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Omicron’s less severe cases prompt cautious optimism in South Africa

Medics and scientists in South Africa have welcomed early hospital data suggesting that the Omicron coronavirus variant could result in less severe illness than previous waves but warned that higher transmission rates could still overwhelm hospitals.

Early data from the Steve Biko and Tshwane District Hospital Complex in South Africa’s capital Pretoria, which is at the epicentre of the outbreak, showed that on December 2 only nine of the 42 patients on the Covid ward, all of whom were unvaccinated, were being treated for the virus and were in need of oxygen.

The remainder of the patients had tested positive but were asymptomatic and being treated for other conditions.

“My colleagues and I have all noticed this high number of patients on room air,” said Dr Fareed Abdullah, a director of the South African Medical Research Council and an infectious disease doctor at the Steve Biko hospital.

“You walked into a Covid ward any time in the past 18 months . . . you could hear the oxygen whooshing out of the wall sockets, you could hear the ventilators beeping . . . but now the vast majority of patients are like any other ward.”

The data will reassure global health officials who have been alarmed by South Africa’s rapid rise in infections. But experts have warned that the sharp increase in cases, linked to the new coronavirus variant’s apparent ability to evade immune protection from prior infection or vaccination, could still strain hospitals to a similar extent as the summer Delta wave.

Meanwhile, concern is mounting in neighbouring Zimbabwe where surging infection rates are beginning to test the creaking healthcare system in the first sign of the Omicron wave spilling across the region.

The pattern of milder disease in Pretoria is corroborated by data for the whole of Gauteng province. Eight per cent of Covid-positive hospital patients are being treated in intensive care units, down from 23 per cent throughout the Delta wave. And just 2 per cent are on ventilators, down from 11 per cent.

Although the total number of Covid-positive patients in Gauteng’s hospitals is approaching the level it reached at the same stage of the Delta wave, researchers said a large portion received treatment for other conditions. And the number of Covid patients in intensive care is one quarter of what it was three weeks into the Delta outbreak.

Chart showing that although the number of Covid-positive patients in Gauteng is approaching the level from the Delta wave, the number in ICU is much lower. Total Covid-positive patient numbers are currently at 80% of the level they were at at the same point of the Delta wave, but ICU patient numbers are only 25% of the Delta level at the same stage

“I’m extremely optimistic,” said Shabir Madhi, professor of vaccinology at the University of the Witwatersrand, who predicted that while there will be a “large number” of breakthrough infections and reinfections, a smaller proportion of cases would end up requiring hospital treatment.

On Sunday, top US health official Anthony Fauci also said early signals about the severity of the variant were “encouraging”.

However, the potential for Omicron to result in less severe symptoms may be more a consequence of immunity than the virus evolving to become less virulent, according to Prof Richard Lessells, an infectious disease physician at the University of KwaZulu-Natal in Durban.

Scientists stressed that even if the country is spared a more lethal variant, Omicron’s contagiousness alone could cause major problems. Weekly hospital admissions of Covid-positive patients across Gauteng province are increasing at five times the rate of the fastest growth period during the Delta wave.

Chart showing that Covid cases, test positivity and hospital admissions in Gauteng are rising far faster than in past waves

“If it spreads and transmits more efficiently, and you get more people infected in a short space of time, that is really bad news for your hospitals and health system,” said Lessells.

Jantjie Taljaard, an infectious diseases physician at Tygerberg Academic Hospital in Cape Town said hospitals in the city are readying themselves for their own wave of Omicron admissions that could match the Delta wave after case rates increased six-fold over the last week.

Taljaard added that he suspected the hospital data from Gauteng “may be a bit skewed” because of infections in the early stages of the wave being more prevalent among younger people, who are less likely to get severely ill.

Across the border in Zimbabwe, health officials are increasingly nervous about how a similar surge could play havoc with the country’s healthcare system which is less well resourced than that of its more affluent neighbour.

There has been a sharp uptick in the number of seriously ill Covid-positive patients in Zimbabwe’s hospitals, with numbers climbing from six to 26 in the seven days to last Friday, ahead of where they stood at the same stage of the Delta wave in June.

Prof Rashida Ferrand, director of a research partnership between a Zimbabwean health facility and the London School of Hygiene and Tropical Medicine, noted that infections in Zimbabwe were increasing at the fastest rate of “any point during the pandemic”, mirroring the spike in Gauteng.

“That threatens to overwhelm the healthcare system, much more than it would in South Africa,” said Ferrand.


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