It spreads like wildfire: how to exit the Omicron surge remains a puzzle

Eilish O'Regan

David Nabarro, Covid-19 special envoy for the WHO

January 11 2022 02:30 AM

Omicron may be conquering the world but many Covid-watchers in Ireland and abroad are buoyed by reports that, although it spreads like wildfire, it is much less likely to land someone in hospital or intensive care.

It is an indication of how desperate we are for some optimism at this stage in the pandemic that we can still see a ray of light as daily cases breach 26,000, hospitalisations hit more than 1,000 and 89 patients lie seriously ill in intensive care with Covid-19.

What we can say is this is more of a tidal wave compared to the tsunami which hit hospitals last January.

A combination of immunity gained from vaccination as well as indications that it is much less able to replicate in the lungs – where damage from the virus can lead to pneumonia and cause patients to need a ventilator – has blunted some of its force.

The Indo Daily: Omicron and Covid Anxiety - Everything you need to know

Early national data from Scotland suggests Omicron is associated with a two-thirds reduction in the risk of hospitalisation compared to Delta.

But there is much to the Omicron puzzle we have yet to figure out and, with a peak in infections yet to come, it is still not clear how fast or safely we can exit this wave.

We still do not know what the knock-on from the record-breaking cases of last week will be.

It can take about 10 days from infection for a person to become sick enough to need hospital treatment, so we don’t know how many will need to be in a ward.

The trends in age groups who are getting infected with Omicron from the end of December to early January show 60pc were under 35. However, there was a 161pc increase in cases in people aged 75-84.

This rise in infection in older people needs to be put in context because it is coming from a low base – rising from 436 to 1,137.

The high level of booster vaccines in their age group provides a strong shield – but at the same time this kind of drift poses a potential risk because of their age and vulnerability.

The age profile of Covid-19 patients who are in intensive care is also shifting and there has been a fall in the number and proportion of those who are over 50. They still account for more than one in two seriously ill patients with the virus in intensive care.

There are also some complex decisions to be made about how to juggle any reduction in isolation periods in order to help tackle the surge in Covid-related absences from work without triggering a spiral in infections.

Similarly, unlocking restrictions may not be that easy if we have a knowledge deficit, including little evidence of what the level of risk is of getting reinfected with Omicron even if you are fully boosted.

The World Health Organisation (WHO) envoy David Nabarro yesterday predicted “continued surges” every three to four months. We need to be better armed every time.

Antiviral drugs, which reduce the risk of an infected person being hospitalised, are on the way. But we have to see how well they work against Omicron.

Supply may be limited and there will need to be careful guidelines on who will get them, as well as systems to ensure they are given early in infection.