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Dr Angelique Coetzee talks about how she first spotted the Omicron variant, how it has replaced Delta in South Africa and whether the Omicron wave will enable herd immunity. This session was moderated by Anuradha Mascarenhas, Senior Editor, The Indian Express

I am a general practitioner and still old-school. So, even with the Beta and Delta wave, we let patients come in, and, I think, that assisted us greatly in understanding how these variants attack the body. We were out of the Delta wave for about eight weeks, and one morning a young man came with some complaints. He tested positive, and subsequently, his family did too. That day, I also saw other patients with more or less the same symptoms, which were very different from Delta. I call it musculoskeletal, mostly because of the sore body, backache, headache, chest pain, scratchy throat and a slightly runny nose, but not really fever and any oxygen needs. In the beginning, when I first saw these patients, I still followed the Delta protocol. In Delta, you have to see your patients back (after a few days), because they tend to turn around by about Day 10; between Day 7 and 10, that’s when they really get bad. But within one week, I realised that out of all the patients that I’d seen, only four came back for a follow-up. The rest said they were much better.

First, you need to look at the definition of the WHO (World Health Organization) regarding mild illness of Covid-19. The definition is clear; signs of upper respiratory tract infection, no shortness of breath, dyspnea, or any abnormal chest X-ray — patients should be able to be treated at home. So, if you look at the definition, less than one per cent are getting severe illness. The majority of patients in primary healthcare are adhering to the definition of mild illness. If you’re unvaccinated, if you have comorbidities, then any viral infection might lead to severe illness and that severe illness would be pneumonia. That’s what we have seen with Omicron. What I can advise you is that do not look at your positivity rate or your daily cases. You need to look at how many people are admitted in the ICU and what are your death rates for patients admitted specifically for Covid-19.

Our data is clear that less than one-third of patients with Omicron were severe in hospitals. With Delta, on July 8, there were 19,900 in hospitals, on July 14, 17,000 in hospitals and on July 10, there were 2,597 in high-care and ICUs. With Omicron on December 17, we had 23,000 cases per day, 528 in high-care and 7,900 in hospitals. Our death rate was much lower; average was about 100. With Delta, we had seen a huge increase in death rates.

In the mild cases, it doesn’t seem to matter whether you have been vaccinated or not. We have seen just as many mild cases in vaccinated people as in the unvaccinated. However, what we did notice was that the severity of the headache or the scratchy throat or the malaise is less intense among the vaccinated. In our ICUs, 88 per cent are unvaccinated.

Not that much as was the case with Delta. Remember the definition of severe illness, which is lung infiltrates, so that’s pneumonia. And those patients with pneumonia will either be in the ICU or in high care. But for the average person out there, Omicron will not affect the lower respiratory tract. In severe disease, it does affect the lower respiratory system, that’s why you are admitted, because of the pneumonia…and that would cause inflammation and cytokine storm, although clinically not so severe as we have seen with Delta, especially among the vaccinated people.

We do see youngsters. From the data on January 7, we see ICU admissions among the 70-plus age group were 270 for the past two weeks, ventilations: 135, and 91 deaths. Among the 60-69 age group, hospitalisations were around 35 per cent. In the 70-plus age group, the hospitalisation was 49 per cent, 50 to 59 was 29 per cent, 40 to 49 was 17 per cent and from 18 to 39 it was 11 per cent. That was the status of hospitalisation for two weeks that was released on January 10.

In South Africa, Omicron has taken over from Delta; we don’t really see Delta cases anymore. Second, regarding protection, you have to understand that this is our fourth wave. There are a lot of people in our country who have been infected before with one of these variants, and have what we call T and beta cells. So, your antibodies will go down, but the moment you encounter a new variant, there will be some memory that will help protect you. For now, definitely Omicron will protect you with T and beta cells.

What we have seen is that whether you have been vaccinated or not, you still get the mild disease. I think, it’s extremely important that people understand this, that the vaccines are not going to protect you against mild disease but your symptoms will be less intense. And that’s what we’ve seen. In that case, vaccines are still good for the world. However, going forward, I don’t think you’re going to get your population to go every six months for a booster. I think at some stage people are going to say no, I’ve had enough of this.

In South Africa, unfortunately, one-third of our healthcare workers are not vaccinated for various reasons. We didn’t see a huge strain on our hospitals. Maybe we have a different system than other countries because we are very much primary healthcare-orientated, with people going and seeing the doctors physically, and that also helps to explain the disease to patients. So, it’s all about empowering the people out there. But there is mental fatigue everywhere. Even I get fed up, I actually had a fight with two patients who were admitted, because they didn’t get vaccinated. Luckily, our hospitals are not overwhelmed so it was easy to get a bed for them. But this could have been prevented.

The use of masks should not be negotiable; it should be compulsory. It’s interesting that one of the first things some of the first-world countries did was to close the borders with other countries, including South Africa, while they let people walk around without masks, spreading the virus. A mask should be part of your daily make-up.

Let’s tackle the mutation. First, it’s a possibility. Hopefully, that will never happen. But if it would, that would be a disaster, because then you will have a faster-spreading viral infection with a lot of severity.

I presume that there will be a few cases with long Covid with Omicron for those people who have been on the ventilator and discharged. But, so far, we haven’t really had any experience with that.

Yes, we did see that right in the beginning. That’s always in any wave; children first. So for now, at this stage, even looking at the data, there are not really anyone (children) in the hospital. We don’t see children getting that sick anymore.

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