Why would the SA doctor say the omicron is mild, if it isn’t?

[Pipecleaners]

Just that really…

Why would she tell the world’s media that it’s mild if she was exaggerating or whatever else?
She’s also said Boris Johnson’s response verges on ‘hysteria’ and calls for the UK to stay calm.

Dr Tedros Adhanom Ghebreyesus, WHO Director-General, who has more facts and data at his fingertips than your average GP, has said it was “wrong for people to consider Omicron as mild”.

There are all sorts of reasons why it can be different. And word of mouth is not as reliable as data. I think she's being irresponsible personally.

We are going off SAGE and modelling and we all know their propensity for exaggeration. Big mistake

I agree with @Triffid1. UK media has been at pains to point out the median age of the population of SA is 27 compared with 42 in the UK.

However, not one article I have read even references ethnicity issues. We know from previous research that being from some ethnic groups is a risk fact for poorer Covid outcomes so it's interesting this hasn't been considered/ mentioned in the SA context where only about 13% of the population are white.

@Iggly

She’s the only one saying it from SA - where are the SA public health officials on this?

It is summer in SA, their population is younger than ours so maybe the impact is different.

I don’t think the issue is the mildness as such though, it’s the sheer numbers. If a small % of a bigger number end up needing ICU then the nhs is still fucked.

This.

We've been here before. At the start of both the Alpha then Delta waves, UK doctors were telling us infection seemed milder. I remember the doctor on Sky or BBC news saying patients were younger, less unwell, in hospital a shorter period of time, just needed a bit of oxygen rather than ventillation etc. Same thing again. The SA doctor is not lying - she's just reporting what she sees at the current time in one particular hospital. The truth is it's too early to know what the true impact will be in the UK.

For example, the average age of their population is 27 and they have far less obesity

Obesity rates are actually around the same as the UK. Its not a particularly healthy population.

I’m sure we’ve had the opposite too.

That it was more virulent, can’t recall variant maybe gamma which didn’t take off and become prevalent

I do think the SA Dr is problematic though as we’ve now had messaging to try and reverse it

As we don’t know yet how it will be here - the 29% is interesting but it has to be assessed here

SA us a much younger demographic than the UK, so it quite feasible that it could be worse of have a much different effect here.

As others have mentioned, they also have a much lower vaccination rate (early studies show that 2 x the vaccine is still 70% effective against serious illness. And we’ve already boosted a high percentage of our most vulnerable groups).

You have to remember that Boris and his cronies reacted slowly in 2020, hate lockdowns etc and don't want to be caught out so they are using the (probably short lived) hysteria to drive vaccinations which do work in reducing the effect of the infection (though don't completely stop it). Other governments sort of followed our lead though how much is mostly down to who actually sequences lots of pcrs (we do the most)

It is an interesting question why anyone with a medical or scientific background would think it appropriate to announce to the world that omicron is mild when they had only seen 6 cases...

Your average GCSE science student would understand that you can't conclude anything from such a tiny sample size. She is now saying that she has only seen one severe case with COVID induced pneumonia in someone with HIV. How many people with severe COVID or pneumonia are going to make an appointment with a (private) GP instead of going to hospital?

I would assume she has an agenda. She certainly expressed her anger about travel bans to SA because she felt SA was being punished for having a good testing and sequencing programme. She may well be just be enjoying her 15 mins of fame. It could be confirmation bias, she told the world the first few cases that she saw were mild (the first case was one of her patients) so she is looking for evidence that she was right and ignoring evidence that she might not be.

What does the data say? So far, there seems to be slightly fewer hospitalisations and slightly less severe symptoms than in previous waves. That doesn't mean omicron has mutated to less virulent (severe), it is likely that what is being observed could be down to immunity from vaccination or prior infection. It is us who have changed, not the virus.

What does that mean for the UK? It means that it is very difficult to predict what will happen here from what is happening in SA because, although over 90% of the population in the UK have antibodies from infection or vaccination, immunity wanes over time, and there is less data on how many people have antibodies on SA (at least, I can't find anything up to date) to compare with.

It also shows that omicron is far more transmissible (infectious) than previous variants, the number of cases is doubling every couple of days. That is a problem because even if fewer people as a percentage fall seriously ill than with other variants, a small percentage of a large number is still more than the NHS can cope with eg even if the rate of hospitalisations is halved, if you have a large number of cases at the same time, that equals more people in hospital, 10% of 100 cases a day is 10 hospital admissions per day, 5% of 1000 cases a day, is 50 hospital admissions.

There are lots of differences between SA and the UK that will affect transmission and severity of symptoms:
It's summer in SA, reducing transmission
It is flu season in the UK
SA requires masks to be worn in public
Immunity - we are at a point where most people in the UK were vaccinated over 3 months ago so immunity is starting to wane. We need to get a move on with the boosters.
Age profile of the 2 countries
Genetic differences - we know that 15% of Europeans and 60% of South Asians in the UK have a gene that doubles the risk of dying from COVID that is rare in people of black African heritage

We can't really be sure about omicron in SA, it's early days and there is limited data, let alone predict what will happen in the UK. There are enough warning signs that it could cause serious problems and we should act now while we have the chance.

I don't have time for links but there are plenty of links to the data and a range of expert opinions not from a GP who likes the sound of her own voice on all the gazillion threads about omicron.

@AndreaC67 the GP OP is referring to is Dr Angelique Coetzee, who was on Sky today saying the UK's response is hysterical, so presumably the person you saw too. She isn't the equivalent of Chris Whitty, she is just a private GP. She is chair of the South African Medical Association but that is a trade union. I'm sure she is a very credible source when it comes to medical employment issues in SA.

Your average GCSE science student would understand that you can't conclude anything from such a tiny sample size.

Exactly. It's like the tale of the blind men and the elephant - she's grasped the tail and is saying, "Don't you know, an elephant is very skinny, like a rope."

@DoThePropeller

She’s one GP, sharing what she’s seeing. i don’t think it’s about if she’s telling the truth or not - it is not a robust evidence base for decision making and is why we have experts in immunology, viruses, epidemiology etc all working on this to take everything we know into account. Not just one person’s experience, she basically has anecdotes - that’s not to say she’s wrong and personally I hope she is right!

Yes, this.

And even if it happens to be less virulent than previous variants, it's about the number of infections it can cause in a certain time period (i.e. how transmissible it is) that is potentially problematic.

A tiny % of a very very large number still has the potential to have really serious consequences for the UK - if we have many people ill/isolating/requring medical treatment at the same time, it will have a real negative impact on society.

Interesting piece from a Sage advisor on why Omicron is more transmissible and why it ‘might’ not be so severe

threadreaderapp.com/thread/1471088936999137281.html

South Africa has a relatively young population, with an average life expectancy in the 60s.

We are older, proportionally fatter, with more chronic conditions and an average life expectancy of 81.

We have greater risk factors for serious illness and death by Covid.

I am still hoping omicron snuffs out the pandemic to be honest. Perhaps this new variant is a storm in a teacup. That would be great news....

I do think the SA Dr is problematic though as we’ve now had messaging to try and reverse it

I think she's being irresponsible personally.

I agree, @MarshaBradyo and @luckylavender.

She is still going on about her personal anecdotal evidence based on a handful of patients at her GP surgery and ignoring the data. At the weekend, she was saying that she understood the UK's caution but we should listen to SA that omicron is mild. She didn't volunteer the information that since September, SA has had more restrictions than the UK, a night time curfew, restrictions on large capacity venues, masks are required in public and at work, social distancing regulations etc.

She is being incredibly irresponsible. She is using her position as a GP to give her credibility and the fact that she was the first person to identify a case of omicron to give her a platform to spout her personal viewpoint that is based on pretty much nothing. In other words, she is using her scientific training to give her credibility but she isn't using her scientific training to assess the data in a reasoned manner.

Interesting piece from a Sage advisor on why Omicron is more transmissible and why it ‘might’ not be so severe

Really interesting. It looks like it gathers in the nose rather than the lungs. Makes me wonder if we could zap a lot of cases with a nasal spray in the early cases. It also suggests that the virus will cause a lot fewer acute and chronic symptoms, although I do also wonder if issues with loss of smell might actually be worse.

Given the number of mutations in the spike protein I am inclined to think it is not unlikely this variant can cause much milder disease . Was looking if any data available on binding the mutated RDB domain to ACE2 but there aren’t seems to be any. Maybe yet

It looks like it gathers in the nose rather than the lungs.

Where did you find that, @Kokeshi123? The paper linked to was looking at the bronchus (the major airways in the lower respiratory tract that conduct air from the trachea into the lungs) compared to lung tissue.

The loss of taste and smell in COVID is neurological.

There are several nasal spray vaccines for COVID being trialled at the moment. The hypothesis is that they might achieve greater protection than the current vaccines, particularly against transmission, by creating an immmune reaction that is targeted at the nose, blocking infections at the point where the virus enters. It also has the advantage that it is a less unpleasant way to be vaccinated, which may encourage people to take the vaccine.

@Kokeshi123

Interesting piece from a Sage advisor on why Omicron is more transmissible and why it ‘might’ not be so severe

Really interesting. It looks like it gathers in the nose rather than the lungs. Makes me wonder if we could zap a lot of cases with a nasal spray in the early cases. It also suggests that the virus will cause a lot fewer acute and chronic symptoms, although I do also wonder if issues with loss of smell might actually be worse.

But covid isn’t really a respiratory disease though. So possibly you’d expect fewer lower respiratory tract symptoms if there are lower levels in the lungs, but would it necessarily follow that there’d be fewer issues with the heart, brain, kidneys and associated systems?

Interesting about the infection staying higher in the nose and not travelling to the lungs.

Completely anecdotal (as it’s just me 🤣) but I went to a suspected Omicron super spreader party on Friday. By Monday over 60% of the party (all double or triple vaccinated) had positive PCRs. Main symptom: sore throat. I’ve been using a nasal spray every day since Monday and symptoms have eased, I feel much better. Now I’m sure my double vaccination is the main thing that’s helping me. But nasal spray can’t hurt? The minute I get a scratchy throat I spray and it eases off. Just a purely anecdotal tip.

I’m looking forward to seeing more data that this variant is less likely to go to the lungs. If true that would be such a positive development.

Disclaimer (I have no idea if I have omicron but timeline and hit rate and symptoms suggest it!

Because she is not fully qualified in the field is she? It’s her thoughts from the small sample she has seen

SA is far larger than the UK, with a slightly smaller population made up of different demographics to us, so actually how would she know what the impact would be on us? Or indeed any other country who has done exactly the same as us