South Africa

THE CONVERSATION: THE VARIANT

Omicron is the new COVID kid on the block: five steps to avoid, ten to take immediately

The departures board at OR Tambo International Airport on Saturday, 27 November, 2021. Photo: FELIX DLANGAMANDLA

It’s naive to believe that imposing travel bans on a handful of countries will stop the import of a variant. This virus will disperse across the globe unless you are an island nation that shuts off the rest of the world.

South Africa reacted with outrage to travel bans, first triggered by the UK, imposed on it in the wake of the news that its genomics surveillance team had detected a new variant of the SARS-CoV-2 virus. The Network for Genomics Surveillance in South Africa has been monitoring changes in SARS-CoV-2 since the pandemic first broke out.

The new variant – identified as B.1.1.529 has been declared a variant of concern by the World Health Organisation and assigned the name Omicron.

The mutations identified in Omicron provide theoretical concerns that the variant could be slightly more transmissible than the Delta variant and have reduced sensitivity to antibody activity induced by past infection or vaccines compared to how well the antibody neutralises ancestry virus.

As vaccines differ in the magnitude of neutralising antibody induced, the extent to which vaccines are compromised in preventing infections due to Omicron will likely differ, as was the case for the Beta variant.

However, as vaccines also induce a T-cell response against a diverse set of epitopes, which appears to be important for prevention of severe COVID, it is likely that they would still provide comparable protection against severe Covid due to Omicron compared with other variants.

The same was observed for the AstraZeneca vaccine. Despite not protecting against the mild-moderate Beta Covid in South Africa, it still showed high levels of protection (80% effective) against hospitalisation due to the Beta and Gamma variants in Canada.

In view of the new variant, there are a few steps that governments shouldn’t be taking. And some they should be taking.

What not to do

Firstly, don’t indiscriminately impose further restrictions, except on indoor gatherings. It was unsuccessful in reducing infections over the past 3 waves in South Africa, considering 60%-80% people were infected by the virus based on sero-surveys and modelling data. At best, the economically damaging restrictions only spread out the period of time over which the infections took place by about 2-3 weeks.

This is unsurprising in the South African context, where ability to adhere to the high levels of restrictions are impractical for the majority of the population and adherence is generally poor.

Secondly, don’t have domestic (or international) travel bans. The virus will disseminate irrespective of this – as has been the case in the past. It’s naive to believe that imposing travel bans on a handful of countries will stop the import of a variant. This virus will disperse across the globe unless you are an island nation that shuts off the rest of the world.

The absence of reporting of the variants from countries that have limited sequencing capacity does not infer absence of the variant. Furthermore, unless travel bans are imposed on all other nations that still allow travel with the “red-listed” countries, the variant will directly or indirectly still end up in countries imposing selective travel bans, albeit perhaps delaying it slightly.

In addition, by the time the ban has been imposed, the variant will likely have already been spread. This is already evident from cases of Omicron being reported from Belgium in a person with no links to contact with someone from Southern Africa, as well as cases in Israel, UK and Germany.

All travel bans accomplish in countries with selective red-listed countries is that they delay the inevitable. More could possibly be accomplished by rigorous exit and entry screening programmes to identify potential cases and mandating vaccination.

Third, don’t announce regulations that are not implementable or enforceable in the local context. And don’t pretend that people adhere to them. This includes banning alcohol sales, whilst being unable to effectively police the black market.

Fourth, don’t delay and create hurdles to boosting high risk individuals. The government should be targeting adults older than 65 with an additional dose of the Pfizer vaccine after they’ve had two shots. The same thing goes for other risk groups such as people with kidney transplants, or people with cancer and on chemotherapy, people with any other sort of underlying immuno-suppressive condition.

South Africa shouldn’t be ignoring World Health Organisation’s guidance which recommends booster doses of high risk groups. It should de-prioritise, for the time being, vaccinating young children with a single dose.

Fifth, stop selling the herd immunity concept. It’s not going to materialise and paradoxically undermines vaccine confidence. The first generation vaccines are highly effective in protecting against severe COVID-19, but less predictable in protecting against infection and mild COVID due to waning of antibody and ongoing mutations of the virus. Vaccination still reduces transmission modestly, which remains of great value, but is unlikely to lead to “herd-immunity” in our lifetimes.

Instead, we should be talking about how to adapt and learn to live with the virus.

There is also a list of things that should be considered in the wake of the Omicron variant, irrespective of whether it displaces the Delta variant (which remains unknown).

What to do

Firstly, ensure health care facilities are prepared, not only on paper – but actually resourced with staff, personal protective equipment and oxygen, etc.

There are 2000 interns and community service doctors in South Africa waiting for their 2022 placement confirmation. We cannot once again be found wanting with under-prepared health facilities.

Provide booster doses of J&J or Pfizer to all adults who received a single dose J&J. It’s needed to increase protection against severe COVID. A single dose of the J&J vaccine reduced hospitalisation due to Delta variant in South Africa by 62% in South African healthcare workers, whereas two doses of AZ and mRNA vaccines in general had greater than 80%-90% protection against severe disease from the Delta variant.

Studies confirm a two dose schedule of the Johnson & Johnson vaccine is superior in protecting against hospitalisation than a single dose. And if you want durability of protection, you need to boost, which can be done with another dose of Johnson & Johnson or a dose of mRNA vaccine.

The evidence is clear that the type of immune responses from a heterologous approach of AZ or JJ followed by a mRNA vaccines such as Pfizer/Biontech induces superior neutralising and cell mediated immune responses than two doses of the non-replicating vector vaccines.

Thirdly, implement vaccine passports for entry into any indoor space where others gather, including places of worship and public transport. Vaccination might be a choice currently, however, choices come with consequences. Even if vaccines only reduce transmission modestly, over and above the infections they prevent, a breakthrough case in a vaccinated individual poses less risk of transmission to others than infection in an unvaccinated and previously uninfected individual.

Fourth, continue efforts at reaching out to the unvaccinated and under-immunized. This should include the use of pop up facilities where people are likely to gather and other targeted community outreach programs.

Fifth, immediately boost high risk groups older than 65 and others who have immunosuppressive conditions. The primary goal of vaccination therefore needs to be on reducing severe disease and death. This requires targeted strategies on who to prioritise.

Sixth, encourage responsible behaviour to avoid re-imposing alcohol and other restrictions to punish all due to irresponsibility on part of a minority.

Seventh, monitor bed availability at regional level to help decide on regional action to avoid overwhelming of facilities. Higher levels of restrictions need to be tailored for when we expect overwhelming of health facilities. As hospitalisation usually lag behind community infection rates by 2-3 weeks, keeping an eye on case rates and hospitalization rates could predict which facilities in which regions may come under threat.

This would allow for a more focused approach to imposing restrictions to relieve anticipated pressure on health facilities 2-3 weeks before expected. This will not change the total number of hospitalisations. But it will spread it out over a longer period of time and make it more manageable.

Eighth, learn to live with the virus, and take a holistic view on the direct and indirect effects of the pandemic on livelihoods. The detrimental indirect economic, societal, educational, mental health and other health effects of a sledge-hammer approach to dealing with the ongoing pandemic threatens to outstrip the direct effect of COVID in South Africa.

Ninth, follow the science and don’t distort it for political expediency.

Tenth, learn from mistakes of the past, and be bold in the next steps.The Conversation DM

Shabir A. Madhi, Dean Faculty of Health Sciences and Professor of Vaccinology at University of the Witwatersrand; and Director of the SAMRC Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Gallery

Comments - share your knowledge and experience

Please note you must be a Maverick Insider to comment. Sign up here or sign in if you are already an Insider.

Everybody has an opinion but not everyone has the knowledge and the experience to contribute meaningfully to a discussion. That’s what we want from our members. Help us learn with your expertise and insights on articles that we publish. We encourage different, respectful viewpoints to further our understanding of the world. View our comments policy here.

All Comments 21

  • There is no evidence that Omicron gives anything BUT mild symptoms – 1-2 days of body aches and a slight cough. No hospitalizations yet on this variant. We cannot lock down the world for this – it is truly madness. Let it run its course.

    • Agree with your last 2 sentences, but where did you get your info on the “mild symptoms” and “no hospitalizations” yet. As far as I know, no information has as yet been released on either by the heath authorities. Be careful not to post fake news when your are not 100% certain of your facts.

      • If one looks at the News24 Covid Dashboard, the proportion of Covid tests that are positive is rising, as is the number of new cases, but currently the number of hospital admissions is continuing to fall.

        • Paddy, for now yes. However, the new rise in infections only started a week or so ago, and it normally takes a while before that can result in hospitalisation, and much longer if it results in death. The dashboard can be misleading, as hospitals do not report admissions, and the reasons of such, timeously. We’ll see what that dashboard looks like in about 10 days or so. I however, hope you’re right, but it is far too early to tell. What I do know though, after listening to a panel discussion with health authorities on RSG, is that 95% plus of new infections are indeed from the Omicron variant. That in itself is a major concern. Bottom-line, read the comment below by JB Jellybean. He/she is 100% correct.

      • The head of South African Medical Association said that the Omicron variant of COVID-19 produces “unfamiliar symptoms” in patients.
        With cases of the Omicron variant of COVID-19 rising fast, South African expert revealed the symptoms that have been observed in patients with COVID-19 disease caused by the latest variant of concern.
        Talking to news agency AFP, Dr Angelique Coetzee, chair of the South African Medical Association, said that the new variant was causing “unfamiliar symptoms in patients”. She is doctor who raised the alarm against Omicron, has said that the COVID-19.
        As per Dr Coetzee, the symptoms included extreme tiredness, mild muscle aches, a scratchy throat and dry cough, while only a few of the cases showing slightly high fever. Nevertheless, she observed that the symptoms displayed by patients infected with the Omicron variant were “mild”. Furthermore, she revealed that the patients were able to completely recover without the need to be hospitalised. She has treated more than 30 COVID-19 patients with “unfamiliar symptoms” in the last 10 days.

    • Thank you for this article and very sound and reasonable advice, we certainly do need to implement vaccine mandates as opposed to blunt lockdowns, and we need to stringently implement the other measures to prevent spread, distancing , making and sanitising. We also need to stop large gatherings, such as matric ‘rage’ parties, which are obvious large spreading events. We also certainly need to protect and support immunocomlromised and vulnerable people and that is through getting a high level of vaccination that helps protect the vulnerable as well, and also make boosters very easily accessible all of them. Government needs to really emphasise that vaccination is essential to allow the economy to restart, preserve jobs, and protect the vulnerable.
      Unfortunately understandable distrust of government and the dissemination of misinformation is having such an undermining effect on the vaccination peogramme, and we are seeing the impacts

  • What a pleasure to read a calm, rational and reasoned set of recommendations. Dare we hope that the government’s response is based on this rather than the draconian nonsense the warring internal factions in the ANC inflict on the long suffering public? Could someone please neutralise (as well as they have silenced) Nkosazana Dlamini Zuma…… She IS still there is she?

  • Hi Shabir, you are perhaps 100% correct in your assessment, and your opinion on what to avoid, and what steps to take.. Unfortunately, it is only 2 days and a bit since the news broke of the new Covid variant. Everyone will now give his/her opinion, and we still don’t know how serious this new variant is compared to say the Delta variant. Already, there were some stupid comments by many prominent people. The worse that I have seen was actually from the Major of Cape Town, only about 10 days into his job. In a article on News24 yesterday morning, Hill-Lewis apparently phone Stephen Grootes as a news anchor at SAfm and lambasted the Dept. of Health for announcing the new variant. Why, because of the damage it will cause to tourism in the Western Cape (which is true). However, the net result of that article was the incredible response from subscribers, with more that 200 in a matter of hours. My estimate was that at least two-thirds of the comments agreed with the major. There were zero, yes zero, monitoring of these comments by News24 (the article was removed at about 14:00 yesterday). Around 10am there was another article, where Prof. Glenda Gray made a statement that is the duty of of the health authorities to reveal the new variant. Again, incredible response from subscribers, many openly and aggressively insulting Dr. Gray (some of the comments have now been removed). Until and when we hear from the scientists, we simply would not know how to react, and what to do.

    • Just, to clarify. up to 2 weeks ago the average number of new Covid cases was about 250 a day. Since a week ago, it start to increase. On Thursday it was 2400, on Friday 2800, and yesterday 3200. Byt he end of the coming week it might be 10,000 (and we all know under-reported cases actually are.. However, until we here from scientists on how bad this variant is, and if the current vaccinations will be effective against such, it will be ludicrous for the Government to imposed all kinds of new lockdown measures.

  • The problem is it is easier for politicians like Johnson to make a decision that protects them self. If they act they can’t be blamed for doing nothing even if the action served no purpose.

  • Firstly, to the good professor and the many more professionals who work tirelessly in their efforts to defeat this virus THANK YOU FOR YOUR SERVICE!

    Then thank you for a clear, concise and informative article on what to do and what not to do; all of which makes eminent and logical sense!

    If only people would follow the advice that’s being offered; and get vaccinated!

    Finally, the sooner the government starts to enforce a vaccination mandate, as suggested in the article the better. And if we want to see an enormous up-tick in the vaccination rate, make it mandatory to present a vacation certificate to gain entry into any liquor outlet!

    Makes you DRINK, doesn’t it 🍷

    Cheers

    • Yes, it does drive one to drink but perhaps for not much longer. If what I witnessed in the shops this morning is any predictor of expectations of government action then people are definitely expecting an alcohol ban of four to six weeks.

  • The UK is still peeved that we shunned their vaccine. Amusing that it now turns out they already had O but did not know what they had!

    For the rest, covid is with us forever. People need to make their own decisions and live with the consequences. One thing for sure : we cannot continue with the lockdowns/restrictions.

    • Ditto…and I am sick to hear of those that refuse to be vaccinated, causing unbelievable harm to the rest. Just beg, plead, that the president will announce compulsory vaccinations…sick of this so-called constitution which protects the ones that should not be protected….Worldwide figures show clearly that countries with a high percentage of vaccinations might still have a high number of daily positive cases (especially Europe, Asia, North America), but the death percentage is extremely low.

      • People who refuse to be vaccinated are being incredibly selfish and blind to scientific facts but I do not believe that a mandatory vaccination programme would pass legal muster. I do believe that vaccination passports should be introduced and people who are not vaccinated should be banned from all shops, restaurants, public transport etc. etc.

        • Vaccination or not, covid is endemic. Natural immunity of the young exposed will eventually make the need for vaccines for the general population irrelevant.

          Covid vaccine will become something like the annual flu vaccine – something available to everyone but which very few healthy people opt to take.

          Why? There is no good reason to take the trouble.

          Stop framing simple statistical issues in moral terms Paddy.

          It just turns out that your moral framing is to your own benefit, eh?

          • It is nothing to do with morals. My wife and I lived in the Caribbean island of Grenada for fourteen years. The population is around 100,000. There have been 200 Covid deaths to date; 6 of these persons were fully vaccinated; 4 were partially vaccinated; 190 were unvaccinated. I repeat – those who refuse vaccination are being selfish and blind to scientific fact.

  • Wait. Is this just normal Corona-virus mutation.

    Like the common cold.

    Do we know yet that this variant has any dangerous impact on humans?

    So far I have only seen good news. So far mild symptoms only.

    Is this not perhaps the variant we do want to provide easy access to.

    We do know that covid is eventually going to become endemic. In other words it is going to be part of human society forever. This is the dance of (semi-)life.

  • Sorry, as a doctor and/or epidemiologist you should be embassassed by this:

    “Fifth, stop selling the herd immunity concept. It’s not going to materialise and paradoxically undermines vaccine confidence.”

    Covid is a coronavirus. It will be endemic. The end game is not perpetual vaccination of the full world population.

    The dangerous strains of covid have close to zero danger to young kids. There is no reason to vaccinate kids against covid except to protect older and infirm other people.

    This is a very different moral or ethical issue compared to measles, mumps, polio etc. which really are dangerous to individual children.

    The reason covid will become endemic is exactly this reason – it is utterly innocuous to young healthy people where ‘young’ statistically can be extended to even 30 or 40. The data does not lie.

    The end-game of covid globally is exactly human herd immunity and the faster we can get our youth immune the better. Not by vaccines but through continuous exposure to new strains, until and unless we actually determine through data that new strains are more dangerous to young people than driving a car is.

    Please get some perspective people. Remember the days before mandatory masks and totalitarian government response?

    I know you’re all scared but please get a grip. I have healthy kids. Stop projecting your irrational fears onto their life opportunities.

  • Please peer review 3 community comments before your comment can be posted