#BTColumn- How to prevent another post-holiday COVID-19 surge from Omicron and Delta

by Dr. Yitades Gebre

Experts in the United States and the United Kingdom predict that Omicron will eventually outpace Delta to become the dominant SARS-CoV-2 variant that causes COVID-19 disease.

This was reported by Professor Peter Hotez, Dean at Baylor College of Medicine in Texas.

Omicron was detected in 89 countries in less than four weeks after the World Health Organization (WHO) declared Omicron a new variant of SARS-CoV-2 on November 24th 2021. Compared to the highly transmissible Delta which was detected late last year, this number is significantly higher. The Delta variant spread to 65 countries in the four weeks since its first announcement.

This does not necessarily make the Omicron variant more explosive than Variant of Concern (VOC) Delta, but rather that countries’ capacity to detect and conduct viral genomic sequencing has also improved significantly in the past year.

It is not yet clear whether infection with Omicron causes more severe disease as compared to infections with other variants, including Delta. Preliminary data suggests that there are increasing rates of hospitalization in South Africa, but this may be due to increasing overall numbers of people becoming infected, rather than a result of a specific infection with Omicron.

Similarly, the UK Health Security Agency (UKHSA) confirms that reported cases of Omicron have increased substantially. The Omicron variant likely will spread more easily than the original SARS-CoV-2 virus, but how easily Omicron spreads compared to Delta remains unknown.

There is consistent evidence that Omicron has a substantial growth advantage over Delta. It is spreading significantly faster than the Delta variant in countries with documented community transmission, with a doubling time between 1.5–3 days.
Denmark public health authorities were successful in illustrating outbreaks of Omicron that were linked to several seasonal gatherings or events including concerts, and schools.

A major driver of this development was a large party with young adults – a population group with more social and close connections than adults and children, according to Dr Laura Espenhain and her colleagues report in this month’s Euro surveillance Journal.

There is currently no information to suggest that symptoms associated with Omicron are different from those of other variants. Initially, reported infections were among university students—younger individuals who tend to have a more mild disease—but understanding the level of severity of the Omicron variant will take days, possibly several weeks.

All variants of COVID-19, including the Delta variant that is dominant worldwide, can cause severe disease or death, especially for the most vulnerable people, and thus prevention is always key. Although older people and those with underlying conditions are most at risk of severe disease and death, they are not the only ones at risk.

What can you do to protect yourself? The most effective steps individuals can take to reduce the spread of the COVID-19 virus during this holiday season and beyond is to keep a physical distance of at least one metre from others; wear a well-fitting mask; open windows to improve ventilation; avoid poorly ventilated or crowded spaces; keep hands clean; cough or sneeze into a bent elbow or tissue, and get vaccinated.

Vaccines protect people COVID-19 vaccines currently listed by WHO for emergency use continue to provide protection against the globally prominent Delta variant, and it is expected that they may be effective against Omicron. A study conducted in the UK and reported by UKHSA in its early estimates suggests that vaccine effectiveness against symptomatic disease with the Omicron variant is significantly lower compared to the Delta variant. Nevertheless, moderate to high vaccine effectiveness of 70 to 75 per cent is seen in the early period after a booster dose. Vaccines typically have both direct effects on those who are vaccinated and indirect effects on the wider population due to a reduced probability that people will come into contact with an infected individual.

Hence, it is important to keep your holiday events to those among family members and others who are vaccinated and to maintain proven public health COVID-19 prevention methods as stated above. Vaccination reduces the risk of the Delta variant infection and accelerates viral clearance. Nonetheless, fully vaccinated individuals with breakthrough infections have peak viral load similar to unvaccinated cases and can efficiently transmit infection in household settings, including to fully vaccinated contacts as shown in a UK study by Dr Anika Singanayagam and her colleagues.

The health system under pressure There is no doubt that the health system in Barbados has been under tremendous pressure over the last two years. The health workforce itself is affected by COVID-19 and has lost few remarkable and selfless staff. No doubt it has prevailed with fewer industrial actions. Nurses, consultant physicians and professional bodies such as the Barbados Association of Medical Practitioners have all raised alarm on health services capacity during the explosive Delta outbreak peak last October. We should not forget that when the health system is overwhelmed, COVID-19 deaths rise.

This holiday season we all need to take the right actions to protect ourselves and others from getting infected and, more importantly, the health system from collapsing. Remind yourself and others, hands, face, and space.

Dr. Yitades Gebre, PAHO/WHO Representative for Barbados and the Eastern Caribbean Countries.