Public health experts say Kerala may face a unique situation of having both delta and omicron in the community, which can overwhelm the health system.
As Kerala prepares for the possible spread of the Omicron virus in the coming days, several plans and strategies will have to be implemented to ensure that the health system is not overwhelmed and non-COVID care is not affected as it was during the peak. The last delta wave.
“It’s a different set of challenges that we may be up against this time around, if there is community transmission of the Omicron variant. After two years of dealing with the pandemic, we know there’s no need for a knee-jerk reaction. But that’s it. But there is a lot of uncertainty at what point we should act and whether we should anticipate that the situation involving Omicron could be as bad as Delta,” says a senior public health expert.
While real-world data from South Africa always maintained that the Omicron variant caused less severe disease than the delta’s, public health experts were waiting for data from the UK and Europe to confirm this.
So far, the Scientific Advisory Group for Emergencies (SAGE), UK, has maintained that there is nothing to suggest that Omicron was less severe than Delta.
However, the latest study from Imperial College, London concluded that Omicron-infected people are 20–25% less likely to be hospitalized than Delta-affected people and are more likely to be hospitalized for more than a day. The probability was less than 40. -45%.
The study also noted that this low severity of illness may be exacerbated by the greater communicability of omicrons, which can infect a large number of people at once, and are particularly vulnerable (elderly, with co-morbidities). and immunological). Much faster than other variants.
Public health experts point out that Kerala may be facing a unique situation of having both delta and omicron prevalent in the community. Going forward, any or a combination of these two can become a problem if the test positivity rate exceeds 10% and things can spiral out of control.
“The key metric we should be looking at in the event of an omicron surge will be how fast hospital beds, ICU beds and oxygen requirements are moving, not case numbers. Once Omicron’s community transmission begins, it will last through all (the doubling time is just two days). A major concern would be that if a large number of health workers are affected, all patient care activities will be disrupted. Absence of health workers in hospitals can create a crisis and for this we may have to plan ahead,” says R Aravind, head of infectious diseases, Government Medical College, Thiruvananthapuram.
Even acknowledging that Omicron may bring on a less severe disease, it could put many people in hospitals in a very short period of time – this naturally included a large number of patients in the vulnerable category. Will – Emphasis on health system. One challenge will be to ensure that tertiary care institutions do not overcrowd mild cases and are free to handle severe cases of both COVID and non-COVID diseases.
“There is a category of people – those above 60 years of age, those with multiple co-morbidities, the immunocompromised – for whom Omicron is not necessarily mild. Since they were vaccinated long ago, their vaccine-derived immunity decreased It will happen,” says Dr Arvind.
“Another main challenge is Omicron’s ability to evade high immunity that can evade both monoclonal antibodies (mAbs) and antibodies generated from vaccines or previous infections. This means that any mAb currently used as life-saving drugs to prevent severe infection (delta) will not work for omicron infection and this could be a hindrance,” he adds.
Public health experts point out that Denmark’s Omicron experience is something Kerala should pay attention to. Denmark was one of the first countries in Europe to experience an omicron increase – a situation like Kerala – with a 77% background vaccination rate and high levels of past natural infection.
The picture that is coming out from both the UK and Denmark looks almost the same. Hospitalizations have increased but are now slowing down and showing signs of stabilisation. The predicted worst-case scenario has not yet been reported anywhere.
Even when data from South Africa, the UK and Denmark point to fewer hospitalizations and a decrease in severity, scientists are cautious because they are not sure whether the variant is intrinsically less virulent or less severe. This is because the cases are so far concentrated in the young population. Uncertainties are enormous, including background vaccination and past infection rates in the population.
“In Denmark, 1% of people affected by Omicron required hospitalization and 0.1% required ICU care. At the peak of the delta, Kerala reported about 43,000 new cases a day. If Omicron in a day can lead to a peak of around one lakh cases, we should expect about 1,000 hospitalizations, requiring 100 ICU care per day. MCH should only turn to people requiring ICU care, whereas Rest of the hospitals should be managed by hospitals in the periphery, suggests Dr Arvind.
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