COVID-19 statement by Minister of Health Dr Joe Phaahla during virtual media briefing programme on the update of SA - 10 December 2021
Omicron variant
This variant B.1.1.529, first reported by South Africa, Botswana and Hong Kong, was classified a Variant of Concern (VoC) by the World Health Organization, and named Omicron on 26 November 2021. As of 8 December, 42 countries in all 6 WHO regions had reported the variant with many countries reporting sustained community spread.
Omicron has driven a resurgence in COVID-19 cases in South Africa, with 89,651 cases reported nationally from 7 November to 4 December 2021. Weekly cases in Gauteng province have increased by 415% for the week ending 4 December 2021 compared to the previous week, while hospital admissions rose 204%.
Recent genomic sequencing results revealed that Omicron was the dominant variant among samples sequenced during November 2021 - 70% (250/358) as of yesterday. Omicron is most likely the variant driving the increase in new cases in Gauteng province over the last three weeks.
This VoC has multiple mutations that may have an impact on how it behaves. Our scientists have been conducting rapid research to better understand many aspects of Omicron, including how well the variant transmits and whether it can escape our immunity, and will share the findings of these studies as they become available.
What is known about Omicron?
Transmissibility: It is not yet clear, but it seems likely that Omicron is more transmissible (more easily spread from person to person) as compared to other variants, including Delta. Omicron very quickly displaced Delta as the dominant variant in Gauteng.
The number of people testing positive has risen rapidly in Gauteng and Omicron has spread to most provinces. The reproductive number of the virus (which shows how many people are likely to be infected by one person) is currently 2.5, higher than it was at any prior point in the pandemic.
Severity of disease: It is not yet clear whether infection with Omicron causes more severe disease or death as compared to infections with other variants, including Delta. Preliminary data suggests that there are increasing rates of hospitalization in South Africa, but this may be due to increasing overall numbers of people becoming infected, rather than a result of specific infection with Omicron.
Early data from the DATCOV COVID-19 national hospital surveillance shows that among patients who already had a hospital outcome and were no longer still in hospital, a lower proportion of patients admitted in the fourth wave had severe disease as compared to patients admitted in a similar timeframe in the second and third waves. (Severity was defined as any patient who developed acute respiratory distress syndrome, received oxygen, ventilation, was treated in high care or ICU or died.)
Similar experiences have been reported from public and private hospital in Gauteng. It must be noted that severity data has several limitations at the early phase of the wave when numbers are small: patients with mild symptoms are more likely to be admitted as a precaution, patients are diagnosed with COVID-19 incidentally when admitted for other reasons, and because there has not been sufficient follow-up time for severity and outcomes to have accumulated, which is typically up to 3 weeks after diagnosis.
Understanding the level of severity of the Omicron variant will take several weeks. Our hospital surveillance has demonstrated that patients still do experience the full spectrum of the disease: from mild to severe disease. All variants of COVID-19, including the Delta variant that is currently dominant worldwide, can cause severe disease or death, especially for the most vulnerable people (those who are older and underlying medical conditions), and thus prevention is always key.
Symptoms of the disease: For now, we don’t have any information to believe that this variant causes different symptoms from other variants. Anecdotally doctors have reported that patients present with scratchy throat, cough, fever, diarrhoea and vomiting. In children many have non-respiratory symptoms.
Effectiveness of prior COVID-19 infection: Preliminary evidence suggests there may be an increased risk of reinfection with Omicron (people who have previously had COVID-19 could become reinfected more easily with Omicron), as compared to other VoC.
A pre-print (not yet peer-reviewed) has been published on the risk of re-infection in South Africa reporting a 2-3 times increased risk of re-infection (defined as a positive test after 90 days have passed from the last infection). More information on this will become available in the coming days and weeks.
Effectiveness of COVID-19 vaccines: Our scientists are conducting studies to understand the potential impact of this variant on how well the vaccines work but it will take 2-3 weeks before we have clear evidence of the vaccines' performance against Omicron. Current vaccines remain effective against severe disease and death.
COVID-19 vaccines have been shown to provide protection against severe diseases with the previous variants, and it is expected that such effectiveness will be maintained against Omicron. Early studies have revealed that there is only some loss in protection of the Pfizer vaccine against Omicron.
Effectiveness of tests: The widely used polymerase chain reaction (PCR) and antigen (rapid) tests continue to detect infection, including infection with Omicron, as we have seen with other variants as well.
Effectiveness of current treatments: Corticosteroids, oxygen therapy, antivirals and anticoagulants will still be effective for managing patients with severe COVID-19.
How does the variant affect children?
During the three-week period of 14th November to 4 December 2021, there was an increase in admissions among children under 5 years of age, observed in the City of Tshwane Metro hospitals where the early resurgence in the fourth wave occurred. Children 18 years and younger comprised 21% of all admissions during this period.
However, this pattern has changed over the three weeks of the early fourth wave in Gauteng, and the proportion of admissions in children <5 years compared to total admissions in the week, has decreased from 14% (week 46) to 11% (week 47) to 8% (week 48).
The provincial and national picture is indicating an increase in both cases and admissions among children of all age groups but no change in the proportion of children with COVID-19 who died. Early data from our hospital surveillance and also reports from public and private hospitals indicate that the admissions are largely in children admitted for other reasons and testing positive incidentally, are of a short duration (3-4 days) and do not show features of severe disease.
We know that over the course of the pandemic in South Africa, children have not been severely affected by COVID-19. Despite making up 30% of the population, they comprise 12% of cases, 5% of hospital admissions and less than 1% of deaths.
However, the children who are at risk for severe disease and death are those who are under 1 years, probably due to their immature immune system, and children with comorbid medical conditions such as premature birth, diabetes, cancers, HIV and TB.
It is still not clear what is driving this apparent increase in the proportion of children admitted to hospital with COVID-19. Time and further investigations will provide some answers
There is need for caution but not alarm. We expect the Omicron variant to behave in the same way as other variants when it comes to children. Children are less likely to be infected when exposed to the virus, less likely to be severely ill when infected with the virus and less likely to die when severely ill.
How are we doing with the COVID-19 vaccination programme?
As at 8 December 2021, a total of 26,781,642 COVID-19 vaccine doses have been administered in South Africa to adults. The proportion of the adult population who have received at least one dose of vaccine is 43%, at the national level, but varies provincially from 37% (Mpumalanga and KwaZulu-Natal) to 51% (Western Cape and Free State).
The daily total number of vaccine doses administered has remained below 150 000 per weekday, despite efforts to encourage uptake. As from 1 December 2021, immunocompromised adults will be eligible to receive a booster vaccine dose (either a third Pfizer dose or a second Janssen dose, as a homologous booster). SAHPRA has very recently announced that a Pfizer booster dose has been approved for all adults aged 18 years and older to be administered at least 6 months after the second dose.
What will we do over the next few weeks?
In South Africa, our scientists will continue, as they have done in the past, to conduct high quality research to understand this new variant, and quickly share the information locally and with the world. Our scientific advisors continue to provide the national government with guidance on national restrictions, expansion of the COVID-19 vaccination programme and introduction of new treatments.
Our government will work hard with the provinces to ensure hospital preparedness, which will include flexible, agile bed surge planning, ensuring the availability of health care workers and resources such as oxygen. We will also make decisions about lockdowns or increasing the levels of restrictions as more information becomes available and as the picture of COVID-19 cases and hospital admissions unfold across the country.
Restrictions have been effective at stemming the rise in increased cases so that our hospitals can better cope with the influx of admissions but have had severe economic consequences, thus a careful assessment of risks is needed. Government will also continue to take advice around implementation of mandatory vaccination.
It is important to reinforce what the public can do to protect themselves and those around them. The most effective steps individuals can take to reduce the spread of the COVID-19 virus is to keep a physical distance of at least 1 metre from others; wear a well-fitting mask; open windows to improve ventilation; avoid poorly ventilated or crowded spaces; keep hands clean; cough or sneeze into a bent elbow or tissue; and get vaccinated.
