Commentary: An Omicron spike in Singapore will be fast and furious
But paying attention to the unvaccinated, elderly and those with pre-existing conditions can help us avoid straining the healthcare system, says SingHealth Duke-NUS Global Health Institute’s Dr Paul Pronyk.
SINGAPORE: An Omicron spike in Singapore is inevitable.
But with one of the most highly vaccinated and boosted populations in the world, Singapore is unlikely to witness large numbers of serious infections and deaths. If data from elsewhere holds, this surge is likely to peak in about a month before returning to normal.
While we are prepared, managing this surge won’t be easy. After more than two years, the world is experiencing pandemic fatigue. With each new wave and variant, governments and citizens are increasingly eager for a return to some form of normalcy.
And we are only at the start of this spike. Omicron has just recently arrived in Singapore. Infections have doubled over the past week, and it is gradually displacing Delta as the main virus transmitting in the community.
We should not underestimate the scale of this challenge. The number of global infections has increased four-fold in the past several weeks – from a previous peak of 1 million infections daily during previous surges, to a whopping 4 million with Omicron.
This new variant has been marching steadily across the globe. Omicron was first identified in South Africa in November 2021, with a spike in new cases in December 2021. The UK, Europe and North America were affected in late December 2021, and Latin America in early January. Only recently has the variant been introduced in Asia, with infections in India and Bangladesh increasing over the past two weeks.
Most countries experiencing an Omicron surge have not intensified restrictions. Singapore’s current approach on maintaining moderate restrictions until the end of Chinese New Year is prudent. In the context of Omicron, daily infections alone are no longer an effective signpost.
It is only in the event of a growing strain on health services such as a surge in COVID-related hospitalisations and ICU admissions, that this guidance may need to be revisited. As a minimum, maintaining the present “middle-ground” until we are confident of Omicron’s retreat is a sensible approach.
FEWER SERIOUS INFECTIONS
We should not lose heart. While Omicron is the most highly transmissible form of the virus to date, it also seems to cause fewer serious infections. Most infections have no symptoms at all.
The virus has mutated in ways that make it less likely to move into the lungs. This makes pneumonia, which is the most common cause of hospitalisation and death, less likely.
Countries experiencing an Omicron surge have not witnessed large numbers of additional deaths. In those countries, new infections have consistently peaked after about four weeks.
In South Africa, new infectious have already dropped to its pre-Omicron baseline. In the UK, numbers of new cases have dropped by 50 per cent in the past week. Infections in North America have also started to decline.
The other good news is that exposure to Omicron leads to a broader immune response. Most vaccines expose people to a small part of the virus – usually the spike protein. Natural infection with Omicron exposes us to the entire virus particle.
Some studies suggest that “hybrid immunity” resulting from a combination of vaccination and natural infection may offer higher levels of protection, helping the body to “remember” the virus in the future. For example, there is evidence that Omicron infection protects against the Delta variant.
Furthermore, a combination of exposures makes the immune system stronger, which protects against serious infection and deaths in the long term.
Greater immunity in the population may also reduce the risk of future variants. When the length of time this immunity lasts becomes clearer, recommendations on booster doses can be improved.
RISKS TO THE UNVACCINATED, ELDERLY AND THOSE WITH PRE-EXISTING CONDITIONS
But there’s no escaping the serious risks of an Omicron wave to the unvaccinated. Patients who require oxygen or intensive care with Omicron are almost universally unvaccinated.
The elderly and individuals with pre-existing conditions such as problems with the heart, lungs or immune system are particularly vulnerable. These groups need to be prioritised for boosters.
Omicron has also led to major disruptions in service delivery in many countries across the world. Doctors, nurses, laboratory technicians and ambulance drivers are getting infected given its high transmissibility and are unable to perform their duties.
The combination of potentially higher numbers of hospitalisations in a short time alongside staff shortages have affected health services delivery, with fewer nurses and doctors to deal with the surge and other urgent medical conditions.
While these strains may be short-lived, they need to be prepared for. Hospitals may again be required to increase bed and staffing capacity and reduce elective procedures.
During this period, it will be important to protect our health providers so they can better respond to those who need it most.
One way to do this is to exercise personal responsibility. The Singapore Government has made rapid tests widely available. Persons testing positive should adopt a “test-and-stay home” strategy.
Vaccinated persons who are low-risk and test positive with mild or no symptoms can safely self-isolate at home.
Only those who are un-or-partially vaccinated, have underlying medical conditions or who are experiencing serious symptoms should seek medical assistance. The Government’s guidelines on home recovery are a helpful reference for those with questions.
PRESERVING PUBLIC TRUST IS KEY
Despite the fatigue we are all experiencing, public trust will be critical in the coming weeks. The current set of restrictions and any new ones are likely to be short-lived.
Vaccination remains essential, and immunisation among children will be key to avoid outbreaks among the young and limit transmission in homes and schools.
As a virus that lives in animals, COVID-19 is not a disease that can be eradicated. Accepting that it is here to stay, much like dengue and common influenza, requires a change of mindsets. While it’s too early to say the end is in sight, societies are learning to live with the virus.
COVID-19 has been an important teacher about vulnerabilities that exist within and between countries. While Singapore has been boosting, many citizens in our neighbouring countries have not received their first vaccine dose.
No country is an island and the safety of Singapore against future outbreaks hinges upon partnerships with scientists and clinicians across the region.
Dr Paul Pronyk is deputy director at the SingHealth Duke-NUS Global Health Institute.