The first doctor to report the Omicron variant on November 18th, 2021 was Dr Angelique Coetzee, National Chairperson of South African Medical Association. “On that day, I saw seven patients with similar symptoms of myalgia, headache, fatigue who tested positive for COVID-19 with rapid tests at my consulting rooms,” Dr Coetzee said in an email interview with Citizen Matters. “Their symptoms were different from Delta and I alerted the South African Ministerial Advisory Committee on Vaccines of which I am a part. It took our scientists six days to announce to the world that there’s a new variant.”
Subsequently, on November 26th, 2021, the World Health Organization (WHO) declared Omicron (B.1.1.529), as it was then named, as a variant of concern. A week or so later, the first two cases of Omicron were detected in India in Karnataka in early December, 2021, with active cases rising to 3,30,447 as on January 23rd, 2022.
Since the detection of the first case, there has been plenty of discussion and some studies, over Omicron’s transmissibility, symptoms and the rate of hospitalization.
Omicron projections
One such study was the ‘Omicron Projections January-March 2022 IISc-ISI Model’ by Professor Siva Athreya, Professor Rajesh Sundaresan and the Centre for Networked Intelligence at IISc-ISI, Bengaluru. The model predicts when the third wave in India will start to flatten, decline and end and estimated the number of daily cases during this period.
The model states: “Past infection, vaccination, affected by immunity waning makes a certain fraction of the population susceptible to the new variant which is taken as a parameter: 30%, 60%, 100%”. This means that the model presents three separate scenarios i.e. 30% susceptible population, 60% susceptible population, and 100% susceptible.
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According to the model, the third wave will most probably peak by January end. It will start to decline by February, flatten by March 1st, and would probably end by March 31-April 1, with data differing from state to state. According to the study, if the susceptible population is 30% daily cases may reach three lakhs, while daily cases will touch approximately six lakh if the susceptible population is 60% and 10 lakh cases per day if the susceptible population is 100%.
How Omicron is different from Delta
For one, the transmissibility of Omicron vis-a-visa Delta seems to be much higher: Omicron is 2.7 to 3.7 times as infectious as the Delta variant among vaccinated people, according to Dr Coetzee.
The symptoms of the two variants too are different.
In Dr Coetzee’s words: “Omicron presents with patient history of sweaty feeling during the night or hot/cold feeling, waking up with either headache, chest pain, back ache, fatigue, might have a scratchy throat or slight dry cough, very seldom having a real temperature or elevated pulse on clinical exam and no real oxygen need. If progressing to severe, the symptoms would be pneumonia, tiredness and shortness of breath.
“Delta, on the other hand, will present with sore throat, blocked nose, lack of smell/taste, tachycardia, low oxygen levels. They proceed to severe pneumonia within 7-10 days with the patient being extremely sick, and will in most cases have a temperature. You should most probably be hospitalised only when you suffer from pneumonia with Omicron.”
Should Omicron be considered ‘mild’?
Dr Coetzee’s answer: “Mild speaks to the clinical picture and most patients presented with mild symptoms as per WHO definition. But any viral infection can become severe depending on your immune system, vaccination status, co-morbidities and age. The older you are, the greater your chance of getting severe infections, especially if you have no previous exposure to SARS Cov-2, previous infection or vaccination”.
It is now generally accepted that Omicron is replacing Delta in number of positive cases due to the former’s higher transmissibility.
How effective are vaccines in protecting against Omicron?
Dr Coetzee responds: “In mild disease cases, there’s no difference between clinical symptoms of the vaccinated vs unvaccinated patients, although vaccinated patients experience the intensity of their symptoms less. At high care and ICU, 80% are unvaccinated, strengthening the notion that vaccine protects 88-94% against severe disease, death and hospitalization.”
Dr Coetzee, however, debunks the misconception that Omicron is a ‘natural vaccine’. “It is primarily a virus infection and might be a very dangerous “natural vaccine” for unvaccinated people above 50 with co-morbidities.”
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Conclusion
Dr Coetzee has been a family practitioner for 33 years. “I am still old school and do not believe you can treat patients “over” electronic health platforms,” says the doctor. “There is a place for electronic health, but not the way it is currently taking over medicine. I have treated patients during Beta, Delta and Omicron and the clinical experience gained is priceless. I am no scientist, I am an outcomes-based primary healthcare physician who believes each and every patient has a story in the form of their clinical history to tell me and then for me to give them the best clinical advice with skills and experience available to me.”
Even as media reports on COVID-19 abound with the focus at present on Omicron, there is also a problem of misinformation and confusion among the general populace over this variant.
“Yes there is a lot of misinformation,” admits Dr Coetzee. “We hear politicians and scientists speaking, but the voices of the average person and healthcare worker dealing with most COVID-19 cases are not heard. We do not speak with/to the average doctor, nurse, patient, but over them; then we are amazed that they don’t do what we are telling them.
“I hear fear spreading over how hospitals will be overwhelmed, how high the positivity rate is. I don’t hear empowerment of the average person on what they can expect if they get COVID, when they need to test, what type of test, when they physically need to see a doctor, when they need to access hospital care, what medication they can use, why they need to get vaccinated, why they need to follow on-pharmaceutical interventions, why they should try to avoid crowds etc.”
Dr Coetzee describes the lack of proper communication thus: “We do not speak the language of the average person, but we want them to hear us.”
Dr K Ravi, Chairman, Clinical Expert Committee (Physician-CEC), Professor and HOD of Medicine, BMCRI, Bangalore, gives insights into the COVID situation and Omicron cases in Karnataka and Bengaluru.
“As of now genome sequencing is being done and as on January 20th around 766 cases have proven to be Omicron,” says Dr Ravi. “The infectivity rate of Omicron is quite high; hence as of today the positivity rate in Karnataka, is almost 18%. The symptoms of Omicron are mild, which includes mild fever, body pain, throat irritation, myalgia. We haven’t usually seen the involvement of the lungs. Karnataka has also been conducting a large number of tests, 2.5 lakh tests as of January 20th.”
“We request the public to follow COVID-appropriate behaviour: masking, social distancing, and vaccination is very important. Most of the patients who are not developing severity is probably because of vaccination.”
He adds that hospital admission rates are definitely lower in the third wave as compared to the second wave. “It is around 1- 2 per cent, of which those requiring oxygen could be approximately 20-25%,” said Dr Ravi.