Omicron up close: SA’s experts offer their views

The panicked reaction across much of the world to the Omicron Covid-19 variant comes with a scramble for information.

In SA, where Omicron was first identified and where infections are increasing, scientists and doctors have described what they are seeing. 

Here are highlights from several interviews and a briefing.

Marc Mendelson, head of infectious diseases at the University of Cape Town, who also works at Groote Schuur Hospital:

• “Anecdotally, we are seeing a lot of reinfections. What we don’t know at the moment, because we haven’t got the data yet, is how many of those people are unvaccinated vs the vaccinated.
• “While people are freaking out, the other thing to stress is that if you look across the variants, the vaccines have protected against severe disease, hospitalisation and death. Looking at the Omicron mutations, though there are an awful lot of them, there’s nothing to indicate the ability of vaccines to fight this is going to be affected to a very great extent.
• “In truth, it doesn’t want to kill you, it wants you to stick around.
• “The only ones putting their hand on their hearts and telling the world don’t worry, this is going to be mild, haven’t learnt enough humility yet in the face of this virus.
• “It’s always nice to hope, but don’t set everything on this because I think your hopes could be dashed.”

Richard Friedland, CEO of Netcare Ltd:

• “If in the second and third wave we’d seen these levels of positivity to tests conducted, we would have seen very significant increases in hospital admissions and we’re not seeing that. In our primary care clinics it is mainly people under 30 years old.
• “I think there is a silver lining here and this may signal the end of Covid-19, with it attenuating itself to such an extent that it’s highly contagious, but doesn’t cause severe disease. That’s what happened with Spanish flu.
• “We are seeing breakthrough infections in people who have been vaccinated, but the infections we’re seeing are very mild to moderate. For healthcare workers who have had boosters, it’s mostly mild. This whole thing has been so poorly communicated and so much panic has been generated.
• “It’s early days, but I’m less panicked. It feels different to me on the ground.”

Shabir Madhi, a vaccinologist from the University of the Witwatersrand who led trials of AstraZeneca’s and Novavax’s shots in SA:

• “Omicron seems to be moving at a faster speed than Delta, but at the same time what seems to be happening is that our hospitalisation rate is somewhat more muted.
• “Vaccine or past transmission create T-cell immunity, which are good at protecting against severe disease and death. The mutations of the virus very likely make it more successful against antibody activities, but it seems like there may well be preservation of the T-cell immunity.
• “I’m optimistic that in this resurgence, while the total number of cases will probably be greater, hospitalisations and deaths will be lower than what we experienced during the course of any of the first three waves. That is because all indications are that 75% to 80% of people in SA were infected with the virus during the course of the first three waves. That is probably going to equip those individuals not to resist infection, but rather prevent progression of infection to severe disease.”

Anne von Gottberg, a clinical microbiologist at the National Institute for Communicable Diseases (NICD):

• “All the data has shown that children have a less severe clinical course and we’ve had some anecdotal reports from hospitals in SA that they are seeing a few more children in some hospitals and are admitting them, but many of them have an uncomplicated clinical course during the few days they are in hospital.
• “We monitored reinfections for the Beta and the Delta waves and we didn’t see an increase in reinfections over and above what we expect when the force of infection changes, when a wave starts. With Omicron, we are seeing an increase in reinfections.
• “This virus may be similar to Delta in its ability to spread or in being contagious. However, it’s the susceptibility of the population that is greater now because previous infection used to protect against Delta and with Omicron it doesn’t seem to be the case.
• “However, we believe with reinfections the disease will be less severe and the same would hold for those who are vaccinated. That would be good news.”

Adrian Puren, acting executive director of the NICD:

• “While there are large numbers of cases and evidence of increased hospitalisations, large-scale sequencing would show if this variant is starting to fully displace the Delta variant. Current evidence shows Omicron accounts for about 75% of the variants in circulation overall.
• “If it does displace the Delta variant, we’d need to see if this is the result of immune evasion or because of increased transmissibility.
• “We had the Beta variant, which was more about immune evasion and we had the Delta, which was more about increased transmissibility. But reinfection data shows transmissibility is a major contributor, so we are trying to see if Omicron fits more into immune evasion primarily or more into increased transmission or both. Reinfection data points to immune evasion.”

Leon Geffen, a general practitioner in Cape Town’s Sea Point suburb and director of the Samson Institute for Ageing Research:

• “We are seeing a massive upsurge in the total number of cases. People are mostly presenting with coughs and upper respiratory tract infections.
• “Most people I have seen or spoken to have been vaccinated.”

Anthony Smith, a general practitioner in Cape Town:

• “It was like a tap being turned on from Thursday or Friday last week. It’s been mostly young people, but there have been some older people, probably about 20%.
• “Most children were infected at communal events. They are from a younger demographic and presenting with milder symptoms, mainly sore throats and respiratory phenomenon. Even in older people it’s been relatively mild.
• “No-one has been even close to being seriously ill but it’s probably too early to tell if this will be a milder variant.”

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