Ground zero of omicron provides little reason to panic

Scientists hope early evidence from South Africa suggesting variant provokes a milder form of virus will be confirmed by further studies

When Professor Chris Whitty said on Wednesday that there was an “incredibly steep” increase in Covid cases in South Africa, the country was used to warn of the impending doom facing the UK.

The Chief Medical Officer of England pointed to a 300 per cent spike in hospitalisations to justify the raft of new restrictions on its way.

But, while the headline case number figures are alarming, the severity of the disease caused by omicron remains to be assessed. Early evidence indicates it may be milder than previous variants.

With soaring case numbers over the last two weeks, it was to be expected that a rise in hospitalisations would follow, but the great unknown in the battle against this worrying new variant is how likely it is to kill those who contract it. Even the world’s foremost scientists and medical professionals must, for now, sit tight in a bleak game of “wait-and-see”.

There is good cause to fear omicron, as it is believed to be very infectious and better at avoiding vaccines, but if it is also more mild, what does this mean for hospitalisations and deaths?

Some people think it will be devastating, but previous knee-jerk reactions from gloomy academics have been proved wrong as their doomladen predictions failed to materialise.

And yet, Sage warned this week that even if omicron is only half as deadly, the sheer number of people it will infect could lead to significantly more pressures on the NHS.

“Currently there is no strong evidence that omicron infections are either more or less severe than delta infections,” said Britain’s leading scientists.

But while experts such as Prof Whitty yearn for large trials, robust data and clear evidence, initial anecdotal and preliminary findings indicate that it may milder than other variants. This, however, is a contentious issue among academics, and sits on rocky scientific ground.

Dr Richard Mihigo, Immunization and Vaccines Development Program Coordinator at WHO’S Africa division, said: “Emerging data from South Africa suggests that omicron may cause less severe disease.

“Data which looked at hospitalisation across the country between 14 November and 4 December found that ICU occupancy was only 6.3 per cent, which is very low compared to the same period when South Africa was facing the [July] peak which was linked to Delta

‘During the first three waves, 100 per cent of patients needed oxygen. This time it’s 10 per cent’

‘It is very difficult to compare countries because they have very different populations’

‘Many of our patients have milder symptoms than those we saw in the first three waves’

variant.” Again, as all scientists have learnt over the last two years, he was swift to add a caveat, urging cautionary interpretation of the findings.

“This is still a preliminary analysis and we will need another two to three weeks to determine omicron’s full effects,” he said, hedging his bets.

And although such reports are emerging, there is resistance from some scientists to take it on board.

A report by the National Institute For Communicable Diseases (NICD) in South Africa has found that over the last month one in three hospital cases of Covid-19 (33 per cent) in Tshwane – the metropolitan area that includes Pretoria where the first suspected outbreak of the variant occurred – were deemed severe, with the patient needing supplemental oxygen or ventilation.

In contrast, the figure was 66 per cent early in the second wave of the coronavirus pandemic earlier this year and 67 per cent in early 2020.

The NICD cautioned that the study had some inherent limitations – it has not been peer reviewed – and that severe cases could rise as the fourth wave gets going. The report also said nothing about the patients’ vaccination status.

Dr Richard Friedland, chief executive officer of Netcare, the largest private health care provider in South Africa, told The Telegraph that early trends during the country’s fourth wave indicated omicron was a “far less severe form” of Covid-19.

During the first three waves, 100 per cent of the 55,000 Covid-19 patients hospitalised in Netcare facilities needed oxygen, he said. So far, during this wave, 10 per cent of 337 hospitalised patients had required it.

“Having personally seen many of our patients across our Gauteng hospitals, their symptoms are far milder than anything we experienced during the first three waves,” Dr Friedland said, referencing the South African region currently experiencing a dramatic surge of omicron variant infections. However, the healthcare provider and other South African experts all stressed that these were only preliminary findings, protecting themselves from a potential backlash should it transpire that omicron is equally, or more, dangerous than previous variants.

It also appears that the claims of those working on the frontline in Southern Africa are not mere hopeful conjecture, but shoots of genuine optimism that are being echoed outside Africa.

Marco Cavaleri, the head of biological health threats and vaccines strategy at the European Medicines Agency (EMA), said: “Cases appear to be mostly mild, however we need to gather more evidence to determine whether the spectrum of disease severity caused by omicron is different [to] that of all the variants that have been circulating so far.”

And, though the data from South Africa is beginning to become more cohesive and reveal a less murky picture of omicron’s severity, how this applies to other countries, including the UK, remains to be seen.

Prof John Edmunds, a member of Sage and a professor of epidemiology at the London School of Hygiene and Tropical Medicine, said yesterday that some aspects of the data “immediately translate” but others, such as those on severity, are difficult to extrapolate. “Estimating the crude rate of hospitalisation [using] severity indicators, I think, is very difficult to do and [it is] very difficult to compare between countries because the population [there] is very different to the population here,” he said.

“There’s an average difference of 15 years [between the age of the average South African and the average Briton] and those averages hide huge differences. They’ve got a much larger, young adult population [in South Africa] than we have here in the UK.

There are fewer older people, proportionately, in South Africa, he said. “So, if you just look at crude hospitalisation rates in South Africa, you’ll get the wrong answer.

“You can’t just apply them here. We would have much higher hospitalisation rates on average, because our population is much older.”