Omicron: impact on travellers and early data from South Africa…
DEC 09, 2021
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The Scottish Government, like many others, has introduced sweeping new temporary measures to try and buy time and mitigate the effects of the new Omicron variant of concern (VOC) of SARS-CoV-2.
Do please check and recheck the latest restrictions prior to travel, for the country to which you are travelling and any transit countries en route. A useful starting point is to google the FCO website, together with the country name and the search terms: 'entry' and 'covid'.
From cladistic analysis, Omicron appears to have been quietly evolving in isolation since June 2020, either within the body of an immunocompromised individual, and/or small a relatively isolated community somewhere, before making its dramatic entrance onto the international stage in November 2021 in a densely populated district of Gauteng Province, South Africa.
As time plays out, we will surely come to learn a lot more about this variant. What we do know from the first couple of weeks is:
- Omicron is much more transmissible from human-to-human than previous variants. This is not entirely surprising: there is a strong evolutionary pressure for a new virus to change this way.
- Initial hospital data from Tshwane District in Pretoria, the current global epicentre of the Omicron pandemic, indicate that for the past two weeks:
- Most hospital diagnoses of SARS-CoV-2 infection were incidental findings in routinely-screened patients admitted for other reasons. This is consistent with established community transmission.
- The majority of inpatients (70%) diagnosed with SARS-CoV-2 infection (n=166 over 5 days) did not need supplemental oxygen (unlike in previous waves), and in generally had shorter hospital stays. However, this may be partly due to the relative youth of people infected this time round (80% under 50 yrs) and the possibility that some may be vaccinated already or re-infections, which are usually milder.
- Overall in Gauteng, despite a dramatic increase in case numbers, there has not been 'any significant increase in in-hospital deaths' associated with this fourth wave, in contrast with the previous three waves (Ancestral, Beta and Delta).
What we do not know yet is how effective current COVID-19 vaccines will be in preventing transmission, and/or in modifying the severity of COVID disease in those infected with Omicron…
However, given South Africa's extraordinary diversity, in terms of rich and poor, young and old, healthy and immunocompromised people, vaccinated (30%) and unvaccinated, and different genetic ancestry, it is likely that the current 'natural experiment' will yield some very interesting data in the weeks/months to come, which might be of more relevance to other low income countries.
One possible 'best case scenario’, (given that Omicron is already widely distributed globally), is that if it does turn out to be clinically milder than previous variants, and at least partially preventable by vaccines, natural infection may simply fill the gap and immunise those unable (or unwilling) to get vaccinated so far. This could, in theory, help us accelerate towards relative herd immunity and the ecological balance we inevitably need to achieve with this virus in the decades to come. Time will tell.
Either way, until we know more, we should still nevertheless follow the temporary restrictions and extra protective measures recommended by the Scottish Government, particularly as we are only at the start of Winter. We are very lucky to have vaccines in this country and we should all get fully vaccinated ASAP.
The World Health Organisation (WHO) has issued temporary recommendations to guide countries wishing to apply an evidence-informed and risk-based approach to international travel restrictions to delay the exportation/importation of Omicron and to help mitigate its effects on local healthcare services. However WHO continues to strongly argue against the use of blanket travel bans as they have little or no effect in reducing the spread of COVID-19 and generally tends to do more harm than good.
Let us hope common sense and evidence prevails and the current temporary Red List travel restrictions for certain countries in the Global South are not allowed to last any longer than necessary. 'Travel apartheid', a term coined by Nigeria's High Commissioner when condemning the UK's recent red listing of Nigeria (despite England having more than twice the number of Omicron cases), is quite an apt description of the current situation. We should learn from the UK’s extended discriminatory policies in 2021, which had a disproportionately negative effect on people in Africa for no obvious public health benefit.
