Omicron: is the panic justified?

Boris Johnson has refused to rule out tighter Omicron restrictions before Christmas, even as his Plan B measures face a furious backlash from Tory MPs ahead of a vote in the Commons tomorrow, writes Mattie Brignal.

Wales’s health minister has said that tighter rules are “likely”, while Scotland’s First Minister Nicola Sturgeon has warned “further, proportionate protective measures” could be announced this week.

Omicron – which is now thought to make up 20% of total infections in England – has changed the political equation. But should it?

The picture of the variant emerging from South Africa (which is several weeks ahead of the UK), while still blurry, is starting to come into sharper focus.

There is evidence that Omicron is more transmissible. Early data from Gauteng province, the epicentre of cases in the country, suggests that a person with Omicron may go on to infect 3 to 3.5 people compared to 0.8 for Delta. (Even so, Covid cases have started to level off in the last few days).

But Omicron also appears to cause milder disease. South Africa’s Covid case fatality rate (deaths as a proportion of cases 10 days earlier) has collapsed from 11% to 0.5% between mid-November and early December. Omicron being less lethal is one explanation. Or it could be that immunity levels in the population have improved since the last big surge in July. Or both.

Hospital data (which doesn’t distinguish between Omicron and non-Omicron Covid cases, although it’s thought that Omicron accounts for 90% of the surge in new infections) is also encouraging.

The average length a patient with Covid stays in hospital was lower in the past month compared to the long-run average. A smaller proportion of patients were admitted into ICUs (5.6% versus 9%), required oxygen therapy (19.4% versus 43.1%) or ventilation (1.4% versus 8.2%) in the past four weeks. The in-hospital mortality rate has been 2.6% in the last four weeks compared to 22% overall.

This evidence is not definitive. The relatively small data pool and South Africa’s unique characteristics make the numbers difficult to extrapolate from and interpret. Even so, the initial indications are undoubtedly positive.

Yet No 10 is playing it safe, concerned that even if Omicron is less deadly, a surge of infections could still leave the health service struggling.

Johnson’s big push for a million boosters a day, announced on Sunday, is underpinned by a real-world study showing that a third Pfizer shot could boost protection from symptomatic infection of Omicron from under 40% to 75%.

To meet the target, routine hospital appointments will have to be scrapped, outpatient clinics will be shut and surgery postponed. It’s an awkward shift of priorities for Sajid Javid, the health secretary, who over the last few months has been focussing on the need to clear the ballooning NHS backlog and the importance of day-to-day care.

Might this be too high a price to pay? Nearly 90% of over-70s have already had a booster shot, an age bracket that accounts for 86% of all Covid deaths across Europe, the UK included. Professor Carl Heneghan, director of the Centre for Evidence-Based Medicine, says: “What we can’t do each year is stop healthcare, switch it off, and replace it with a vaccine system. We have to think wider about what’s going on in the context of healthcare.”

As more real world data on Omicron trickles in in the coming days, it will become clearer if the trade-off is worth it.