COVID19 and Omicron – what next?

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I’ve been sharing regular updates about COVID-19 primarily to help church leaders plan. Occasionally I share my thoughts and opinions about what we should be doing, nationally and internationally. All of this comes with the qualifying caveat that I’m just a bloke sat on his sofa with his laptop -I’m no expert in Epidemiology or virology. However, what I try to do is read what those who are the experts are saying and think through the potential implications.

Information is now starting to feed through from the studies that have been commissioned into the Omicron variant and vaccine efficacy. Here are two studies that have been shared.

The second was tweeted out in German -so I’ve linked via Francois Ballaux’s commentary around it:

From what I can glean, it’s not brilliant news. Although I don’t think it’s helped by being compressed down into tweets and then panic reported by the media.  One scientist involved has also tweeted.

The gist of the results seems to be that against Omicron, the vaccines don’t seem to fair too well in terms of preventing infection. The second study seems to suggest that this includes with a booster jab.  Again with all the caveats of “these are early days” and “real world data may look better than lab studies” the implication seems to be that the vaccines are not going to prevent a significant wave of cases coming through because of the ability of the variant to evade anti-bodies. 

However, this does not mean that vaccines are a waste of time or won’t work at all. There are other ways that they help strengthen immunity and our bodies have other defence mechanisms such as T-Cells which vaccines help strengthen.**  This means that it is possible that whilst the vaccines won’t do so well at reducing our risk of infection and transmission, they may still prove highly effective and reducing the risk of severe disease and death. Indeed, there seems to be a suggestion in the first study that a combination of two jabs and prior infection may help people to fair better in fighting the virus. 

In terms of the Omicron variant, there has been some suggestion coming out of South Africa that cases have been milder and that whilst there has been an increase in hospitalisations, these have primarily been people with COVID presenting for other conditions rather than being admitted because of COVID.

I apologise for becoming repetitive on this but again, the “too early to say” caveat applies. We tend to see milder cases early in a COVID wave especially when it is spreading among younger, heathier people. 

However, if the situation is sustained then things may begin to look promise. Note that this doesn’t mean that the variant itself is milder but rather that what is happening is that prior exposure either to the virus or to the vaccines means that our bodies are no longer seeing it as a novel virus.  Whilst some among the scientific community argue that we need to eliminate COVID-19 to remove the possibility of further mutations, there is another perspective which argues the opposite.

From that perspective, we not only have to learn to live with the virus but will learn to live with it. At the moment, we experience it as novel and that’s what makes it dangerous to us. However, the expectation is that over our life team we can expect repeated exposure to it and each time it will be less dangerous. That’s the basis for the argument that we shouldn’t worry too much about children contracting the virus.  If they encounter it whilst their immune systems are at their healthiest, then we can expect that repeated exposure over  a lifetime to normalise the virus. That’s how it comes to be experienced like a common cold.

I think that’s where our governments/public health officials need to make some clear, strategic decisions and talk honestly about the strategy with people.  Even on the above optimistic scenario, there are still going to be significant numbers of hospitalisations and deaths to come. However, it is probably the case that interventions such as lockdowns now will not prevent many of those cases and deaths so much as delay them. That’s where we need to remember that the original lockdown measures were first and foremost about “flattening the curve” in order to protect NHS capacity.  We didn’t stop people from being infected and we didn’t/couldn’t prevent deaths.

Now, currently we are seeing about 1.8% of cases lead to hospitalisation within 10 days of testing positive and about 0.34% of cases lead to death within 28 days. This means on current projections we are likely to be experiencing hospital admissions at around 925 per day in the run up to Christmas and deaths at 175 per day. This also means that to see admissions return to the peaks we saw in the first and second wave, would probably be looking at 200k worth of cases per day. All of this assumes of course that those rates stay the same.

There are therefore, two possibilities here. The first is that if people continue to experience Omicron as a milder infection then the % of hospital admissions and deaths reduces further. We could then see case rates increasing further but admissions and deaths continuing to fall. Alternatively, loss of vaccine efficacy may apply to disease severity as well as infection in which case we may find ourselves in quite tricky territory with cases rocketing followed by admissions and deaths.

There are of course a lot of unknowns there still and that doesn’t make life easy for the Government or Chief Medical Officer. However, at some point they are going to have to make a judgement call. If they follow the Zero COVID logic then they will have to argue for that, recognise that this is a change of plan and potentially implement fairly stringent lockdown measures in parallel with asking the Pfizer and Moderna to work on updated vaccines to cope with variants.  It will be necessary to keep measure in place after vaccination until the virus has been rooted out and we’ll probably need some form of strict border entry policy to prevent the virus coming back in from countries with lower vaccination rates.

Alternatively, if they continue to believe that the aim is to live with a virus which is transitioning from epidemic to endemic then a different approach will be needed. This approach will require them to hold their nerve whilst case numbers go up. It means we’ll need to learn to live with high case numbers and that probably means we will then at some point have to wean ourselves off of reporting them each day.  If society is going to have to function effectively then we’ll also have to change the rules on asymptomatic infection, testing and isolation otherwise we’ll simply see a form of lockdown through the back door.  I’m not saying this will all happen immediately, in the short term, those informal lockdowns through ping-demic may be proving helpful.  Further, they will need to plan for the possibility that hospital admissions may spike at specific times and put pressure on the NHS. 

We can respond to such spikes by trying to manage and dampen demand or by improving supply. My view from a past role in operations management that included looking at demand and capacity is that it is better to focus on the supply side. In other words we need to invest in the NHS and provide surge capacity. In the summer I argued that we should recruit an NHS reserve and be ready to requisition sites to use as temporary nightingale hospitals when demand is high.  I am disappointed that this does not appear to have been pursued as it would have relieved a lot of pressure and anxiety already this winter if it had.

This also affects measures taken now.  The presumption behind things like the return to face masks and calls for other measures such as Work From Home and vaccine passports is that we might be able to slow the spread of the variant but all we are seeking to do by that is to buy time.  The purpose of buying time is the hope that in x days, better protection will be in place. However, if we have already got boosters into the most vulnerable and those boosters turn out not to protect against infection then we may not actually be buying time. We may find ourselves like an ancient king trying to hold back the tide.

I suspect though that such a message is impossible to put out there.  I don’t envy the person who tries and so I suspect what we’ll see is further restrictions coming in over the next few weeks.  The dominant approach is likely to be “caution.”

Additionally, I think it remains too early to make that kind of pronouncement with confidence (though even with more data political optics may be challenging). So, NPIs may be a reasonable holding measure until we know more. However, those NPIs need to be robust and effective.

The Government Plan B included 3 measures

  • communicate a change to risk
  • Reintroduce mandatory facemasks
  • COVID passports for selected venues.

The first two of these have already been implemented though I’m not sure what impact facemasks on their own actually have. The third of course depends on the assumption that vaccines are effective against transmission of the virus. It looks increasingly likely that even with the booster that we will have much reduced reduction in transmission risk although hopeful still significant protection against serious disease. On that basis I’m not sure what help the vaccine passport will be. It won’t stop people from being infected and infecting others. Meanwhile the most vulnerable to severe disease are unlikely to be at the venues concerned.

So, at this stage, my view is that we probably should ramp up rapid testing using LFTs. A clear LFT should be required for entry to key venues including possibly use of public transport. Additionally, whilst at the moment we are required to isoalte if we come inot contact with someone who has the Omicron variant, this is not mandatory if vaccinated and it is one of the other variants. The problem with that is that it takes time to get confirmation back of the specific variant and in that time someone could infect others. So, it surely makes more sense to require anyone who has been in contact with someone who has tested positive to self isolate at least until they have received a clear PCR test. In other words, we shift from assuming it isn’t Omicron until proven otherwise to presuming it could well be Omicron until confirmed otherwise.

So much for government policy, as I said, I don’t claim expertise and its easy for me to have opinions from my armchair.  What should we be doing from home? I think the answer is that we have to follow the best advise available which means listening to those who are putting their necks in the line  by making public health decisions, so comply with the measures put forward.  I’d rather discover I’d followed a measure that wasn’t necessary than discover later that by ignoring a recommendation or rule that I put other lives at risk. 

Finally, I keep coming back to something I talked about at the start of the pandemic. This world is bewildering and frightening at times. Jesus said it would get that way as we waited for his return.  We however should not allow worry to overwhelm us. Our trust is in the Lord of eternity who holds our lives in the palm of his hand.

** Very much in layman’s terms here but basically we are interested in three things

  1. Neutralising antibodies -these are the ones that defend cells from the pathogen. These are the ones that help prevent/reduce the risk of infection.
  2. Binding antibodies – these attach to the pathogen and help your white blood cells detect it and fight it off.
  3. T-cells – These are white blood cells that fight the pathogen.

Whilst neutralising antibodies help to prevent infection, even if these are less effective, the presence of binding antibodies and T-Cells may help to fight off infection and so reduce severity.

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