As viruses spread in the population, it is normal for them to change (or mutate) with time.
When the changes (or mutations) cause the changed (or mutated) virus to become significantly different from the original one, they are termed variants.
The Omicron variant of the SARS-CoV-2 virus, which causes Covid-19, was first reported by South African scientists on Nov 24 (2021), and was classified as a variant of concern by the World Health Organization (WHO) on Nov 28 (2021).
In slightly over a month, Omicron has become the dominant variant in Europe and North America, with exponential increases in the number of Covid-19 cases and hospitalisations there.
Of concern is the marked number of paediatric (child) hospitalisations in these countries.
Omicron cases have also been reported in Japan, China and Asean countries, including Malaysia, although mostly imported ones to date.
However, cases of local transmission without any travel history have also been reported.
It will not be long before Omicron will replace Delta as the dominant variant in Malaysia.
Potentially more dangerous
The data on Omicron is still evolving; not much is known about this variant.
However, it is known that Omicron’s numerous mutations enable it to spread more rapidly than the Delta variant and to escape some of the protective effect of current vaccines.
Covid-19’s rate of spread has increased with the new viral variants, i.e. Omicron spreads more than Delta, which spreads more than Alpha, Beta and the wild variants.
Omicron infections reportedly take two to three days to double, compared to six to eight days for cases with the Delta variant.
The vast majority of hospitalisations in Europe and North America due to Omicron are unvaccinated.
However, Omicron can also infect the vaccinated, although South Africa, the United Kingdom, Canada and the United States report that the majority of Omicron infections in the vaccinated are less severe than those with the Delta variant.
Most of the monoclonal antibodies used in treatment are ineffective in patients infected by Omicron.
The Covid-19 vaccines currently available do provide protection against Omicron, but their effectiveness is reduced by this variant.
However, antibody levels have increased severalfold in those who have received boosters of the Covid-19 vaccines.
There are many unknowns about Omicron.
They include the severity of infections in specific population groups and its complications, which include long Covid, diabetes etc.
Health experts worldwide expect that anyone with the Omicron infection can spread the virus to others, even if they are vaccinated and do not have symptoms.
Because of the vast numbers of Omicron infections that include healthcare staff, this variant has put overwhelming pressure on healthcare systems in Europe and North America.
Many countries have implemented restrictive measures to contain its spread.
Many scientists are concerned that the more Omicron spreads and the more it replicates, the more likely the virus will change and the more likely a new variant can arise with the potential of being more dangerous.
Vital, but not the sole answer
The Covid-19 vaccines have been effective against the Delta variant in Malaysia.
An analysis of 20,823 reported Covid-19 deaths from Feb 24 to Sept 14, 2021, by researchers from the private sector and universities reported that the age-standardised mortality rate (ASMR) per 100,000 population for the unvaccinated (47.5 per 100,000) were 43.2 times and 12.5 times that of those who had two doses of the Pfizer-BioNTech (1.1 per 100,000) and Sinovac (3.8 per 100,000) vaccines.
In short, the unvaccinated were more likely to die from Delta than those vaccinated.
Those who received the Sinovac vaccine, but still got Covid-19, were 3.45 times more likely to die than those received the Pfizer-BioNTech vaccine.
The Health Minister announced on Jan 6 (2022) that an unpublished study by the National Institute of Health found that the “weighted infection rate for two Sinovac Covid-19 doses was 2,088 per 100,000 population.
“However, Sinovac primary series recipients who received a Pfizer booster shot, had a weighted infection rate of 500 per 100,000”, which was a “significant drop”.
The current Covid-19 vaccines are still effective against Omicron, especially when booster shots have been administered.
There are many unvaccinated persons in Malaysia.
These include vaccine-hesitant adults, the immunosuppressed, many adolescents and all children below 11 years of age.
When vaccination of children below 11 years will begin is still unknown.
In the meantime, the administration of vaccine boosters has to be ramped up, so that children will have some degree of protection when the adults surrounding them are all vaccinated and boosted.
As there is insufficient time to address the many vaccination gaps, vaccination will not prevent the impact of the Omicron variant.
Diagnostics are critical
Testing and contact-tracing have always remained vital tools in managing the Covid-19 pandemic.
The availability of diagnostic tests is critical, as evidenced in North America and Europe.
Anyone with symptoms should be tested, regardless of their vaccination status, with isolation of persons with positive results to limit viral spread and reduce the burden on the healthcare system.
There are reports that there may be false negatives with rapid test kits in Omicron cases.
The authorities’ responsibility is to provide relevant information to the public on this issue.
Contact-tracing of probable or confirmed Omicron cases should be prioritised.
With large numbers, digitised contact-tracing has marked advantages over the manual contact-tracing being done currently.
Increased genomic sequencing is necessary to confirm infection by a specific variant, with genomic surveillance important in facilitating decision-making.
There is a need to ramp up Malaysia’s genomic sequencing, which currently leaves much to be desired.
What you can do
A multi-layered approach with multiple measures is needed to reduce the risk of contracting Covid-19, with vaccination an important tool to protect an individual and his/her family, particularly children.
If you are unvaccinated, get vaccinated.
If you have not completed the primary series of vaccination, get vaccinated.
If you have completed the primary series of vaccination, get your booster dose.
And make sure you keep your vaccination appointments.
Non-pharmaceutical interventions are equally important. They include:
- Usage of appropriate face masks.
- Physical distancing of at least 2m.
- Maintenance of hand and respiratory hygiene measures.
- Avoidance and reduction of crowds, closed spaces and close contacts.
- Ensuring adequate ventilation, especially in closed spaces.
- Staying home when ill.
- Adherence to medical advice and instructions.
A small fraction of a very large number is still a large absolute number, e.g. 2% of 10,000 and 100,000 are 200 and 2,000 respectively.
As such, Omicron’s threat to the population is real and cannot be taken lightly.
The Health Minister stated on Jan 6 (2022) that the ministry’s modelling estimated that Omicron could lead to 15,000 to 30,000 new cases daily.
The ministry’s 42,936 hospital beds; the universities’ and armed forces’ 4,052 beds; and the private sector’s 16,469 beds cater for medical, surgical and obstetric conditions, in addition to Covid-19 patients.
It is likely that hospitals and the health system will be unable to cope with a new deluge of Covid-19 admissions.
Omicron’s threat was put succinctly by the WHO director-general on Jan 6 (2022): “While Omicron does appear to be less severe compared to Delta, especially in those vaccinated, it does not mean it should be categorised as mild...
“Just like previous variants, Omicron is hospitalising people and it is killing people.
“In fact, the tsunami of cases is so huge and quick, that it is overwhelming health systems around the world.”
Dr Milton Lum is a past president of the Federation of Private Medical Practitioners Associations and the Malaysian Medical Association. For more information, email email@example.com. The views ex- pressed do not represent that of organisations that the writer is associated with. The information provided is for educational and communication purposes only, and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.