GUEST BLOG: Ian Powell – Reply to omicron
Associate Professor Siouxsie Wiles knows a lot about viruses. She directs the laboratory of bioluminescent superbugs (production and emission of light by a living organism for us, mere mortals) at the University of Auckland.
She is an outstanding communicator on the coronavirus, in particular, and science, in general, in mainstream and social media. In addition, Dr. Wiles is also often violently attacked in Cameron Slater’s far-right blog. Referrals are often not that impressive.
One of his regular media perspectives is Writing who, on December 20, published an excellent article from him:.
Dr Wiles discusses the disturbing rise of the latest globally threatening variant of Covid-19, the omicron. It has also arrived in Aotearoa in New Zealand although to date all cases have been detected at the border.
The Gauteng experience
Dr Wiles focuses on the very high transmissibility of omicron, noting that the cases are increasing very rapidly. It is based on the analysis of data from Dr Ridhwaan Suliman (mathematician) in South Africa. Suliman analyzes data from Gauteng.
Located on the Highveld, Gauteng is one of the nine provinces of South Africa. Although the smallest province in that it only comprises 1.5% of the country’s land area, Gauteng is a good choice for data analysis. But, in this relatively small area resides over 25% (nearly 16 million) of the country’s population, including Johannesburg and Pretoria.
Dr Suliman compares the four main waves of Covid-19 (southern seasons) – the first (winter 2020) followed by beta (summer 2020-21), delta (winter 2021) and omicron (summer 2021). The transmissibility of Omicron compared to previous waves is amazing.
Comparing the daily infection cases (based on seven-day moving averages), Omicron is currently close to 10,000 per day. For the same number of days, the delta was about 8,000 (the first two waves were about half the delta).
This sounds an obvious wake-up call, as delta subsequently hit its maximum daily case rate of over 10,000. But that’s the start for omicron. As the waves are conveniently connected with the seasons, omicron has experienced less than half a season in Gauteng.
Suliman’s data shows a slight decline (previously it was just above 10,000), although there was a small drop earlier quickly followed by a larger rise. Delta’s current daily rate has now fallen below that of the first two waves for the same length of time.
Additionally, the effects of vaccination rates should be taken into account when considering the implications for New Zealand. Our vaccination rate for the general population is 75% (76% in Australia). Compare that with South Africa’s 26%. This puts us in a much better position, all other things being equal. But it’s different to be in a good position.
Dr Suliman is also looking at weekly hospitalization rates in Gauteng by comparing them to previous waves of Covid-19. Hospitalizations are on the rise. Currently it is around 3,000 (about 1,000 per capita in New Zealand). The delta at its peak was around 6,500 but is now declining.
Taking into account large differences in vaccination rates, Gauteng is consistent with what is happening internationally, including across Europe. Even though the Delta continues to soar in the UK, it has been overwhelmed by omicron as the dominant strain. Across Tasman, New South Wales has recorded more than 2,500 cases a day, up from around 500 a week ago.
Omicron a milder variant?
It has been suggested that the effects of omicron are milder than those of delta, although this is now disputed. You have to be very careful to draw firm conclusions. Dr Wiles notes research showing that omicron was 70 times better than the delta variant at infecting and replicating in bronchial tissue and 10 times less at infecting and replicating in lung tissue.
Hospitalizations and deaths are normally several weeks behind cases because it takes a long time for people to get very sick, and sometimes they can be in intensive care for weeks or even months before dying. Not enough is known about how well vaccines work against serious illness and death and what happens to unvaccinated people who receive omicron.
As Dr Wiles points out: “… even if omicron turns out to cause milder disease for most people, it won’t be for everyone. And due to the sheer volume of people catching omicron, hospitals are always at risk of being overwhelmed. We also don’t yet know if those with mild omicron disease will develop long covid and be affected for life. “
Timely advice for New Zealand response
Public health specialists from the University of Otago published in their online publication Public health expert very timely quality advice on how to respond not only to the delta threat but now also to omicron:.
The article is written against the backdrop of the encouraging progress now being made in reducing the delta threat with infection rates falling significantly in Auckland and well limited to small numbers in a few other provinces. The increase in immunization rates has clearly made a big difference. Their aim is to strengthen international border security and a range of public health measures. It is recommended to read.
It is unfortunate that we returned to September when Auckland was down. The decision to lower the alert levels from 4 to 3 was too early and contrary to the advice of government modelers (the government was disappointed with an erroneous advice from the Ministry of Health).
This reckless decision meant more than just a delay of about two months. It also meant a subsequent exponential increase in infections and hospitalizations, resulting in a longer and preventable overall lockdown.
Aotearoa would be in a much better position now if external experts had not been kept out and been able to directly and proactively access government. The reality is that, as in most other areas of health, most of the expertise lies within the health system but outside the ministry of health. If the omicron is to be successfully fought, this expertise should not again be so disengaged.
Where are we
But we are where we are. There is a big question mark as to whether the combination of the removal of restrictions and the holiday season will cause the delta to rise again. This is now made worse with the arrival of omicron at our border.
The most critical response is to better secure the overseas border against omicron. The government’s announcement yesterday to delay returnees from Australia until the end of February, to reduce the time between the second dose of vaccine and the first booster to four months, and the rollout of the vaccine for 5-11 years are good steps in the right direction.
The announcement suggests a return to the zero tolerance approach that has served New Zealanders so well, at least until October of this year.
But it seems that on average we have a case of community transmission after about 200 arrivals overseas in isolation and managed quarantine. As difficult as it may be, the flow of arrivals needs to be slowed down considerably, especially from high-risk countries (there are many), to ensure that the numbers are safely manageable.
This slowdown would be at least until good progress has been made in immunizing 5-11 year olds, providing boosters to those already vaccinated, and improving vaccination rates for those over 12 (or more learn more about the effects of omicron).
When asked if the French Revolution of 1789 was a good idea, Chinese revolutionary Mao Zedong reportedly said it was too early to tell (in fact, I think it was his revolutionary colleague Zhou Enlai).
It doesn’t matter who said it, what is certain is that if it’s too early to say what the effects of omicron will be, it won’t be long before we do.
The continuation of the zero tolerance approach demonstrated by the government yesterday, including its scope, will make the difference between success and failure.
Ian Powell was Executive Director of the Association of Salaried Medical Specialists, the trade union representing senior physicians and dentists in New Zealand, for over 30 years, until December 2019. He is now a healthcare systems specialist, labor market scholar and political commentator living in the small river estuary community of Otaihanga (the place by the tide). First published at Otaihanga Second Opinion