Omicron

28th November 2021

UK COVID Deaths – Daily 51 / 7-Day average 121

Total UK COVID Deaths within 28 days – 144,775

Total UK Deaths with COVID-19 on the death certificate – 167,927 (up to 12 Nov)

James Cook Hospital – Total COVID deaths –709

All COVID cases within South Tees Hospitals Trust – 62

James Cook Critical Care

COVID cases – 7 (5 ventilated)

Non-COVID cases – 43 (20 ventilated)

The pandemic has taken a new turn this week, with the discovery of the Omicron variant in South Africa. Despite sounding like an 80’s Bond villain, this new variant of concern is worrying Governments all around the world. The reason for the alarm is because of Omicron’s unprecedented number of mutations, many of which are to be found in the virus’s spike protein.

It is the spike protein that allows the virus to enter human cells and cause infection. Any change to the spike protein can help it evade the antibodies that are generated by vaccines and previous infection. Our current vaccines all target the spike protein that was found in the original ‘Wuhan’ strain of the virus. The emergence of a variant with a substantially different spike protein may, therefore, result in these vaccines becoming less effective and the emergence of a virus that is both more infectious and more likely to cause serious illness.

However, even if our current vaccines become less effective, there is no danger that they will stop working altogether. Vaccines result in the production of antibodies and T-cells. Whilst these may not be a perfect match for any new variant, the large amount of both that are generated following three doses of a vaccine should still be enough to prevent serious illness and death in the majority of people. It’s a bit like training crack troops to fight a specific enemy. Even if your enemy were to discover your Achilles heel, all is not lost - throwing more and more of your troops at the enemy can still overwhelm them and lead to victory.

The potential threat posed by the heavily-mutated Omicron variant has galvanised the UK Government into action. They have added ten southern African countries, where Omicron is rife, to the red travel list. There is to be a return of PCR testing for everyone entering the UK and those who have been in contact with anyone infected with the Omicron variant will have to self-isolate. Compulsory mask-wearing will return in shops and on public transport and we can expect the country’s booster vaccination programme to go into overdrive.

I have to admit that the Government’s response has worried me a little. Back in April this year, they did bugger-all to prevent the initial arrival of the Delta variant. It took three weeks for them to place India on the travel red list and the current, uncharacteristic, decisive action that they are taking now has made me a little concerned that they know more about the Omicron strain than they are letting on. Of course, it could be that the leopard has changed its spots and the Government is, at last, simply following the science? Perhaps it’s nothing more than a desire to save Christmas or, at least, not be accused at a later date of ruining it?

Saving Christmas presumably involves limiting the spread of Omicron until the festive season has passed. After all, no-one wants a more infectious variant under the mistletoe this year. Of course, if Omicron really is more infectious than the now ubiquitous world-wide Delta variant, then we won’t ultimately be able to stop it. Restricting travel from Omicron-infested areas and re-imposing some measures to prevent the spread of COVID-19 may slow down its arrival and buy us a bit of time, but like King Canute, it won't stop the tide. There have already been three confirmed Omicron cases within the UK and more and more are cropping up throughout Europe.

The battle to save Christmas may also help a beleaguered NHS. The existing Delta variant still poses a definite threat to the health service and many of us have been worried about a post-Christmas rise in hospital admissions. Steps to limit the spread of Omicron will, hopefully, lead to fewer Delta cases and reduce hospital admissions. Super-charging the vaccine booster programme will also serve to protect more of our vulnerable population.

So how alarmed should we be? There are conflicting reports of how much danger we face. Some in South Africa claim that the Omicron variant may be less lethal than the Delta variant and the world is over-reacting. Up to 90% of all infections in the Johannesburg area are now caused by the Omicron strain but they have not yet seen any significant rise in hospital admissions. This seems at first glance to be good news but South Africa has a much younger population than the UK and so this may not be as reassuring as it seems. Any virus that spreads easily but is less lethal may well end up causing more fatalities than a more lethal, less contagious one.

At the hospital, things are better than they have been. We have been looking after fewer patients recently and the daily struggle to find beds for everyone has eased a little. The last few days have seen an increase in the number of COVID patients needing CPAP on the wards but the number of COVID patients being admitted each day remains fairly static.

Whether this fall in COVID numbers is a result of the reduction in cases that was seen earlier this month or whether we are approaching something like ‘herd immunity’ remains to be seen. One thing is for certain - we could really do without a significant rise in cases before Christmas – the household mixing that will occur over the festive period and the subsequent rise in infections and hospital admissions that we might see in the New Year remains a very palpable threat, even without Omicron’s arrival.