Who gets hospitalized during an omicron wave?

The Omicron variant (B.1.1.529) is currently the dominant variant of concern of SARS-CoV-2. Its mutations confer it higher contagiousness but less disease. Some people can still be hospitalized with an Omicron infection, but who?

That question is answered by a South African study released yesterday by the Journal of American Medical Association. The study is Characteristics and Outcomes of Hospitalized Patients in South Africa During the COVID-19 Omicron Wave Compared With Previous Waves. [1]

South Africa experienced rises in COVID-19 cases described as waves as presented in the image below from ourworldindata.org.

The fourth wave peaked in a shorter period compared to the previous three. The tall and narrow shape of the fourth wave is a testament to its higher infectiousness and lesser disease it causes.

Source: ourworldindata.org

The Network for Genomic Surveillance in South Africa (NGS-SA) estimated the Omicron variant to be 81% isolated by November and 99% by December 2021.[2]

Source: NGS-SA

Characteristics of patients Hospitalized during the fourth wave

The patients hospitalized in the fourth wave tend to be younger (median age, 36 years vs maximum 59 years in wave 3; P < .001) with a higher proportion of females.

Significantly fewer patients with comorbidities were admitted in wave 4, and the proportion presenting with an acute respiratory condition was lower (31.6% in wave 4 vs maximum 91.2% in wave 3, P < .001).

Of 971 patients admitted in wave 4, 24.2% were vaccinated, 66.4% were unvaccinated, and vaccination status was unknown for 9.4%.

Vaccinated people amount to 44.3% of the adult South African population as of December 2021.[3]

The study compared the patients in the four waves, and the summary is presented below.

Maslo et al.

The authors mentioned that one limitation of the study is

Patients admitted for COVID-19 could not be differentiated from asymptomatic patients admitted for other diagnoses with an incidental positive test result, and this likely differed between waves, suggested by the lower proportion admitted with respiratory diagnoses in wave 4.

That means the actual number of admitted patients that are sick with omicron could be fewer.

The proportion of patients requiring oxygen therapy significantly decreased ( 17.6% in wave 4 vs 74% in wave 3, P < .001) as did the percentage receiving mechanical ventilation (Table 2).

Admission to intensive care was 18.5% in wave 4 vs 29.9% in wave 3 (P < .001).

The median Length of Stay (in the hospital) (between 7 and 8 days in previous waves) decreased to 3 days in wave 4. The death rate was between 19.7% in wave 1 and 29.1% in wave 3 and decreased to 2.7% in wave 4.

Maslo et al.

The South African study is the first report I have seen about hospitalization during an omicron wave, and it is consistent with what we know about the omicron.

 

The amount of mutations in the spike protein of the Omicron variant allows it to evade existing antibodies from vaccination.

But T-cells still work to prevent severe disease.

People who recovered from COVID-19 have effective T-cells against the omicron

The following article is about the mutations in the omicron that made it highly infectious but unable to infect lung cells. That’s the reason why Omicron diseases do not require oxygenation and intensive unit care.

Multinational study shows why the Omicron variant has low fatality and high infectivity.

The good news is that an omicron infection can elicit antibodies not only to omicron but against several variants of concern.

Omicron infections elicit neutralizing antibodies against variants of concern.

Syrian hamsters agree: Even Syrian golden hamsters say the omicron produce mild disease

In this interview from FoxNews, Dr. Robert Malone, the inventor of the mRNA gene therapy, likens it to a live-attenuated vaccine that produces a mild disease.

The increase in herd immunity can mean that the COVID pandemic may be near the finish line. However, it is still prudent to be careful to protect the elderly, immune-compromised, and at-risk.

Here is to everyone having a better 2022!

Source: WishingImages.net

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Reference:

  1. Maslo C, Friedland R, Toubkin M, Laubscher A, Akaloo T, Kama B. Characteristics and Outcomes of Hospitalized Patients in South Africa During the COVID-19 Omicron Wave Compared With Previous WavesJAMA. Published online December 30, 2021. doi:10.1001/jama.2021.24868
  2. Network for Genomic Surveillance in South Africa (NGS-SA). SARS-CoV-2 sequencing update. December 17, 2021. Accessed December 20, 2021. https://www.nicd.ac.za/wp-content/uploads/2021/12/Update-of-SA-sequencing-data-from-GISAID-17-Dec-21_Final.pdf
  3. Latest vaccine statistics. Department of Health, Republic of South Africa. Accessed December 20, 2021. https://sacoronavirus.co.za/latest-vaccine-statistics/

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