AS the Omicron variant of the SARS-CoV-2 virus continues to sweep through the globe, political leaders in many countries have applied knee-jerk responses fuelled by hysteria and sometimes xenophobia without critical input from scientists and health-care leaders.

Three years into the pandemic, citizens are fatigued, confused, and resigned to living with the virus. But amid the doom and gloom, there is reason to be optimistic and even greater reason to begin now to plan for life after the pandemic. Finally, we can say that there appears to be light at the end of the tunnel, but only if we look at the science and the facts. The evidence is there in plain view. 

The concept of herd immunity

At the height of the pandemic in the summer of 2020, the world clamoured for and hoped for herd immunity as a protective blanket against the virus. Infectious diseases spread through populations when its members are susceptible to the disease. Spread of disease is more efficient in populations without prior exposure or vaccination. The global population was therefore an efficient vehicle for the spread of the new SARS-CoV-2 virus and hence, the rush to produce vaccines to inoculate the population against the virus. When a large population develops natural immunity through prior infection or are vaccinated, herd immunity occurs, limiting further disease spread. Herd immunity can be attained by vaccination or following recovery from infection among survivors. Vaccination is a safe, proven, and controlled mechanism for inducing immunity without having to contract an infection. When a community achieves herd immunity, the spread of infection within the community becomes severely reduced and protection accrues even to those who are unvaccinated, never infected, or unable to be vaccinated for one reason or the other including individuals with immune deficiencies and newborns. When herd immunity occurs, the risk of spread from person to person decreases; those who are not immune are indirectly protected because ongoing disease spread is very small. The proportion of a population who must be immune to achieve herd immunity varies by disease. For herd immunity to be achieved through infection, a large proportion of the population must be infected and recover from the infection and developing antibodies to the infecting organism to withstand subsequent exposures. People who do not have immunity to a disease may still contract an infectious disease and have severe consequences of that disease even when herd immunity is very high. Herd immunity reduces the risk of getting a disease but does not prevent it for non-immune people. 

Why should we be optimistic?

In the past 12 months, many rich countries have pursued an aggressive vaccination programme, often hoarded vaccines, and undermined the global COVAX regime designed to ensure equitable vaccine access that covers both rich and poor countries. The self-centred approach by the richer nations all but assured that the pandemic would not be contained as new variants are guaranteed to always pop up from the neglected and unvaccinated communities. Such new variant is the Omicron variant which is now sweeping the globe. The Omicron variant first identified less than a month ago has now been reported in all states in the USA and likely in every country in the world. Omicron is reported to be three to five times more infectious than the delta variant and to be spreading much faster than any prior known variant of the COVID-19 virus.

As we learn more about the Omicron variant, there is good reason to be optimistic. The Omicron variant is easily transmissible and is occurring at a time when a significant population in the world have had prior exposure to the virus or been vaccinated and so have a degree of immunity to the virus making them less susceptible to severe infection. People catching Omicron are 50 per cent to 70 per cent less likely to need hospital care compared with previous variants according to a major analysis from the UK Health Security Agency. The report includes real-world data on COVID-19 cases and hospitalisations as of December 20, 2021. Based on an assessment of the data, the report finds that the risk of hospital admission alone with Omicron infection was approximately two-fifths of that seen with the Delta variant, and the risk of needing emergency care or hospitalisation was approximately 60 per cent of that for Delta infection.

These findings are consistent with a separate paper released last week by the Imperial College, London COVID-19 Response Team, which estimates the risk of being hospitalised for a day or longer due to the Omicron variant to be 40 per cent to 45 per cent lower than for the Delta variant.

These reports mirror data from South Africa and Denmark which both point to reduced severity. Omicron is thought to result in milder infection due to several factors including a combination of our immunity and mutations to the virus itself. The variant is mostly infecting people who have been previously infected with other variants or who have been vaccinated. 

Omicron will go everywhere

Dr Angelique Coetzee, chair of the South African Medical Association who was the first to report a clinical case of Omicron, recently noted that out of 106 COVID-19 patients with Omicron, she only admitted one with pneumonia two days ago.

“For me, the fast-spreading virus is less of a concern because the overall clinical picture that the patients are presenting with are predominantly that of mild cases. I’d rather take a fast-spreading viral infection with predominantly mild infections than a slow spreading with majority of severe cases,” Coetzee told CNN. “This is a fast-spreading virus. Yes, it’s going to go everywhere. It will affect the whole globe, and the more you get your people to test, the more you can control.”

The rapid spread of the Omicron variant and the less severity of the illness may result in much of the world especially the unvaccinated being infected and recovering with enough antibodies to withstand assault from new variants. When that happens, herd immunity will likely result and further spread of the virus will be limited and the pandemic will come to a halt. This may be the silver lining of Omicron and/or similar variants with easy transmissibility and less severity. Sometimes, viruses mutate themselves out of virulence. We suspect that we may be witnessing such a scenario. No doubt that the large number of infections from a highly transmissible variant like Omicron could pose a serious threat to health systems and may overwhelm the ability of the less resilient systems to respond, it could however, ultimately lead to herd immunity which will contain further spread of the virus. Despite the callousness of the richer countries in hoarding vaccines, the wide scale spread of Omicron resulting in mild infections and recovery will offer the poorer countries a large population with natural immunity against further variants of the SARS-CoV-2 virus and will signal a match towards the end of the pandemic. Until that time comes, we must continue with proven strategies including vaccinations, routine hand washing and physical distancing while expanding testing and surveillance measures without panic.

Now is the time for serious visioning and planning for the post-COVID era. The world will not be the same. New opportunities have been unearthed and new friction points have been identified. Let’s plan now so we can optimise our systems, take advantage of new opportunities, and create a more resilient economy and health system to withstand future shocks. 

Dr Ernest Madu, MD, FACC and Dr Paul Edwards, MD, FACC are consultant cardiologists for Heart Institute of the Caribbean (HIC) and HIC Heart Hospital. HIC is the regional centre of excellence for cardiovascular care in the English-speaking Caribbean and has pioneered a transformation in the way cardiovascular care is delivered in the region. HIC Heart Hospital is registered by the Ministry of Health and Wellness and is the only heart hospital in Jamaica. Correspondence to info@caribbeanheart.com or call 876-906-2107