Dr Angelique Coetzee, Chairperson, South African Medical Association, the doctor who first identified Omicron, says symptoms of this variant, though mild, are easy to miss and even those vaccinated three or four months earlier can be reinfected.
Treatment is a mild dose of cortisol with Ibuprofen, to recover faster. She requests pharma companies to come up with tablets to end the pandemic, as it is difficult to reach injectables to poorer countries. Excerpts:
How did you know this was not the same strain of Covid-19 that was already in circulation in South Africa?
It is all about the clinical picture. There is a difference between the clinical picture of Delta, beta and Omicron. I have seen over 600 delta patients and treated them. With the clinical experience I could tell that the first patient I saw on that day had different symptoms which were close to Beta. The very same day I saw seven new patients presenting similar symptoms, different from Delta. And it had been few weeks since we had not seen delta cases and also we were just out of our third wave. So this was worrying. I reported this to the advisory committee of the minister and that is how we found it.
How are symptoms of Omicron different from Delta?
Delta symptoms are fever, low saturation, sore throat, cough, loss of taste or smell, while Omicron presents with body ache, especially muscle pain, severe headache and extreme fatigue. Intensity of symptoms is less intense for vaccinated people. But children below the age of 13 present with sore throat and fever, and loss of appetite. Interestingly, with Delta, we also saw diarrhoea on the third or fourth day, but with Omicron, there is no diarrhoea.
It's quite easy to miss isn’t it?
If you don't know what to look out for then you will definitely miss it.
Since the day you identified this variant till now, are the cases mild or has it advanced?
The number of admissions is slowly rising in hospitals again, it’s nothing compared with Delta. Unfortunately, hospital data doesn’t distinguish between Delta and Omicron. It (Omicron) is spreading fast. There is a high reinfection rate and breakthrough infections too. But the illness, compared to Delta, is mild. Within the next two weeks, we will know whether this is a predominantly mild disease or not. We are also trying to understand if T cell antibodies is developing or not in unvaccinated older people.
Is there any data on time gap for reinfection by Omicron, among those vaccinated?
If we look at the data what we noticed is that majority of them were vaccinated in July and end of August. We had one patient beginning of October and one or two in September. Majority of them were vaccinated with Pfizer and Johnson and Johnson’s in July. We know that vaccines are not going to 100 percent protection and Omicron can infect even if they are vaccinated less than three to four months ago. so don’t be complacent and think that you are vaccinated three months back so it’s not COVID 19. Go test if you have symptoms.
What has been the treatment strategy?
At this stage, I know a lot of specialists will say you should not start with cortisol treatment early in the disease, but with Omicron, if you start with a mild dose of cortisol then the only other medicine we have prescribed is Ibuprofen. It works extremely well. Patients recover in three to four days.
Data from South Africa shows hospitalisation has gone up in children. Is Omicron leading to hospital admissions in children or them being unvaccinated?
The answer to this question may not be very easy. We know that in any wave, children are very vulnerable. They are out in schools, creches, difficult to keep their masks on etc. Yes, Children are not vaccinated. Yes, Omicron is a fast-spreading viral infection. But admissions in hospitals in South Africa were not because of Omicron. Admissions increased for flu and other respiratory infections, but tested positive in hospital. Unfortunately, they are reported as Covid cases. But they are not primarily sick because of that. So there was this and a real hype around children has been done. We don’t see any major illness in them. If it was serious we would have seen loads of children get very sick and come to PHCs first and majority going to casualty. That’s not happening.
Is there no Cytokine storm in adults with Omicron?
That's what we are waiting to see. We hope we will have more clarity within the next few days. This data will come from the ICUs and it is important that this hospital ICU cases to distinguish between delta and Omicron to get this data. Otherwise we will not know if the drugs given in the ICU are working against Omicron patients or not.
Bengaluru doctor infected with Omicron said he got better with Monoclonal antibody treatment? So is this working?
I think this treatment must have worked. We are also studying on this. It is again important treatment do those in the ICU.
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Travel ban and your take on this?
It is not going to help. Do not close borders. Instead, tell your people to stay away from crowds, wear masks, get vaccinated. Unfortunately, the mildness of symptoms is such that if you are not alert then you are not going to see it. It may already be there everywhere.
Also, Rapid tests won’t detect Omicron if they are sick from few hours. A minimum of 24-48 hours of symptoms of sickness is needed for the PCR or Rapid to detect Omicron. I have noticed that there were many false negatives amongst those who woke up with body aches and headache and came to doctor for testing. In such cases it is advised to get a PCR done again after 48 hours.
How important it is for Vaccines to reach Africa?
No one can sleep safely at night and soundly and happiness if Africa is not vaccinated. So you have to get Africa vaccinated. But I also realise that currently the injectables are very difficult to administer in Africa. If I can give advice to any pharmaceutical company then please develop a tablet that's easy to travel, that's easy to administer, a tablet that is affordable. The more injectables you come up with, the more logistics of storage issues, the less chances you will get successful results with vaccinating Africa. Nasal spray based vaccines if yields good results and is less expensive then it can be a good thing for Africa.
There are arguments that Omicron is milder than delta so this is a blessing in disguises and means the end of pandemic. Is that true?
No. I don't think the pandemic is over yet. We are still going to grapple with these viral infections for a year or two. Yes it is true that variants will mutate but the host bodies they would choose to mutate will be people who are unvaccinated, people with immune-compromised disease who are not on any treatment and there are lots of such people in Africa. They become ideal host for virus to mutate as their defence mechanism or immune system cannot detect the virus because their CD4 counts are very low. However, it is not in the virus’s best interest to kill people because then it will die too. So the virus will most probably going forward either be fast spreading or maybe there will be virulence with severe cases. My gut feeling is it will be around mild cases. But the problem is you never know whose condition will get severe or die from this virus. That is why vaccines need to come and come as early as possible.
If you have to give us five solutions to end this pandemic?
Vaccinate, Vaccinate. Boosters, boosters. Follow Covid-appropriate behaviour. Governments must Communicate clinical symptoms of new variants to people. It doesn’t help them to know there is Omicron and they don’t know what to look out for.