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Intensive care admissions in variant-stricken South African province are HALF of levels during Delta


Some people seem very worried about the new variant. Should I be, too?

Intense research into Omicron has only just begun, so it’s too soon to know much for certain.

So far there has been a lot of speculation ‘which isn’t helpful’, said Dr Julian Tang, a virus expert at the University of Leicester. ‘Relatively little is known about Omicron, even among scientists,’ added Professor Mark Woolhouse, an epidemiologist at the University of Edinburgh.

The facts so far are as follows. On November 25, South African health officials announced an uptick in Covid cases linked to a new variant. Due to the large number and type of mutations, or changes, to the variant, it could be more transmissible, the scientists said – meaning it could spread faster than previous iterations.

The next day, the World Health Organisation (WHO) declared it a variant of concern, and named it Omicron – the 15th letter in the Greek alphabet – following its variant naming system.

Since then it has been identified in more than 20 countries worldwide, including Britain.

Last Thursday, Dr Michelle Groome of South Africa’s National Institute For Communicable Diseases said there had been an ‘exponential increase’ in infections over the past two weeks. In mid-November, the country – where just a quarter of the population have been jabbed – was seeing roughly 300 new cases per day.

Last Monday they recorded 2,858 cases. By Wednesday it was 8,561, and on Friday it was 16,055.

Based on what’s being seen there, experts say the South African scientists’ initial assessment seems correct – Omicron is likely more infectious than the currently dominant Delta variant, which itself was 60 per cent more infectious than the Alpha variant which overtook the original Wuhan virus in late 2020.

And it is this, primarily, that has caused concern. 

How much more infectious is Omicron?

However, due to South Africa’s low vaccination rate it’s not possible to make direct comparisons with European countries.

‘We’d need to see more numbers before putting a figure on it,’ said Prof Woolhouse.

I have read ominous things about ‘vaccine escape’. Does this mean our jabs won’t protect us against Omicron?

The swift spread of Omicron in South Africa hints that it has some capacity to overcome existing immunity, but there is no suggestion that the vaccines will no longer be effective.

Indeed, scientists we spoke to believe the jabs will still provide an ‘incredibly strong’ protection against serious illness, which is key. And this is why the booster programme, which aims to have every adult offered a third dose by the end of January, is still vital.

What we know for certain is that a South African study published last week examined medical reports of roughly three million people with lab-confirmed Covid. It found 35,670 suspected reinfections – people who’d caught Covid a second time after having tested positive three months or more before. Based on this data, the scientists estimated Omicron was three times as likely to cause reinfection as the Delta or Alpha variants.

‘This is not overly surprising,’ said Professor Francois Balloux, director of the Genetics Institute at University College London.

‘The large number of mutations in the spike protein [is likely to] increase the Omicron variant’s ability to bypass immunity.’

The spike protein is part of the Covid virus that allows it to bind to healthy cells – much like a key entering a lock. The outer shell of the roughly spherical viral particle is covered in them.

Most Covid vaccines, including the Pfizer, Moderna and AstraZeneca jabs, are designed to mimic the coronavirus spike protein. They work, in part, by teaching the immune system to create defensive cells called antibodies which recognise and attach to this part of the virus – stopping the key from ever entering the lock.

Scientists have long known that the more changes there are to the spike protein, the more likely it is that Covid antibodies, even in a fully vaccinated individual, will not recognise the virus, allowing it to slip past the body’s defences. In Omicron, the spike protein has 32 mutations differentiating it from previous variants, which is what has led experts to suspect that existing antibodies will be less effective in fighting it off.

How much this is the case isn’t known. This is partly because antibodies are not the only cells that the immune system develops to fight off viruses.

The Covid vaccines also trigger the creation of T-cells and B-cells – fighter cells that attack foreign invaders – and experts believe that these cells will still be able to identify the Omicron variant, neutralising it before the majority of fully vaccinated people become seriously unwell.

A similar pattern was seen with the Delta variant which arrived in the UK in March. Early lab studies suggested mutations to the spike protein would allow it to slip past many of our antibodies, and scientists estimated the jabs would be only 67 per cent effective – a massive fall from the initial 90 per cent touted by the manufacturers.

However, half a year on, experts believe protection against Delta provided by the vaccines only fell by roughly three per cent.

‘We have our T-cells and B-cells to thank for this,’ said virologist Dr Tang, ‘and I expect we’ll see the same with Omicron.

‘The majority of the vaccinated population will still be protected from the worst of the disease.’

Is it true that Omicron is causing a milder illness than previous variants?

Early signs, again from South Africa, suggest that many people who catch Omicron are experiencing only mild symptoms. However, experts have warned against making too many comparisons or forecasts at this stage.

Based on the current evidence, little is known about the severity of infection – with or without vaccination – caused by Omicron. Prof Balloux said: ‘South Africa has a low vaccination rate but a large proportion of the population has been infected during previous Covid-19 waves. The population of South Africa also tends to be fairly young, with a median age of 27.6 years [compared with 40 in the UK]. More data will be needed before we can make robust predictions about the potential threat posed by a global spread of Omicron.’

Speaking at a press conference on Wednesday, the WHO’s Dr Maria Van Kerkhove said: ‘We have seen reports of cases with Omicron that go from mild all the way to severe. There is some indication that some the patients are presenting with mild disease, but it is early days.’

The severity of Covid illness depends on a multitude of factors, which is what makes this a particularly difficult question to untangle – and a proper answer may not come for many months.

The main concern is that, even if it’s not causing severe illness in general, Omicron could spread rapidly through the vaccinated population, increasing the chances that it will reach vulnerable people whose immune systems have not been sufficiently trained by the vaccines, or the unvaccinated.

Professor Penny Ward, a pharmaceutical expert at King’s College London, said: ‘It may be a while before we know the effect on older, more vulnerable people.’

How quickly is Omicron spreading in the UK?

Some 568 cases of the Omicron variant detected in the UK, but scientists believe there are already many more that haven’t been picked up.

A cluster of cases was identified in Scotland, while individual cases have been seen in almost every region of England and in parts of Wales. None have been identified in Northern Ireland to date. 

Experts warn the actual number could be closer to 2,000 — more than four times the official count. They add that cases of the mutant strain are likely doubling every two to three days and that it could trigger a major wave by Christmas.  

‘We know from experience of Alpha and Delta that by the time you’ve learnt it’s here, the horse has already bolted,’ said Dr Tang. ‘Considering we have so few restrictions in place, it’s likely this virus will propagate at speed.’

However, it will likely take some time before it outpaces Delta, which is still causing nearly 50,000 new cases each day. 

Will we see more restrictions?

On Monday, Health Secretary Sajid Javid confirmed that hospitalisations would be ‘what matters more than anything’ when considering further measures. And based on what we know so far, these are unlikely to rise for some time.

The variant would have to significantly reduce the effectiveness of the vaccines before major social restrictions such as lockdowns were necessary in the UK, experts told us.

But Whitehall officials are already drawing up plans for work from home in England, while people have been told to start following the policy if they live in Scotland.

No10 has called on businesses not to cancel their Christmas parties, but many companies are already doing this. 

Studies show the booster jabs, which have now been given to nearly 90 per cent of Britons over the age of 70, provide an unprecedented level of protection against the virus – and even if Omicron ‘dents’ this, we’re starting from an ideal position to fight it off, said Dr David Strain, clinical Covid lead at the Royal Devon and Exeter NHS Foundation Trust.

According to an Israeli study published in November, a third dose of the Pfizer jab increased protection against symptomatic infection to as much as 94 per cent.

The effect of this is already being seen in the UK, where hospitalisations are now falling – particularly in older age groups – even as Covid cases rise.

Dr Strain explained: ‘The boosters put us in a wonderful position before this new variant arrived. Omicron has dented that campaign somewhat, but if you are fully boosted you are still in an ideal position to defend against it.’

Disease modellers believe that the strength of the boosters is such that the NHS could ‘tolerate’ even a large wave of Omicron.

Prof Woolhouse said: ‘Healthcare settings could probably bear some fall-off in protection, given just how effective the boosters appear to be.

‘However, I’d like to see some numbers before I say that with certainty. Studies looking at how effective the boosters are against this variant are a priority right now.’

On November 25, the Government announced that it would temporarily ban travellers from six southern African countries, and reintroduce PCR tests for all passengers on arrival, no matter where from, to combat the spread of the variant.

And last week masks once again became mandatory in indoor public spaces, including shops and public transport.

These measures will buy the UK some time while scientists race to analyse the variant, ministers have said.

We’ve been told that boosters are vital – but the rules keep changing. How will I know when and where to get mine?

Last week the Government announced that all adults would be offered a booster Covid vaccine three months after their second dose. It means the entire adult population will have at least been given the opportunity to have a third dose by the end of January.

On Friday, NHS England issued an update, saying the rollout would begin on December 13.

Until then, those eligible to book a booster remains as it was: only those aged 40 and over; those aged 16 and over with a health condition that puts them at high risk from Covid; and frontline health and social care workers who had their second dose more than six months ago.

These groups should already have received an invitation, via text message or email or both.

After December 13, as with the initial vaccine campaign, people will be invited in descending age order. Again, this will be in the form of text or email.

At present, if you look at the NHS Covid vaccine booking website, it states in a yellow box at the top of the page: ‘The NHS is working on plans to offer a booster dose to everyone aged 18 years old and over… Please wait to be contacted by the NHS.’

The Government recommends that people book a jab appointment or locate a walk-in service through the NHS website (go to nhs.uk, scroll down and click ‘Find out about Covid-19 vaccination’ – or Google ‘book a Covid jab’, and click on the top result, titled: Book or manage a coronavirus (COVID-19) vaccination).

The process is relatively straightforward and requires people to enter their name, age, and address (the nhs.uk booking form asks if you know your NHS number, however it’s not a problem if you don’t have this to hand).

Once this is done, you will be given a list of nearby clinics where you can access the booster. These might be a GP surgery, a pharmacist, a hub at a community centre, hospital or a walk-in service.

Anyone who has trouble accessing the internet can book their booster jab through their GP, but family doctors have asked that this is done as a last resort.

Dr Dean Eggitt, a Doncaster-based GP, said: ‘If you ring up your surgery for help with a booster jab, they should be able to organise it for you, but you could be waiting on the phone for quite some time so it is far speedier to do it online.’

Eligible people who are housebound will be prioritised under the new system, and should already be known to their GP, who will organise a booster to be done in the home. If you are housebound and are not sure if your GP is aware, you should contact them. Patients in hospital who have not yet had their booster will also be able to receive their shot in hospital.

In some areas, such as the Isle of Wight and Hampshire, special ‘booster buses’ have been deployed, offering jabs to eligible passers-by in different locations on each day.

Do we have enough vaccines to boost everyone?

Yes, but the real challenge will be finding enough people to administer them. According to the Government, there are enough available vaccines to offer every adult in England a top-up shot by the end of January.

To achieve this, the number of boosters administered every day will have to increase from 350,000 to 500,000.

Speaking last Tuesday, Prime Minister Boris Johnson said that 1,500 pharmacies would begin providing boosters alongside temporary vaccine centres that will be ‘popping up like Christmas trees’, as well as 400 military personnel and a ‘jabs army’ of volunteers.

GPs will also be called on to carry out more boosters, and will be offered up to £30 per vaccine given. However, GPs have warned this will affect the level of care they can offer patients.

Dr Eggitt said the challenge was enormous: ‘If we’re expected to vaccinate on this ambitious timeline, practices will have to make the decision over what they will do less of, and that may include measures such as temporarily suspending routine health checks.’

What about Christmas? Is it really OK to carry on as planned?

Yes, but it wouldn’t hurt to be careful, say experts. It is too soon to say how quickly the Omicron variant will proliferate, but based on experience with the Delta variant it will take several months before it becomes widespread.

This means the chances of catching Omicron right now are incredibly small, and that will still be so in three weeks’ time. For this reason, socialising with family is still a low-risk activity.

‘I really don’t think Christmas is anything to worry about,’ said Professor Paul Hunter from the University of East Anglia.

‘During Christmas and Boxing Day you’re actually mixing with fewer people than you do on a normal day – so if anything you’re reducing your chances of catching it during this period.’

Scientists point out that, right now, the huge presence of Delta is a bigger worry, with more than 50,000 new cases a day.

Ministers have sent mixed messages, with Work and Pensions Secretary Therese Coffey warning the public not to ‘snog’ under the mistletoe, and Mr Javid countering that ‘it’s got nothing to do with the Government who you kiss’.

He did however encourage people to take lateral flow tests before attending Christmas parties.

Prof Hunter said: ‘I think if you are older, and concerned about your health and Omicron, I would probably recommend giving crowded Christmas parties in busy bars a miss, because the number of people you will be mixing with is much larger.

‘I wouldn’t tell anyone to cancel their Christmas Day plans.’

Prof Woolhouse said: ‘There’s nothing in the data to suggest any need for a policy change before Christmas. Hospitalisations and deaths are still falling.

‘I agree that taking a lateral flow test before attending a Christmas party would be wise – we know these tests will flag up this new variant, as well as others.’

Could more jabs be needed, even after the booster?

Possibly. On Thursday it was announced that the UK had bought 114 million extra booster jabs from Pfizer and Moderna, which will be used over 2022 and 2023. Vaccine developers are already putting plans in place to adapt their current jabs to the new variant, should it be deemed dangerous, but this does not necessarily mean that new vaccines will be needed.

The technology used to create the Pfizer and Moderna jabs can be tweaked at speed to match the mutations of emerging variants. Last week Pfizer said it was investigating the Omicron variant to assess whether an ‘adjustment’ was needed. If it is, the American firm said it could develop new doses in six weeks and begin shipping in just over three months.

Moderna and Oxford-AstraZeneca have also said they are analysing how effective their vaccines are against Omicron. However, Ugur Sahin, chief executive and co-founder of Pfizer’s German partner BioNTech, said: ‘We think it’s likely that vaccinated people will already have substantial protection against severe disease caused by Omicron.’

Despite this, virus expert Professor Lawrence Young, at Warwick Medical School, said it would be prudent for the manufacturers to adapt future boosters to the Omicron variant whatever the result. ‘There are only so many mutations that can occur to the spike protein, and Omicron has the most we’ve seen yet by far. Any vaccine that can be adapted to match it will have a good chance at fighting off any future variants too.’

There seem to be more questions than answers. When will we know more?

Experts say it could be months before we have a clearer understanding of Omicron.

Scientists around the world are currently analysing the variant. Blood samples taken from people either previously infected with the virus or fully vaccinated against it will be exposed to Omicron, to see how the two interact. Primarily, they will be looking at how effective existing Covid antibodies are at neutralising the new variant. Even then, laboratory tests can only work out how much protection prior immunity provides. They do not tell us much about the severity of disease.

Professor Penny Ward, a pharmaceutical expert at King’s College London, said: ‘The only way we can know how many people will end up in hospital or dead as a result of the variant is through real-world data involving people.’

This means the more people who catch the virus the clearer the picture will become. Last week, Professor Wendy Barclay, a virologist at Imperial College London, said: ‘It will take several weeks if not a few months before we have clearer answers.’

Will this blasted pandemic never end?

Government scientific advisers warned Ministers that Covid would be a threat to the NHS ‘for at least a further five years’, according to documents released on Friday.

After that, the scientists – members of the Government’s virus modelling group Spi-M – said it was likely the virus would settle into a ‘predictable endemic state’ – where the virus continues to circulate in the population but does not threaten to overwhelm the health service.

The Government have already bought two more years’ worth of vaccine supply, for annual boosters in 2022 and 2023.

‘After Omicron there will be another variant, and another after that,’ said Prof Woolhouse.

Scientists make the comparison with Russian Flu, a pandemic that occurred in the 1890s killing around one million people. Modern studies suggest that Russian Flu was a form of coronavirus called OC43, similar in structure to the one that causes Covid. Professor Young said: ‘The Russian Flu pandemic went on for roughly four years and then petered out. I’d expect us to see a similar pattern.’

However, Prof Woolhouse did have some hope: ‘The majority of deaths from Russian Flu happened in the first two years. Based on that, and the strength of our vaccines, I’m confident the worst of this pandemic is behind us.’

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