The emergence of the omicron variant of the SARS CoV-2 coronavirus opens a new chapter in the ongoing COVID-19 pandemic. Early evidence indicates it is more transmissible than some previous variants of concern. South Africa, however, is experiencing a decline in the number of cases as rapid as the increase that was observed as the number of cases after its detection in November 2021. Additionally, South Africa has not had a high percentage of severe cases, as measured by the number of COVID-19 patients who were hospitalized.[i] Many hope that other countries will experience a similar trend as the omicron variant overtakes previously predominant variants. There are some specific circumstances that distinguish South Africa from the United States and the spread omicron variant could have a very different outcome in the latter country.
Preliminary epidemiological analysis of the spread of the omicron variant in southern Africa, where it was first detected and sequenced, suggests that while omicron is more transmissible it has not caused similar percentages of severe disease observed from some previous variants among South Africans. If this is confirmed, it does necessarily mean that there will be a similar pattern in the United States. There are several characteristics of the South African population that are quite different from other countries such as the United States. First, the population of South Africa is younger than the U.S. population. Based on the pathology observed from the delta and other variants, younger people tend to have less severe disease as a group. Second, because South Africa did not have widespread access to vaccines during the early stages of the pandemic, it is likely that a far larger percentage of the population became infected with SARS CoV-2 and developed some level of natural immunity. It remains unknown if recovery from previous COVID-19 infection is effective in reducing severe disease or death from the omicron variant but such a hypothesis is plausible. Data supporting this hypothesis was reported in an analysis that compared severity of disease for the alpha and beta variants in Qatar during 2020-21.[ii]Thirdly, according to a bulletin published by the U.S. Embassy in South Africa, mask wearing in public places remains mandatory in public places and there are penalties for non-compliance.[iii]The U.S. Centers for Disease Control and Prevention continues to recommend[iv]the use of masks to control the spread of COVID-19 and numerous scientific studies have confirmed mask wearing reduces COVID disease transmission for those who use them.[v] Compliance with mask and social distancing recommendations continues to be much lower in the United States and it is an ongoing impediment to effective infection control.
At the end of the day, infection control (measures such as social distancing and masking in crowded settings) and vaccination provide an effective approach to limiting the number of cases that may arise during the current disease surge in the United States. Early data show that the initial vaccination (two injections of the Pfizer/BioNTech or Moderna or one injection of the Johnson and Johnson) plus a booster provides effective protection against severe disease and death. Vaccination and avoiding exposure to SARS CoV-2 is the best means of preventing disease.
[i] F. Abdullah , J. Myers , D. Basu , G. Tintinger , V. Ueckermann ,
M. Mathebula , R. Ramlall , S. Spoor , T. de Villiers , Z. Van der Walt , J. Cloete ,
P. Soma-Pillay , P. Rheeder , F. Paruk , A. Engelbrecht , V. Lalloo , M. Myburg , J. Kistan ,
W. von Hougenhouck-Tulleken , M.T. Boswell , G. Gray , R. Welch , L. Blumberg , W. Jassat ,
Decreased severity of disease during the first global omicron variant covid-19 outbreak in a
large hospital in tshwane, south africa, International Journal of Infectious Diseases (2021), doi:
https://doi.org/10.1016/j.ijid.2021.12.357
[ii] N Engl J Med 2021; 385:2487-2489 DOI: 10.1056/NEJMc2108120.
[iii]See U.S. Embassy and Consulates in South Africa, COVID-19 Information December 21,2021, available at https://za.usembassy.gov/covid-19-information-2/, on January 2, 2022.
[iv] U.S. Centers for Disease Control and Prevention, Science Brief: Community Use of Masks to Control the Spread of SARS-CoV-2 Updated Dec. 6, 2021, available at https://www.cdc.gov/coronavirus/2019-ncov/science/science-briefs/masking-science-sars-cov2.html#:~:text=A%20study%20of%20an%20outbreak,70%25%20reduced%20risk on January 2, 2022
[v]U.S. Centers for Disease Control and Prevention, Science Brief: Community Use of Masks to Control the Spread of SARS-CoV-2 Updated Dec. 6, 2021, available at https://www.cdc.gov/coronavirus/2019-ncov/science/science-briefs/masking-science-sars-cov2.html#:~:text=A%20study%20of%20an%20outbreak,70%25%20reduced%20riskon January 2, 2022
Early evidence indicates the omicron variant of the SARS C0V-2 virus is more transmissible than some previous variants of concern. South Africa, however, is experiencing a decline in the number of cases as rapid as the increase that was observed as the number of cases after its detection in November 2021. Additionally, South Africa has not had a high percentage of severe cases, as measured by the number of COVID-19 patients who were hospitalized. Many hope that other countries will experience a similar trend as the omicron variant overtakes previously predominant variants. There are some specific circumstances that distinguish South Africa from the United States and the spread omicron variant could have a very different outcome in the latter country.
[1] F. Abdullah , J. Myers , D. Basu , G. Tintinger , V. Ueckermann ,
M. Mathebula , R. Ramlall , S. Spoor , T. de Villiers , Z. Van der Walt , J. Cloete ,
P. Soma-Pillay , P. Rheeder , F. Paruk , A. Engelbrecht , V. Lalloo , M. Myburg , J. Kistan ,
W. von Hougenhouck-Tulleken , M.T. Boswell , G. Gray , R. Welch , L. Blumberg , W. Jassat ,
Decreased severity of disease during the first global omicron variant covid-19 outbreak in a
large hospital in Tshwane, South Africa, International Journal of Infectious Diseases (2021), doi:
https://doi.org/10.1016/j.ijid.2021.12.357
[1] N Engl J Med 2021; 385:2487-2489 DOI: 10.1056/NEJMc2108120.
[1] See U.S. Embassy and Consulates in South Africa, COVID-19 Information December 21,2021, available at https://za.usembassy.gov/covid-19-information-2/, on January 2, 2022.
[1] U.S. Centers for Disease Control and Prevention, Science Brief: Community Use of Masks to Control the Spread of SARS-CoV-2 Updated Dec. 6, 2021, available at https://www.cdc.gov/coronavirus/2019-ncov/science/science-briefs/masking-science-sars-cov2.html#:~:text=A%20study%20of%20an%20outbreak,70%25%20reduced%20risk on January 2, 2022
[1] U.S. Centers for Disease Control and Prevention, Science Brief: Community Use of Masks to Control the Spread of SARS-CoV-2 Updated Dec. 6, 2021, available at https://www.cdc.gov/coronavirus/2019-ncov/science/science-briefs/masking-science-sars-cov2.html#:~:text=A%20study%20of%20an%20outbreak,70%25%20reduced%20risk on January 2, 2022