Ruminations: The Conundrum That Is Omicron

"We believe that it might not necessarily just be that Omicron is less virulent, but we believe that this coverage of vaccination, also in addition to natural immunity of people who have already had contact with the virus, is also adding to the protection."
"That's why we are seeing mild illness."
South African Health Minister Joe Phaahla

"This study provides further evidence of the very substantial extent to which Omicron can evade prior immunity given by both infection or vaccination."
"This level of immune evasion means that Omicron poses a major, imminent threat to public health."
Professor Neil Ferguson, study lead, Imperial College London's statement

"There is a huge amount of uncertainty in these modelled estimates [Imperial College London findings]. And we can only be confident about the impact of boosters against Omicron when we have another month of real-world data on hospitalization ICU numbers and deaths."
"The conclusions made are based on making assumptions about Omicron where we still don't have sufficient data."
"For example, we have no data on the cellular immune response which is now probably driving effectiveness of vaccines. This is a crucial missing assumption in the modelling."
Dr.Clive Dix, former chair, U.K. Vaccine Taskforce

A health care worker administers the COVID-19 vaccine to a young mother in Johannesburg, South Africa, December 04, 2021. Photo by REUTERS/Sumaya Hisham

The science has yet to catch up and keep pace with the narrative assumptions and real-time realities. South Africa's health minister stated Friday that vaccines and past infections might represent the reason the current wave South Africa is experiencing of coronavirus infection led by the Omicron variant seems on the basis of their experience, to be a milder kind of variant, despite its runaway infectiousness.

At a virtual conference that took place that same day, Michelle Groome, an official at the National Institute for Communicable Diseases in South Africa explained the country has experienced a small increase in hospital admissions and deaths, and that "this level is very much lower even than the baseline period we were seeing between the second and third waves".

She later added that the increase "is likely to be milder because of our underlying immunity, rather than intrinsic virulence of the virus". Those who remain uninfected and unvaccinated however, are still at risk of severe illness, she added, from the new variant. These cautious but hopeful observations are at variance with findings of a recently released study by Imperial College London.

Protection afforded by past infection against reinfection with Omicron, according to ICL, may be as low as 19 percent. The discrepancy between the two countries' experts' reportage; the study conclusions as opposed to the data out of South Africa, have been questioned by Dr. Dix, pointing out that vaccines remain reliable against severe disease and death.

Early data suggests Omicron leads to fewer hospital admissions than in previous waves Getty Images

Case numbers in South Africa expanded swiftly from the time of its November 25 alert of its discovery of the presence of Omicron where daily cases have risen far more quickly than in any of the three previous waves the country went through. Yet COVID-19 infections are falling in the area including the capital Pretoria, according to analyses of wastewater samples which indicate the Omicron wave may have peaked there.

These are findings that corroborate comments by South Africa's health minister that the Omicron-driven wave may be peaking in Gauteng, where Pretoria and Johannesburg are situated, home to a quarter of the country's 60 million population. Even yet however, new cases were over 20,000 daily compared with 4,400 the week of the third wave; ample evidence of Omicron's rapid transmissibility.

South Africa has become a harbinger of what may occur with Omicron elsewhere; the variant has now been reported in over 80 countries, and growing. According to scientists however, caution is required in the sense that a vastly different experience may occur elsewhere since the population of South Africa is young (in comparison with those of developed nations) where between 70 and 80 percent of people may have had a prior COVID-19 infection, (according to antibody surveys), affording them some level of protection.

At present about 7,600 people are in hospitals in South Africa with COVID-19; roughly 40 percent of the peak in the second and third waves while excess deaths -- a measure of the number of deaths against a historical average -- are below 2,000 weekly, representing an eighth of their previous peak.

Over 90 percent of hospital deaths were among unvaccinated or partially vaccinated people.
As well, hospitalization numbers in this wave are inflated by the very fact that milder patients are admitted since there is room to accommodate them.

Chart showing that the Omicron variant is now dominant in London, and has sent cases surging to their highest level of the pandemic

Concurrently, the research team from Imperial College London reached the conclusion that a previous COVID-19 recovery provides little protection against infection with the Omicron variant, reflecting the results of a large study underlining the importance of booster shots. According to the study results, previous infection likely offers a mere 19 percent protection against Omicron, roughly in line with two doses of vaccine -- as much as 20 percent effective against Omicron.

The addition of a booster dose had dramatic results, blocking an estimated 55 to 80 percent of symptomatic cases, according to that same ICL study which analyzed all the PCR test-confirmed COVID cases in England between November 29 and December 11, an expansive examination of Omicron's potential to evade the body's immune defences. Additionally, the study found no indication that cases of Omicron infection were less severe than Delta based on the number of people testing positive with symptoms or who had ended up in hospital.

Europe awaits an Omicron-driven fifth wave of infections, while intensive-care units in many areas are filled with patients ill with the Delta variant. According to the U.K. team, the proportion of Omicron among all COVID cases was likely doubling every two days up to December 11. The estimate is that everyone infected with the variant passes it on to over three others.