The Omicron Uncertainty
It has been about a month since we discovered the Omicron variant, thanks to the work of South African scientists. Since then, data around the new variant has been steadily pouring in as well as its spread across the world. We’ve learned many things about it, but with more answers and clarity, comes more questions and uncertainty. This article will look at Omicron in terms of transmissibility, severity and what does it all mean for us.
The data on transmissibility seems the most certain. Most agree that Omicron spread much faster than previous variants, Delta included. But what does this mean? For starters, higher transmissibility means the harder it is to contain the spread. Think of it as a glass overfilling and spilling out its content faster than we can clean up the mess. The key to higher transmissibility seems to be due to the shorter incubation period. While the Delta variant took an average of 4–5 days, Omicron might have maybe a shorter period, around 3 days.
On an individual level, this means the viral load will shoot up very quickly and before we can take steps to contain the virus, we might already be spreading it. The sign for most people would be looking out for symptoms. But we tend to downplay initial symptoms, like a scratchy throat or a slightly runny nose. Therefore we need to be more aware of early symptoms. Hopefully, with more awareness, we can take steps to limit the spread. Fortunately, the basis of self-protection is still the same. Face masks are still very useful to protect yourself and the people around you. Self-isolation, if you have any early symptoms, will be crucial to breaking the chain of transmission and vaccination, primary or booster, will help.
The tougher decisions will be on a community or population level. Travel restrictions are already proven not to work, they only delay the spread and possibly offer a false sense of security. But in a community, higher transmissibility raises questions on isolation period, testing regimes and vaccination schedules. While changes in policies and guidelines should be expected in an evolving pandemic, the uncertainty will cause some anxiety.
The data on severity is harder to draw conclusions. Early data from South Africa shows hospitalisations from Omicron rise very quickly, but they drop equally fast too. Recent studies from England, Scotland and South Africa suggest that Omicron infections are milder. But there are many confounders with the data before we can extrapolate the information to how other countries manage their response. Vaccination coverage in a population will play a part. There is a lot of talk on the mutations on Omicron, enabling it to escape our immunity. This is mostly referring to the primary immune response, which are the antibodies generated by the body from the vaccine. But the immune system is more than just the antibodies. What this means is there might be a spike of breakthrough infections initially, but when other parts of the immunity kick in, it will limit the severity of the disease.
The other part of the vaccine equation is the booster. Putting aside the matter of vaccine inequity, the booster shots seem to work fairly well against Omicron. The explanation might be simple, if you boost the immune system with another shot of the vaccine, more antibodies are generated as a first-line defence against the viral load of Omicron and it effectively renders it harmless. The science around boosters are still evolving and there is evidence suggesting that for the mRNA based vaccines, a third shot might be included as part of the primary series. Nevertheless, vaccination is still proving to be important against the virus whether there are elements of immune evasion.
The other confounder is the demography of the population itself. The demography of the population in the Omicron studies vary with other populations in the world. Factors like age, co-morbidities and something we don’t talk about much, immunity from previous Covid-19 infection. Because there is a lack of demographic uniformity across the countries, it will be hard to make any conclusions.
But severity is not just about individual morbidity. Severity also means the burden on healthcare services. Like demography, healthcare capacity also differs with countries. A mild disease might still require hospitalisation as it can progress to severe disease. The load on hospitals will increase and this leads to two scenarios. First, healthcare services will simply be overloaded, unable to cope with the number of patients. Quality of care will be compromised and chances of patients deteriorating in the hospital will also increase, leading to severe disease and death. The second scenario of overburdened healthcare services means patients will present to hospitals late. Even if it’s a mild disease, without early intervention patients will suffer from complications and possibly death.
The past month has given us some clues on how Omicron will affect our pandemic response. As we uncover more answers, more questions will be asked and this is expected. We have been living with uncertainty since 2020 and the pandemic has shown no signs of letting up. What is certain is we have to be ready for new information and changes in our lives moving forward.
In 2006, Michael Leavitt, the then US Health and Human Services Secretary said, “Pandemics happen. Anything we say in advance of a pandemic is alarmist; anything we say afterwards is inadequate”. The balance is hard to achieve, but more importantly, rather than worry about being an alarmist or being inadequate, is to prepare with the right responses and be ready to adapt to new information.