Riding the Omicron wave this year

The upcoming Johor state elections are a wild card in predicting Omicron cases as it will involve many more voters compared to last year’s Malacca and Sarawak state elections. — Filepic

The Covid-19 Omicron wave has arrived in Malaysia, with five-digit daily cases this past week (February 2022).

What can we observe about this SARS-CoV-2 Omicron viral variant from other countries so far, what are projections for Malaysia for the next three to four months, and what can we do about the Omicron surge?

What we know to date

Here is a summary of Omicron so far.

The first Omicron case in the world was reported last Nov 24 (2021) from South Africa.

It is now found in more than 160 countries, and has replaced the Delta variant as the dominant SARS-CoV-2 strain.

Omicron is different than Delta in the following ways.

One, according to the US Centres for Disease Control and Prevention (CDC), Omicron “spreads more easily” than the original SARS-CoV- 2 virus and the Delta variant.

Two, an Imperial College London report estimates that Omicron has a 5.4 times higher risk of re-infection, compared to Delta (a re-infection is a second Covid-19 infection after you’ve recovered from a first one).

And three, a report in the Nature science journal states that those with breakthrough infections are likelier to have Omicron than Delta (a breakthrough infection is a Covid-19 infection in someone who is already fully vaccinated).

That bad news is counter-balanced by some “good news”.

One, according to the US CDC, Omicron infections “generally cause less severe disease than prior variants”.

Two, the US CDC also reported that Omicron infections have “shorter stays and less frequent ICU admissions” compared to prior variants.

And three, the World Health Organization (WHO) Regional Office for Europe reported that Omicron has a “comparatively lower rate of hospitalisations and deaths” – mostly because of vaccinations.

Divergent policies

Commuters go without wearing face masks at Copenhagen Central Station, following Denmark’s decision to lift all Covid-19 restrictions, despite a rise in cases. — BloombergCommuters go without wearing face masks at Copenhagen Central Station, following Denmark’s decision to lift all Covid-19 restrictions, despite a rise in cases. — Bloomberg

Countries have responded to Omicron in expected and unexpected ways.

Expectedly, nearly all countries have quickened their vaccination and booster programmes.

Equally expectedly, nearly all countries continued their non-pharmaceutical interventions, such as face mask and physical distancing requirements, and some level of movement restriction.

This year (2022) so far, there have been two unexpected pieces of Covid news, both from Europe.

On Feb 2, Denmark lifted all their Covid-19 restrictions, despite an increase in cases.

On Feb 4, Austria introduced a mandatory vaccination law for all adults, with a fine of up to €3,600 (RM17,206.20).

This pair of completely opposite policies in two European nations highlight how Covid-19 policies can be wildly divergent, even in countries with similar characteristics.

Omicron is also coinciding with divergent situations in other countries.

Ottawa in Canada has declared a state of emergency due to protests against Covid-19 restrictions, but “Fortress” Australia has reopened its borders to fully-vaccinated tourists for the first time in two full years.

And Hong Kong announced 614 Covid-19 cases on Feb 7 (2022), a dramatic number for a city of seven million people with only 14,000 total cases since Jan 2020.

(A similar proportion would see only 60,000 total cases for Malaysia, compared to our actual total of 2.9 million total cases.)

Predicting the numbers

The good news is that the Omicron surge in other countries appear to peak within approximately six to eight weeks and drops sharply thereafter.

This is a faster peak and faster drop compared to Delta.

However, the bad news is that the Omicron peak of daily cases appears to be approximately two to four times higher than the Delta peak.

The other good news is that 99.5% of all new cases in Malaysia on Feb 7 (2022) are in Category 1 or 2.

However, the accompanying bad news is that a surge in cases may overwhelm our public hospitals just by sheer weight of numbers.

During the Delta wave last year (2021), Malaysia saw five-digit daily cases between July 15 to Oct 2 – a total of 11.5 weeks (80 days).

Therefore, it is possible that Malaysia will see five-digit daily cases for the next five to 10 weeks, before plateauing and dropping.

Of course, the speed, peak and duration all depends on what public policies are implemented.

Equally, more accurate predictions and models should be publicised by the Health Ministry, e.g. using the SEIR (Susceptible, Exposed, Infectious, Recovered) mathematical model.

There are two wild cards in how Malaysia’s Omicron surge can play out this year (2022).

Firstly, the Johor state elections must be taken into account.

There are two major differences between the Johor elections compared to the 2021 Malacca and Sarawak state elections.

One, Johor will involve many more registered voters (approximately 2.6 million), compared to Malacca (500,000) or Sarawak (1.3 million), due to the Undi18 policy being implemented for the first time.

Two, the Malacca and Sarawak elections took place before the Omicron variant really arrived in Malaysia (i.e. Nov 20 and Dec 18, 2021, respectively).

Secondly, there is the possibility of a general election this year, which changes the calculations of all SEIR mathematical models.

Large and diverse countries have safely held national elections during Covid-19, like South Korea in April 2020, Canada last September and Japan last October.

These had also involved hundreds of other elections, referenda and plebiscites at the state, provincial, regional or municipal levels.

Therefore, the Election Commission of Malaysia must already start preparing for the next general elections, whether it will occur this year (2022) or next (when the current Parliamentary term will end in July).

Dealing with the surge

On the other end of the spectrum, Austrians wait in line to get vaccinated as compulsory Covid-19 vaccination for adults is implemented in the country. — APOn the other end of the spectrum, Austrians wait in line to get vaccinated as compulsory Covid-19 vaccination for adults is implemented in the country. — AP

There are three specific steps we Malaysians, including the government, can take to help deal with this Omicron surge.

Firstly, we must all get boosted, as the evidence shows that vaccine boosters can help reduce the severity of an Omicron infection.

If Delta is the “pandemic of the unvaccinated”, then Omicron could be the “pandemic of the unboosted”.

Therefore, we must work hard to cover the 32% (or approximately one million) senior citizens who are still unboosted.

The expansion of vaccinations to include children aged five to 11 years old since Jan 31 (2022) was also a step in the right direction.

Secondly, it was announced on Feb 7 (2022) that the Covid-19 National Rapid Response Task Force (RRTF) will be reactivated.

This is the less-famous cousin to the Greater Klang Valley Task Force (GKVTF), but no less important.

This reactivation is timely and may ultimately prove to be pivotal.

However, its role, terms of reference and interactions with the current Health Ministry (MOH) infrastructure has to be managed carefully.

It is important that long-term efforts to strengthen the entire health system cannot be at the mercy of short-term fixes.

Thirdly, it is timely that the MOH has announced clearer Home Isolation protocols on Feb 7 (2022), backed by new clinical guidelines for Covid-19 anti-viral medicines.

However, it is equally important to consciously and systematically add three elements, i.e.:

  • Integrated private sector involvement
  • Strong controls to ensure that the self-testing is done correctly and reported honestly, and
  • Clever use of digital tools (like the MySejahtera app, but also virtual Covid Assessment Centres).

Caution comes first

It is difficult to see an endgame for Covid-19 for now, despite some scattered optimistic views from epidemiologists or virologists that the Omicron variant is one step closer to an equilibrium between Homo sapiens and Covid-19.

Public health is neither optimistic nor pessimistic.

At its most fundamental, public health operates on a precautionary principle.

That means that Malaysia still needs to strengthen our health system and our population for Omicron, and we must do all that we can to prevent ourselves, our loved ones and our community from getting infected.

Dr Khor Swee Kheng is a physician specialising in health policies and global health. He tweets as @DrKhorSK. The views expressed here are entirely his own. For more information, email starhealth@thestar.com.my. The information provided is for educational and communication purposes only. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

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