The Omicron variant of the SARS-CoV-2 virus, which causes Covid-19, was first reported by South African scientists on Nov 24 (2021) and classified as a variant of concern by the World Health Organisation (WHO) on Nov 28 (2021). Within about a month, Omicron became the dominant SARS-CoV-2 viral variant in North America and Europe, pushing the Delta variant aside.
It is increasingly being reported in Asia and is on its way to becoming the dominant variant in the Asia-Pacific region. This is not surprising as its doubling time (the amount of time it takes to double the number of infections) is 1.5 to three days, compared with six to eight days for the Delta variant. Several Asia-Pacific countries, e.g. Singapore, Australia and Japan, have reported increasing numbers of Omicron cases.
Although there is increasing knowledge about Omicron, there are also numerous knowledge gaps. This, together with selective snippets of academic discussions, has led to assumptions, speculations, misinformation, and in some instances, disinformation in social media, and sometimes, the mainstream media. The result is confusion and difficulty in decision-making for individuals, and even authorities. This column attempts to clarify the facts surrounding some of the common myths that the writer has encountered in interactions with patients, colleagues and friends.
Myth 1: Omicron Causes Mild Disease Only.
Fact: Omicron appears to be less severe than Delta, but it should not be considered as mild.
Some countries have reported that the severity of Omicron cases have been lower than those infected with the Delta variant. However, most of these countries have high vaccination rates – their comparatively lower rate of hospitalisations and deaths were due to vaccination, particularly of vulnerable groups. Hospitalisations and deaths have affected the unvaccinated in these countries disproportionately. Therefore, it is premature to make a judgment on Omicron’s severity.
Myth 2: Omicron is just like a Common Cold.
Fact: Omicron is much more dangerous than the common cold.
The common cold usually resolves in a few days, with complications being rare. On the other hand, Covid-19 caused by the Omicron variant is more likely than the cold to lead to hospitalisation, and even death. It is expected that those who have recovered from an Omicron infection are at risk of developing long Covid, i.e. long-term health consequences, which is not so with the common cold.
Myth 3: Previous Covid-19 Infection Provides Immunity from Omicron.
Fact: Omicron can reinfect those who have previously already had Covid-19.
Reports of recommendations to get Covid-19 deliberately to get immunity to the infection are not only scientifically flawed, but also irresponsible. Anyone who has had a previous Covid-19 infection can get reinfected with the Omicron variant with the concomitant risk of severe disease, spread of the infection or development of long Covid. Getting fully vaccinated is the best way to protect one’s self and others from severe disease and long Covid.
Myth 4: Omicron Does Not Cause Severe Disease in the Unvaccinated.
Fact: The unvaccinated are most at risk from Omicron. Omicron is looking for the unvaccinated.
The sheer volume of Covid-19 cases is leading to huge numbers of hospitalisations in countries where Omicron is becoming the dominant variant. And the vast majority of those needing hospitalisation are the unvaccinated. Omicron has spread at an unprecedented speed, especially where measures to interrupt its spread are non-existent or there is poor compliance to such measures. Just like the Delta variant, Omicron will affect the unvaccinated the most.
In an analysis of 20,823 reported Covid-19 deaths in Malaysia from Feb 24 to Sept 14, 2021, the total age-standardised mortality rates (ASMRs) “for the unvaccinated group (47.5 per 100,000 population) were 43.2 times and 12.5 times higher than the ASMR of individuals fully vaccinated with BNT162b2 (1.1 per 100,000) and inactivated vaccines (3.8 per 100,000), respectively”. BNT162b2 is the name of the Pfizer-BioNTech Covid-19 vaccine.
Myth 5: Vaccines are not Effective Against Omicron.
Fact: Vaccines currently offer the best available protection against Omicron.
The current Covid-19 vaccines provide substantial protection against severe disease and death from all the viral variants causing the disease, including Omicron. Vaccination stimulates the body’s immune response by producing antibodies and T-cells (also known as killer cells), which provide protection against infections.
While there are studies that have reported that the antibodies produced against Omicron is less than those against other variants, there are also studies that reported that the body’s T-cells still recognise and protect against the Omicron variant. In fact, many researchers argue that greater attention should be paid to our T-cells.
Myth 6: Vaccine Boosters are Ineffective in Protecting Against Severe Disease Caused by Omicron.
Fact: Vaccine boosters are effective at increasing protection against severe disease from Omicron and other viral variants.
Just like many other vaccines, e.g. influenza, the antibodies produced in response to Covid-19 wane with time. It is well documented in many studies that Covid-19 vaccine boosters increase antibodies markedly. This will increase the protection against severe disease from Omicron and other variants.
This is particularly vital for those whose vulnerability to severe disease is increased, i.e. those aged 60 years and above, as well as people with underlying medical conditions of any age. Healthcare staff also need boosters because of increased risk of exposure to the virus, and if infected, the increased likelihood of spreading Covid-19 to the vulnerable to whom they provide care.
Myth 7: Non-pharmaceutical Interventions are Ineffective Against Omicron.
Fact: Non-pharmaceutical interventions are effective protection that help reduce the infection and spread of Omicron.
There is no single measure that can limit the spread of all SARS-CoV-2 viral variants, including Omicron. Multiple measures based on the “Swiss cheese” model are required, with each measure amplifying others. Current evidence indicates that all non-pharmaceutical interventions (NPI) are effective against all variants, including Omicron.
The NPIs include:
- Using face mask(s)
- Physical distancing of at least 2m
- Hand and respiratory hygiene
- Avoiding crowded, closed or confined spaces
- Ensuring good ventilation
- Staying home when ill, and
- Adherence to medical advice and instructions.
These are necessary to reduce viral spread and protect everyone.
Myth 8: As Omicron is Less Severe, the Health System will be Able to Cope.
Fact: Omicron still exposes the health system to high risk.
Current data indicates that Omicron spreads two to four times faster than the Delta variant, thereby having the potential to infect many more people. A small fraction of a very large number is still a large number, e.g. 2% of 10,000 and 100,000 are 200 and 2,000 respectively – a vast difference.
Even if Omicron causes less severe disease than Delta, the rapid increase in the number of cases will result in increased hospitalisations. This will in turn lead to increased pressure on the health system, which also has to treat other medical, surgical and obstetric cases, in addition to Covid-19.
Myth 9: As Omicron is Less Severe, the Pandemic is Coming to An End.
Fact: The end of the pandemic is not yet in sight.
No one knows when the pandemic will end. The huge surge of Covid-19 cases in Europe and North America has been attributed to the Omicron and Delta variants. In countries where Omicron has become the dominant variant, the cases are doubling every 1.5 to three days with rapidly increasing hospitalisations consequently.
It is true that some experts have expressed the hope that the pandemic will become endemic with the Omicron variant. These opinions have been accompanied with the caveat that a new more lethal variant would not arise.
Other experts are concerned that the more Omicron spreads, the more it replicates and the more likely the virus will change, making it more likely a new variant could arise with the potential of it being more dangerous. As such, it is not yet time to be complacent. The media’s responsibility is to ensure that there is no misinformation or disinformation that fuels mistrust that endangers health and lives. Such misinformation or disinformation can undercut public trust, and impair individual and collective responses to the pandemic.
Take Home Messages
Vaccination is an important tool to protect an individual and his/her family, particularly young children. If you are unvaccinated, get vaccinated. If you have not completed the primary series of vaccination, get vaccinated. If you have completed the primary series of vaccination, get your booster dose. Keep your vaccination appointments. And continue to do the NPIs stated above, which is equally important.
Dr Milton Lum is a past president of the Federation of Private Medical Practitioners Associations and the Malaysian Medical Association.
Article was first published in ‘The Star’ on 31 January 2022
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