them safe.

There is much that can be done in schools to reduce the risk of the spread of COVID-19 among children and staff. Mandatory mask-wearing and staggered break times can help but governments must ensure adequate ventilation in classrooms or install approved air filters.

A Swiss study has found that poorly ventilated school classrooms record up to six times as many COVID cases compared with those that are regularly aired. The research by the Swiss Federal Laboratories for Materials Science and Technology (EMPA) looked at data from 150 classrooms in the Swiss canton of Graubünden. Each classroom had a CO2 monitor, which measures levels of carbon dioxide in the air. If this is high it suggests the room is poorly ventilated. It compared CO2 levels in classrooms with the number of children and staff testing positive. It concluded that badly ventilated rooms had six times as many cases as better-ventilated ones. The researchers recommend airing out classrooms by opening windows or outside doors more than usual – ideally three times each hour for five minutes at a time – even when outside temperatures are low.

An alternative of course is to invest in air filters, which filter out virus-containing aerosol particles. These are expensive but worth investing in as they will also reduce the spread of other airborne viruses among children and result in fewer days off school.

Closing schools again must not be an option. Instead, we must accept that children can get this virus, they can pass it onto others or become sick themselves and so the adults in charge of funding and the safety of schools must mandate ventilation or air filters in classrooms.

Good news: Christmas is not cancelled but you must take precautions

It is the week leading up to Christmas, and whether or not you celebrate the religious aspects of it, many families will be off work and school and spending time together. Last Christmas coincided with a rise in COVID cases and increasing restrictions around household mixing and travel. So, families were unable to see each other at this crucial time of year.

This Christmas was supposed to be different. We have the vaccines and boosters that offer a degree of protection against hospitalisations. We have all made sacrifices to get to this point and feel we deserve a safe family Christmas. Then Omicron came along and the worry of Christmas restrictions set in.

Most governments are reluctant to introduce harsh restrictions for Christmas Day, as it will not only make them unpopular but people suffering from lockdown fatigue are unlikely to adhere to the rules, especially in the UK where it has emerged that work Christmas gatherings were held at the prime minister’s office last year.

So governments must tread a fine line between keeping people safe and allowing for some level of family mixing on Christmas Day. This is where the precautions leading up to Christmas come in.

My advice is to keep your eyes on the prize: Christmas Day and spending time with the people who matter the most. If you limit social gatherings with others until then, it will lessen your risk of getting Omicron. If you are going out in crowded places or for Christmas shopping, take a lateral flow test and only go if it is negative. If meeting people indoors, make sure the room is adequately ventilated. Wear a mask when out and about in public and, above all, get vaccinated – it is your best way to protect yourself and others around you.

This way you are less likely to find yourself infected with COVID and self-isolating when you should be spending valuable time with your loved ones on Christmas Day.

Personal account: Big ask of UK health staff to accelerate booster rollout

Late on the evening of December 12, British Prime Minister Boris Johnson made a televised address to the public to take up booster vaccines when eligible in a bid to protect the population from the oncoming Omicron wave.

In his address, he said he was aiming to offer all eligible adults in the UK their booster by the end of December, a month earlier than previously planned. The army would be deployed to help with the vaccine rollout, he added, urging NHS staff and volunteers to also do their part.

I watched the speech slack-jawed. As one of those NHS workers whose surgery has a COVID vaccine centre within it, this was the first I was hearing about a rapid rollout programme. It would have been nice to have had some warning as I had no idea how we were going to provide this service alongside all the other front-line primary care we offer.

Nevertheless, the following morning I received a flurry of emails asking me to sign up to work in vaccination clinics on those days when I wasn’t working as a GP at the surgery. Of course, I agreed to do as many as I could. There was no sign of the army in any of our planning. In fact, in all my years working in the NHS, I have never seen any sign of the army when the government has said it would be deployed to help NHS services. This is not a criticism of the army, simply an observation that whenever the government mentions deploying it, it seems to be intended to convey urgency to the public rather than to offer a practical solution.

Since the announcement, the government has said that GPs can postpone routine planned care for patients in order to prioritise COVID vaccinations. The problem with this is that we are still trying to catch up with routine care we missed through the first waves of the pandemic, and we do not want a repeat of previous messaging that kept patients with worrying symptoms away from their doctor, resulting in delayed presentations of cancers and other serious diagnoses.

What we have seen throughout this pandemic is that whenever a job is handed over to the NHS as opposed to private organisations, things get done. We will do our best, as we always do, but I’d recommend we be informed of the plan we are required to participate in before it is announced to the public. I do not think this is too much to ask.

Reader’s question: If world leaders are not following their own rules, why should I?

The last two weeks have been a political whirlwind for those at No 10 Downing Street, the official residence and the office of the British Prime Minister. Not only did the ruling Conservative Party lose a recent byelection, but there has been a series of revelations about unlawful Christmas gatherings in December 2020, when London was under strict COVID restrictions and indoor gatherings of two households or more were banned. It has been a tough watch for those of us who were working on the front line at the time, but much harder for those who lost loved ones and were unable to see them during their final days and hours.

As Omicron spreads and the risk of a new lockdown looms, many people have lost faith in the current government to do what they ask of the British public in order to keep everyone safe. It is a dangerous position to be in, both politically and medically.

But the truth of the matter is we are experiencing a new wave of COVID infections, nobody wants that less than the front-line healthcare workers who are still exhausted from the previous waves. So no matter how you feel about the alleged hypocrisy of politicians, for the sake of yourself, your loved ones and those front-line workers, please do adhere to any new rules that are imposed to help curb the spread of this virus.