How Deadly Is The Omicron Variant And How Do We Treat It? An Expert's View

The Omicron variant of SARS-CoV-2 is much more contagious than the Delta variant but results in a milder version of COVID-19, according to Dr Sheri Fanaroff.

The Omicron variant of SARS-CoV-2 is much more contagious than the Delta variant but results in a milder version of COVID-19, according to Dr Sheri Fanaroff.

Since the Omicron variant was identified by virologists in South Africa, Dr Fanaroff, who has been treating COVID-19 patients infected by the Omicron variant, has observed that patients exhibit similar symptoms but have milder cases as compared to the ones during the Delta wave.

"What we are seeing in Omicron and what seems to be different in this wave, is that the cases are really at the moment very much milder than what we had with the previous wave. Simply more contagious. So if one person in the family is getting it, we are getting a whole lot of contacts that are all coming down," Dr Fanaroff told BOOM.

"It also seems to have quite a short incubation period. So, we are generally seeing people getting symptoms within 2- 3 days after exposure, and up to about five days. That is a bit shorter than what we were seeing with Delta. With Delta sometimes it would take 8-9, even 10 days for people to get symptoms," she added.

Dr Fanaroff also said that it is difficult to know at this stage whether being double-vaccinated results in a milder case on Omicron.

"From my own patient base, I am talking about a 100 per cent vaccinated, almost 100 per cent of my patients who have Omicron are vaccinated. And we are seeing patients who are double vaccinated with Pfizer or with J&J. Some of the my patients even have had COVID-19 and two vaccines and also getting infected. So, what we really do not know is: are they experiencing really mild symptoms because they are vaccinated? Or are they experiencing mild symptoms because Omicron is a much less virulent virus?" Dr Fanaroff said.

Edited excerpts of the interview follow

You have been treating COVID patients from the beginning of this pandemic. What are you fundamentally seeing different this time from the Delta variant patients cases that you were treating earlier?

Dr Sheri Fanaroff: It was about just two and half weeks ago that we noticed the numbers in Johannesburg very suddenly starting to go up and a lot of people getting infected from gatherings. So we had no patients for about 5 months previously and suddenly started to get a few patients everyday, until we really got a lot of patients in. What we are seeing in Omicron and what seems to be different in this wave, is that the cases are really at the moment very much milder than what we had with the previous wave. Simply more contagious. So if one person in the family is getting it, we are getting a whole lot of contacts that are all coming down.

It also seems to have quite a short incubation period. So, we are generally seeing people getting symptoms within 2- 3 days after exposure, and up to about five days. That is a bit shorter than what we were seeing with Delta. With Delta sometimes it would take 8-9, even 10 days for people to get symptoms. The common symptoms that we are seeing in the beginning stages are quite similar. People are coming in with headaches, muscle pains, fever, and sore throat is quite prevalent. Quite a lot of patients complain about very sore throats. Cough, dizziness, some of them with vomiting, so very similar to what we are seeing before.

What is different is that it seems not to be deteriorating and into the severe stages of Delta. So, with Delta we were starting to see patients deteriorating, Day 5, Day 6, Day 7…a lot of patients had Covid pneumonia. We are really not seeing that anywhere near the same extent with Omicron.

Amongst the patients you are treating right now, how many of them are vaccinated and how may are not?

Dr SF: It is a difficult question for me to answer because in my practice, which is a private practice, 99.5 per cent of my patients are vaccinated. We are aware of few families that are not. So, from my own patient base, I am talking about a 100 per cent vaccinated, almost 100 per cent of my patients who have Omicron are vaccinated. And we are seeing patients who are double vaccinated with Pfizer or with J&J.

Some of the my patients even have had COVID-19 and two vaccines and also getting infected. So, what we really do not know is: are they experiencing really mild symptoms because they are vaccinated? Or are they experiencing mild symptoms because Omicron is a much less virulent virus? And what I am hearing out of the hospitals in Johannesburg is that patients who are in hospitals and certainly patients who are in high-care are mostly unvaccinated patients.

For those unvaccinated patients, do you have sense on how the disease or virus is progressing?

Dr SF: I think it still appears to be milder at this point in time. But it is still quite early. I mean we had Omicron for just over two weeks, in fact it may be around two weeks and with other variants like Delta, deterioration, hospitalisation, and deaths followed about 2-3 weeks later. So, we are feeling that we are seeing a milder disease, and at the same time we have less people going to hospital. I think it is not 100 per cent correct to say at this stage that it is definitely milder,and definitely causing less hospitalisations. It is looking that way, but I think we still need a couple of weeks before we say that definitely.

Among the patients that are coming to you, are you able to treat them where they are and essentially send them back home? How's it going?

Dr SF: At the moment, I haven't needed to admit a single patient with COVID-19 and I do not have any patients even with oxygen at home. And that is really different. We really had a very big wave in June and July. I had a lot of patients treated at home on oxygen. At that stage we were really struggling to find hospital beds for those who needed them.

So, we treated the really sick patients at home and we are simply not seeing that at this stage here. If I need a hospital bed for a patient, I can definitely get one. All the hospitals have space but we are not even needing those beds and not even needing oxygen at home. I am aware of other practitioners, some of their older patients with co-morbidities who are having oxygen at home, but it is a much much smaller percentage. And I am aware of a few patients, even vaccinated patients who have gone to hospitals. But what we are hearing is that they are not sick to the same extent. They are having a milder form of pneumonia. Some of them even just being admitted almost as a precaution.And I am not aware of any vaccinated on the ventilators at the moment.

Are you aware how many of the patients that you are treating have Omicron variant and how many have the Delta variant?

Dr SF: We do not actually get the data from the lab, unfortunately. So, positive PCR results, the labs are reporting that close to 90 per cent of the specimens that they are sequencing are Omicron. So, we are assuming that most of what we are seeing are Omicron but we actually do not know that for a fact.

If you were to go back from April-May 2020 and today, how would you characterize the progression of the virus as you are seeing with your patients?

Dr SF: I think we have learnt a lot more than what we knew then. In April 2020, there was a lot of debate as to do masks work, should we stay home and that type of thing. Now, everybody understands a lot better what the non-pharmaceutical interventions that one can do. The virus has technically changed. In April 2020, we really do not know how to treat it. But now we have got a really good management plan for home.

I know practitioners who treat patients at home. We have good management plans, we know how to monitor, we know how to check to see whether oxygen is dropping, whether heart rates are going up. We do a lot of blood monitoring to see if patients p/clotting profiles and inflammatory markers are going up. If they are, we treat them quite early with cortisone, some of them with anticoagulants. I believe that we are understanding better how to stop the progression of illness. The variant that we are seeing now is different and it keeps us on our toes. Delta seemed like it was a bit more virulent. Omicron is different in that it seems to be infecting even vaccinated people whereas Delta was not really doing that. You Know there are changes along the way.

Are you seeing any differences in impact in terms of age group? How are you looking at children below 12, between 15-25 and the much older people?

Dr SF: We are definitely seeing more children and teenagers being infected than we did in previous waves. It could be partly because children under 12 in South Africa are unvaccinated. And teenagers were only given access to the vaccines only six weeks ago and able to get only one vaccine dose. And actually today, South Africa has opened a second dose of vaccine to 12-17-year-olds. That is really good news. But unfortunately the vaccine uptake in this age group is bad and that is the logic in why we are seeing the epidemic now in the younger people…not so much that it is affecting elder people but the elderly also are more protected by the vaccines.

Is the impact on children under 12 years similar to Delta?

Dr SF: I have not seen any severe cases in young children. There are some reports from some hospitals about some children with more serious illness and there is concern about that. That is also something we are waiting to see, what is the impact going to be.

If you look at the people who are vaccinated and been infected, do you feel that we are in a stage where this has become indeed more endemic, in as much as there is some impact but it's not something that is going to fundamentally affect you more than a bad flu?

Dr SF: Again, I think it is really early to say that. In vaccinated patients I am definitely seeing a difference in my patients. I have a number of elderly patients over the age of 70 and 80 plus years old at the moment. Those patients, if they were infected in June, July before vaccines were available, I would have been really worried about. They are just doing much better at the moment. I think it is the vaccine protection that is keeping them well.

As you look ahead, how this virus or this new variant is progressing? What else would you like, as a general practitioner, to make treatment or approach more better or powerful?

Dr SF: It is quite a difficult question actually. As we all understand the virus better, I think people need to take more responsibility for themselves. The anti-vaccine movement unfortunately across the world is enormous. And I think that has had a major impact on how the vaccines have been rolled out, and had a major impact on the whole epidemic. If more people were vaccinated, we may not have got the new mutation that we got now.

So that is what I would really change is: the social media misinformation that is available because people are confused and they really do not understand what to believe. And one cannot even blame them, there is a massive overload of information and it is difficult to sift through it. So my advice to people is to really follow the health professionals, and big academic institutes and hopefully not have the mistrust that there unfortunately is.

For people who call you today and are not infected and ask you about what to do, should they be sitting at home, should they be locking themselves in? What are you advising your patients or those who you treat even in normal circumstances?

Dr SF: I think we need to learn to live with the virus. So at the moment in Johannesburg, we have a massive amount of cases. So anybody who is vulnerable, and is asking me for advice, I am going to say that they stay at home for the next couple of weeks, while we see what the impact of Omicron is and while we are hopefully confident that its milder, but they will be susceptible to getting it even if they go out. And almost all our older population has not got boosters, we are waiting for boosters to open. And there are people, who after taking a vaccine after six months, in need of a booster. I think everyone who is out and about needs to avoid large gatherings and intimate spaces need to wear masks and keep the social distance.

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