The world is still feeling its way around the contours of Omicron, but what seems to be emerging is a picture of what might be emergency. COVID was already a national crisis in so many places — Europe, for example, has seen towering Delta variant waves through the autumn, and the United States is on the verge of another one. Canada has been largely spared since Alberta and Saskatchewan finally read a good newspaper, and Ontario as much as anybody. For now, at least.
But Omicron will change things. It is already popping up in Ontario’s jails and cafes and unvaccinated children. Canada’s travel bans to African countries are already a shameful artifact, as most countries in Europe have found Omicron, and the testing loophole for Americans is a chasm. Let’s be clear: there is still so much we don’t know. South Africa has a 35 per cent vaccination rate, concentrated in older populations, and Omicron was only reported to the World Health Organization on Nov. 24. We will learn more. Don’t panic.
But there are early signals, too. There are so many questions: how much more transmissible is Omicron than Delta? How much more or less virulent? How much does it diminish either post-infection immunity or the protection of vaccines against both infection but more importantly, hospitalization and death? Remember: the purpose of vaccines was to reduce transmission, but most importantly, to keep people out of the hospital. They are working. Get a booster, when you can.
And vaccination remains our best tool, from what experts can discern. Dr. Peter Juni, the scientific director of Ontario’s independent volunteer science table, has been going over data with South African colleagues and the table all week. And on the most central point, Juni is cautiously hopeful.
“The preliminary data we have clearly points towards that the protection against hospital admission continues with full vaccination also for Omicron,” said Juni. “The data on vaccination is limited: we have vaccination status of those admitted, so it’s incomplete data, right? But it’s a very clear pattern. So I believe even if the data to a certain extent are biased, we will continue to see what they’re seeing and you know, the data right now are accumulating on a daily basis.”
Dr. Andrew Morris, a professor of infectious diseases at the University of Toronto and a member of the table, notes South Africa is short on age-adjusted data; Juni, however, believes that with 85 per cent of hospitalizations being unvaccinated, the signal is strong. Let’s hope. Vaccines holding the line would be hopeful.
Because this is Covid, though, it is complicated. Even if vaccines remain protective against severe infection, Omicron appears to be extraordinarily transmissible. Cases in South Africa are doubling every two to three days. Juni says if first-wave Covid had a basic reproduction number of 3 — meaning one case created three more, on average, in a fully non-immune population with no precautions — then Alpha was a 4.5, and Delta is a 7, Omicron appears to be in the 10-15 range, meaning one case can cause 10 to 15 cases with no safety measures. A Christmas party in Oslo resulted in half of a fully vaccinated room getting infected. Measles, for the record, is a 12-18, and is so infections that you could catch it standing in the same room.
Which means a lot hangs on how virulent Omicron will be. There are anecdotal stories of milder symptoms from South Africa, which is worth hoping for. But unless Omicron is much less virulent than Delta — perhaps 10 times less in the unvaccinated, according to Juni — the increase in transmission rate would likely swamp Ontario hospitals, in the absence of other public health measures.
“There’s some early indication (of reduced virulence), but it doesn’t help,” says Juni. “The problem is that it’s so transmissible, the sheer fact that our roughly 14 per cent of the population that is unvaccinated could be infected within just a few weeks.”
That is before boosters, too. There is also an emerging picture of reinfections — one preprint, non-peer-reviewed paper said those who had already been infected were three times as likely to get reinfected as with Delta — so the unvaccinated may be at even greater risk.
“That’s why the cases matter, right?” says Morris, who is also the medical director of the Antimicrobial Stewardship Program at Sinai-University Health Network. “It’s hard to maintain a low burn rate, especially when people are gathering indoors and are fed up and everything, without other measures. If the burn rate is low, then you’ll continue to get the unvaccinated sick and hospitalized. (But if the case rate soars), then it will absolutely overwhelm the health-care system, because it will find most of those people who are unvaccinated, and undervaccinated.”
So, we come to Ontario. The province is already in exponential growth, with Delta. ICU numbers are trickling upwards. The government wants no part of additional public health measures, though the chief medical officer of health, Dr. Kieran Moore, is a potential bulwark there. Booster access has been expanded starting Dec. 13, but with an estimated daily capacity of 100,000 vaccinations, we may not be moving fast enough, and are definitely not expressing enough urgency. And even exemplary booster uptake only solves part of the problem, because there are an estimated 350,000 unvaccinated Ontarians over the age of 50.
In other words, this may well be a real emergency. There is a real chance the variant will hunt and find the unvaccinated and undervaccinated with a speed we have never seen, and that enough of them wind up in the hospitals, which the science table explained are fragile after the first three waves, and that a province that wants to pretend this is over needs to pivot to more and better vaccination delivery, more durable vaccine passports, wider vaccine mandates, and strategic agility, at the least. And this is Ontario. Feels like a hard sell.
Data can shift. Don’t panic. I know after the brief respite of vaccinating five-to-11-year-olds and excellent booster data, Omicron might feel heavy as hell: as one doctor told me earlier this week, it felt like we were really winning for about three days there. It’s important to remember we still can.
Article From: The Star
Author: Bruce Arthur
