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COVID19 update - Omicron: Getting sick with and of it

COVID19 update - Omicron: Getting sick with and of it

Hi there!

It has been a few months since my last newsletter, and I know people have been asking for another one. The newsletter is meant to be both entertaining and educational. I usually use this platform to try to explain what is generally happening with regards to the pandemic, topical health issues and the clinic in general. I hope you enjoy it as much as I enjoy writing it.

COVID19 variant - Omicron. What is it and how does it affect us?

  1. Omicron is the latest variant of concern. That means that it gets it’s own Greek alphabet. Only significant mutations of the COVID19 virus get this honour. The extra mutations have caused the virus to spread about 2x faster than Delta, but fortunately only 1/3 as troublesome in terms of deaths and hospital admissions. This is because Omicron (and it’s smaller variants) replicate 70x faster in the upper respiratory tract (throat, nasopharynx etc). This means symptoms are more likely to be sore throat and sniffles rather than pneumonia and trouble breathing. The problem is that much more people get sick in a shorter period of time. So - although people get less sick, a lot more people get sick at one time. Imagine all the flu cases in a year compressed into 1 or 2 months.

Does this mean I am more likely to get sick? What if I am vaccinated?

Yes - you are more likely to get sick. COVID19 positive cases increased from about 400 to 800 over the weekend. It is quite likely that the true number of cases is double that as some infected people are not testing because they are either asymptomatic or that they have very mild symptoms.

However - some good news. If you are vaccinated, COVID19 is about 1/2 as dangerous as flu in terms of deaths and hospitalizations. If you are vaccinated - you are still about 20x less likely to go to hospital if you had 2 shots, and 40x less likely if you had a booster. Even if you had a booster - your protection against catching any Omicron after 10 weeks drops from 65% to 45%. Don’t forget, that figure includes mild illness.

So what does this mean for you?

Let’s conservatively say that 1/2 the people in New Zealand will get exposed to COVID19 given some social distancing and sick people staying at home. If you are vaccinated, your chance of catching Omicron is maybe about 40% with exposure - give or take. I’d say crudely that vaccinated people will still have a 20% chance of getting Omicron. If you look at Australia, total recorded cases are 2.9 million. It’s likely double that number is true as a lot of people aren’t tested. Say 6 million out of 25 million Australians have had COVID19. That’s about 20%+ of the population. It is quite likely that NZ will have similar numbers. We do have the advantage of having more vaccinated people at the time of exposure, more boosters, greater adherence to social distancing and a population that is more spread out. But in a lot of ways - both countries aren’t that different.

What happens if I get sick?

Currently - if you have cold symptoms such as cough, sore throat, fever, runny nose or any shortness of breath, you still need to go and get a PCR swab from a testing station. This is phase 1 of the government plan.

Because case numbers are going up rapidly, we will soon enter Phase 2 and then Phase 3. At that time - most of us will be doing rapid antigen tests for a diagnosis. Then if we are positive, probably doing day 5 tests to make sure we are clear before going back to work or school.

Rapid antigen tests are still not as useful at this stage because case numbers aren’t particularly high. When they are low case numbers, rapid antigen tests are less reliably statistically because they have a higher false positive and false negative rate. When case numbers are high - they are more accurate. That is why we are currently still doing PCR nasopharyngeal swab tests. During phase 1 - essential workers and healthcare workers like myself have access to rapid antigen tests to check ourselves if we get sick to determine when we can get back to work. This facility will likely be available to the general public at phase 2 and 3. That’s how countries like Singapore and UK are managing their cases.

Realistically - most of us who catch Omicron are either not going to feel anything, or have a very mild cold like symptoms. Of course a small number will be very sick and need to go to hospital. I think - we can say with some confidence that if you’ve been vaccinated, the new milder but more contagious Omicron is much more like a cold or flu.

I believe it’s important for people to just get back to normal-ish life as much as possible. But just like any other respiratory illness like a cold or flu, if you’re sick - don’t be an arsehole and give it to other people. Just stay home till you are well - test negative and then go back to work or school.

Vaccinations to protect vulnerable people - is this still relevant?

Hard to say. Vaccines are definitely effective at reducing the severity of COVID19. However - because the variant can bypass the vaccine easily, it’s probably more accurate to say that the vaccine stops you from getting very sick, but only slightly protects you from passing it on to other people. If you get sick and stay home, that is probably better at protecting other people You should get vaccinated for yourself, not really for other people.

If I have caught COVID19 before, do I still need the vaccine?

Well - the CDC has released their study on reinfection rates. People who have had previous COVID19 infections are slightly better protected against another infection compared to people who have had 2 vaccine shots. Arguably - they actually have decent protection. However they had to get sick first. That’s no fun. I would rather not get sick at all if I can help it. And if I do get sick, I rather have a mild illness from having a vaccine.

You still need to get vaccinated for vaccine passes and flights out of New Zealand as most countries require proof of vaccination for you to enter them. I would still recommend that you get vaccinated if you’ve had a previous COVID19 infection because it allows you to travel more easily. That is likely to remain a requirement.

Are boosters really that helpful?

Yes - in general boosters will reduce your chance of going to hospital by 50%. So something is better than nothing. Also, at least for the first 10 weeks, they help prevent infection by 20% (65% vs 45%)

If I get sick, or if I am a close contact - why is the isolation time so f**king long?

Well - this is a common question. The reason is that if you catch Omicron - it will take you about 1-8 days to clear the virus. The median is 5 days. So - at phase 1 - the government wants to be super duper careful and they want to prevent almost all spread from confirmed cases. When there is a lot more infection in the community, the government wants the economy to survive and people to get back to work - so they are less careful. That’s where rapid antigen tests are useful - for example if you are symptom free after 5 days and test -ve, then go back to work. But here is something to consider - because of small but significant false negatives - you could test -ve on a RAT (rapid antigen test), go back to work or school and infect other people. This matters less when just about everyone is sick. In summary - think about it this way. When they aren’t a lot of cases and we want to slow things down, the government wants to be 99% sure that people have recovered. When too many people are sick and the economy is falling apart - 90% sure is good enough. It’s essentially pragmatism.

I would argue that if they said 5 days and back to work with a negative test, more people would be inclined to get tested. But anyway - I’m not the government and it seems to be a sucky job because no one is every happy with what you do. Honestly - some days being a doctor feels like that, but I think the government feels that every day.

Does Omicron and future similar variants mean an end to the pandemic?

Probably yes. That is how all other respiratory pandemics seem to have ended. The Spanish flu of 1918 (that started in USA, not Spain) ended 3 years after the flu mutated into a less harmful variant. COVID19 is likely to just become another annoying winter respiratory illness likely the cold and flu. We should feel positive about the pandemic ending hopefully towards the end of the year. Modellers have suggested that there will be an Omicron wave lasting 2-3 months and then another smaller wave in winter. This is realistic as our borders are opening to other countries so we will be importing more variants of COVID19. However - future variants are much more likely to maintain the relative mildness of Omicron based on historical patterns of other respiratory illness. Of course there is always a chance that a super dangerous variant will evolve. But anything in life is possible, we are talking about probability here.

Are we going to get boosters the rest of our lives?

Probably. Might not be every year though. It’ll be a bit like the flu jab where variants of concern are added periodically. Flu gets revised every year because the mutation rate is higher.

What do we have to worry about in the future then aside from Omicron?

Probably an economic recession that will be triggered by governments worldwide on purpose in response to rising inflation. However - I suspect governments will aim for a soft landing rather than the harshness of the late 80s. So get ready to “feel” poor. What I mean by that is that people have a habit of acting how they feel regardless of their actual circumstance. For example - the person that buys a boat because their property appreciates in value - they haven’t sold their house or gotten any richer, but they feel it. I recommend that people focus on getting fit this year - as it’ll take your mind off all those things you can’t control in life. At the very least - you can control how well you stay in shape. I’m practicing what I’m preaching - I’ve purchased a multi gym which I am sure will make an excellent cloth rack in the near future.

Clinic stuff

COVID19 swabs - if you are only mildly unwell and just want a confirmation swab, please go to a testing site. We are trying to keep our clinic and staff COVID19 free as much as we can. However if you are moderately unwell, please call and the nurse will triage you to be seen.

Tent outside for examinations - once COVID19 numbers shoot up - we might set up a tent outside to see people with respiratory symptoms as it’s more convenient. This will be in one of the existing car parks. Not putting it up yet, but I suspect we might have to soon.

COVID19 swab for travelling - Time stamps. Recently a patient brought up this issue with us. Apparently some countries are fussy about a time stamp being on the results, not just the date. Unfortunately - when lab test sends us the result, it often just has the date. We can’t actually do anything about this. However - you will have to ring Labtests directly and ask them to put the time stamp on, and you might have to go to their headquarters to pick up a printed result. Please be aware that this is something beyond our control and we cannot alter official documentation to put a time stamp as this is very likely to result in the invalidation of the result. This was a very stressful situation for this patient - and for some bizarre reason labtests refused to email the time stamp result to them directly. They insisted on emailing it to us, to then email it to the patient. I have no idea the justification or logic behind this.

Long hair

Yes - I’ve decided to just let it grow. No - I’m not trying to look like Simon Bridges. I’m trying to look like Keanu Reeves. I know it’s failing spectacularly - but I’m trying to look a bit different to remember the pandemic times. I imagine myself in 10 years - kicking back and having a beer with a mate discussing the great pandemic of 2020. Lo and behold - a picture will come out with me in my flowing locks - and I’ll instantly remember the time. Ah - the sweet, sweet memories. Also those wonderful times with hair and no greys.

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