Spread of Omicron

The last few months have been dominated by concerns over the spread of the Omicron variant of the Covid-19 coronavirus. The variant was first recorded in South Africa at the end of November 2021, with cases then reported in the UK over the following week.

Some of the primary concerns with the Omicron variant are its high transmissibility and evasion to immunity and vaccination. An early study by Imperial College London estimated that the protection against reinfection by Omicron afforded by past infection “may be as low as 19%”. It also estimated that two vaccine doses offered protection against symptomatic Omicron infection of between 0% and 20%, with booster doses significantly increasing protection to between 55% and 80%.

The UK has seen a surge in coronavirus cases over the last three months, with Omicron understood to be a large part of this. Coronavirus case numbers grew from around 36,500 cases a day at the beginning of November to around 47,700 a day at the beginning of December, before rising to around 192,400 a day at the beginning of January. The Government responded to the emergence of Omicron by speeding up its booster rollout, aiming to offer all adults the opportunity to have a booster jab by the end of 2021.

Despite the growth in cases and the pressures this has brought to the NHS, evidence continues to emerge that the Omicron variant may be milder than previous variants. Part of this, studies have found, is because the virus appears to focus more on the upper respiratory tract and is therefore less likely to significantly impact the lungs. The UK Health Security Agency has suggested that hospitalisation rates for Omicron may be around 50% to 70% lower, with researchers from the University of Cambridge also highlighting the important role the vaccine has had in reducing severity.

However, others have cautioned against taking Omicron lightly. The World Health Organisation (WHO) has still stressed the dangers of the variant overwhelming healthcare systems and says that much of the evidence about its severity comes from heavily vaccinated countries. In addition, there is no evidence to suggest it could not cause ‘long Covid’. Indeed, the US President’s Chief Medical Adviser Dr Anthony Fauci has stated:

Long Covid can happen no matter what virus variant occurs. There’s no evidence that there’s any difference between Delta or Beta or now Omicron. We should always be aware that when people get symptomatic infection […] anywhere from 10% to up to 30% of people will go on to have persistence of symptoms.

Future management of coronavirus

The recent developments have led many to question the future handling of the coronavirus pandemic, particularly the policy of regular boosters. For example, the Chancellor of the Exchequer, Rishi Sunak, has reportedly raised concerns about the economic cost of running regular booster programmes. In addition, Dr Clive Dix, previous head of the UK’s vaccine taskforce, has recommended the end of mass-population vaccinations, with greater focus on protecting vulnerable groups instead.

The public health specialist Maggie Rae has also written an article in the British Medical Journal stating that, although the UK’s booster programme to protect against Omicron was important in the circumstances, it was even more important to focus resources on vaccinating the rest of the world. Writing in December 2021, she argued this was the best way to protect against the emergence of future variants:

While 80% of the UK population is fully vaccinated, this figure stands at only 6.6% for the African continent. While we still seek a definitive answer as to where the Omicron variant of Covid-19 originated, what is certain is that unless populations across the world are protected from the threat of the virus, we will continue to see new variants emerge and spread internationally.

Our most important call to governments then, is to support global vaccination efforts through lifting import restrictions and intellectual property protections, while also resourcing and supporting vaccine delivery programmes in low-income countries. Covid-19 is not a short-term problem; our aim as a global community must be to learn to live alongside the virus, and to achieve this goal requires coordinated international action based on principles of equity.

Writing about this issue in the Nature journal, Elie Dolgin noted that booster programmes have long been a concern among global health researchers due to the low vaccination rates still apparent in other parts of the world. He stated that these rates have already “spurred debate over issues of equity and prioritization of limited vaccine resources”. He said that scientists are concerned that the rush among wealthier countries to offer more boosters due to the spread of Omicron would “further exacerbate the global vaccine imbalance—a disparity that many health researchers say probably contributed to Omicron’s emergence and rapid spread”. However, he believed the future of booster use in countries would depend on the severity and communicability of future mutations of the virus and the efficiency of boosters at curbing infection rates.

WHO Director General Tedros Adhanom Ghebreyesus believes that we could see the end of the pandemic this year if vaccination efforts continue around the world. Speaking in December 2021, he said WHO projections showed that vaccine supplies should be sufficient to vaccinate the entire global adult population and to give boosters to high-risk populations by the first quarter of 2022. However, he concluded with a warning: “Unless we vaccinated the whole world, I don’t think we can end this pandemic”.

Cover image by Braňo on Unsplash.