Is Omicron the beginning of the end?

Queue for Covid testing at Ispro Center, Modi'in  credit:  Nevo Trabelsy

The latest Covid variant could be what the world has been waiting for, but epidemiologists who spoke to "Globes" aren't so sanguine.

Following the latest restrictions on the economy because of the fear of the spread of the Omicron coronavirus variant, Ministry of Finance chief economist Shira Greenberg wrote to the director general of the Ministry of Health, Nachman Ash, with an estimate of the economic damage. According to Greenberg, the cost is NIS 320 million weekly. Greenberg's letter states that for every 100,000 people in isolation, the economy loses NIS 175 million a week. How long can the Israeli economy pay that price?

From the information we have, it appears that Omicron is in a sense what the world has been crying out for: a variant that is highly contagious but not highly lethal, particularly in combination with vaccinations. The medical community hoped that a variant would occur that would serve as a sort of weakened live immunization.

Meanwhile, the endless queues at the entrances to test sites around Israel and changing government policy, together with leaks from government meetings, have left the public confused. It's not just the public that is confused; even government ministers have admitted that they no longer follow the guidelines.

In the discussions on the pandemic at the professional level, officials insist that there is method in the decisions: from closing the skies, and isolation for anyone who has come into contact with a verified case, to the decision to allow foreigners to enter the country and shorten the list of "red" countries to which Israelis are not allowed to travel. The next stage, they say at the Ministry of Health, will be relaxations of the requirements for testing. Some Ministry of Health officials now acknowledge that restrictions will not be effective: "These are decisions that were relevant a week ago but that by now are otiose."

At the weekend, there was talk of restricting gatherings, but that proposal too was rejected. "There's a great deal that could be done, but it costs money and requires backing, and we don’t have that," Ministry of Health sources said. But the complaints against Minister of Finance Avigdor Liberman, who refuses to budget for compensation, remain at the forefront of relations between the Ministry of Finance and the Ministry of Health. Complaints are also directed against the Ministry of Health, for not having used the past few weeks to encourage vaccination of children and implement the fourth vaccination dose for those aged 60 and over, which has started only this week.

A short, cruel wave

The assessment is that the current wave of Covid-19 will be cruel, but short: three weeks of 50,000 verified cases daily, according to Prime Minister Naftali Bennett's forecast, and then a decline. The prime minister indicated that the government was ready to contain the wave and to accelerate vaccinations, and was recommending those at risk to stay at home.

A great deal has been said and written about herd immunity. It turns out that it comes and goes. Israel approached herd immunity after the first vaccine dose, and the pandemic faded, until the Delta variant came along and the decline in the effectiveness of the vaccinations impaired immunity. It looked as though Israel was again nearing herd immunity after the third vaccine dose, but the effectiveness of that declined as well, and along came Omicron.

Is the Omicron variant really less lethal?

It's hard to remember, but the Omicron variant has been with us for just over a month, and in most countries less than that. During this period, even in countries that had to cope with a large wave of cases fairly early on, no steep rise in severe morbidity has been observed, unlike in previous waves. Nevertheless, the numbers can be misleading. Waves of the coronavirus tend to start in the healthy population, and it takes time until a new variant reaches weaker individuals. Furthermore, some of these countries have been through severe waves in the past, and their populations may have greater immunity.

Happily, laboratory research supports the assessment that Omicron is not as deadly as previous variants.

Tests on animals have shown that the variant mainly reproduces in the upper airways, and so causes less scarring of the lungs. This could explain why this version of the virus is more contagious but less lethal. Furthermore, lab research has shown that antibodies in those who have been vaccinated, especially after three doses, significantly curb the virus's rate of reproduction.

When will we start to see a decline in morbidity?

Prof. Eran Segal, a computational biologist professor at the Weizmann Institute of Science, who has presented fairly accurate forecasts in the past of the spread of Covid-19, said via his Twitter account that he expected tens of thousands of patients a day within a few weeks. Segal added that if we wanted to suppress the pandemic now, we would have to prevent 60% or more of interpersonal contacts. At present, the Israeli public is not prepared for that, and so the pandemic will spread.

A report by the The Gertner Institute for Health Policy and Epidemiology and the Technion - Israel Institute of Technology states that because of the level of infectiousness of the virus, and the failure to introduce preventative measures, in the end, 99% of the population will be infected. Prof. Hagai Levine, who is chairman of the Israeli Association of Public Health Physicians, Prof. Nadav Davidovitch, who heads the Ben-Gurion University of the Negev's School of Public Health, and other epidemiologists to whom we spoke, say that such a situation is impossible, and that even without substantial preventative measures, the pandemic will start to fade after 80% of the population have become infected, and perhaps even less than that. Davidovitch and Levine both say that distancing and masks are still worthwhile.

Levine says that reliable home testing kits are important. "Promoting public health means giving people tools to look after their health. There can't be psychological resilience when the public feels powerless, not knowing where an isolation order might come from, and people lose faith," he says. Davidovitch adds: "When people say that the coronavirus is like the flu, I get annoyed, not just because the disease is more severe, but also because we don’t deal with the flu well either. There are so many ways in which we could save people who today die for no reason in the annual flu epidemic."

What will life be like in two months' time?

"In the positive scenario, the variant will put an end to the pandemic stage, and as with the flu we'll have years that are more severe and years that are less severe, but the coronavirus won't rule our lives as it does today," says Prof. Levine. "We need to prepare for this possibility, and have the courage gradually to release the brakes.

"The most likely scenario is that we'll see a quick, strong wave of infection, and quite a few severely ill people and fatalities, and it will be almost impossible to stop it," Prof. Levine adds. "The bad scenario is that we'll find that 'long Covid' is common among Omicron patients. Another possible scenario is that a variant will come along that is even more infectious and causes more severe morbidity."

"You can't make policy on the basis of the positive scenario," Prof. Davidovitch says. ""To get it over with in a month or two' is not a work plan. The possibility of error is too great. In the end, it will happen, but there's no certainty that we're at the end."

Published by Globes, Israel business news - en.globes.co.il - on January 4, 2022.

© Copyright of Globes Publisher Itonut (1983) Ltd., 2022.

Queue for Covid testing at Ispro Center, Modi'in  credit:  Nevo Trabelsy
Queue for Covid testing at Ispro Center, Modi'in credit: Nevo Trabelsy
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