Dear Aunty And Uncle, Preparing For Omicron Wave — Dr Amar-Singh HSS

Malaysia can expect a sharp rise in Covid-19 cases in the next 1 to 3 months but we hope this will be short-lived.

I am writing this to the extensive aunty and uncle networks that flourish via WhatsApp and Telegram groups. I am sure all of you are aware of the Omicron variant, but may have a limited picture of what to expect. Allow me to share with you and your networks what we can expect with this variant in Malaysia.

Possible Omicron Wave In Malaysia From January To March 2022

The current detected cases of Omicron in the country may appear low, but we must realise that our genome testing is very limited (0.25 per cent of cases), compared to countries of our level of development.

If you look carefully at the data, you will see a steep rise in the number of infections in imported cases. Most of these are probably the Omicron variant. It is very likely, in many countries, including Singapore, that Omicron is beginning to spread locally in the community.

As we know from good data, Omicron spreads very fast and has a rapid doubling time of 1.5 to 2.5 days. This means that small numbers can rapidly escalate in a short time.

Note that the Institute for Health Metrics and Evaluation (IHME) has already predicted a sharp rise in Covid-19 cases in Malaysia due to the Omicron variant, with a peak happening in January 2022.

Looking at what has happened in other countries, especially South Africa and the United Kingdom, Malaysia can expect a sharp rise in cases in the next one to three months, but we hope this will be short-lived.

How Will Omicron Impact Our Health?

What we know so far from the available data is that Omicron causes breakthrough infections more easily for those who are vaccinated, and appears to be less severe, but we have no idea of the risk of long Covid.

The latest technical briefing from Public Health England has data that offers better estimates of vaccine effectiveness (VE) against getting infected. To summarise:

  • Two doses of Pfizer or AstraZeneca vaccines do not protect against the Omicron variant three to four months after vaccination (unlike with Delta).  
  • For those who received Pfizer vaccines, another Pfizer booster dose pushed up protection initially, but this dropped to about 45 per cent after 10 weeks.
  • For those who received AstraZeneca vaccines, a Pfizer booster dose pushed up protection initially, but this dropped to about 35 per cent after 10 weeks.
  • Boosting Pfizer or AstraZeneca vaccine recipients with a Moderna vaccine produced better results.

This data suggests that anyone can get infected despite being vaccinated, and that boosters have a moderate effect in reducing infection. Vaccines can reduce hospitalisation.

Note that VE against hospitalisation was not shown, which is of more value and importance to us. South African data suggested that hospitalisation was reduced significantly when one is infected with Omicron compared to Delta, but we must realise that their population has lower vaccination rates and higher natural immunity from extensive Covid-19 spread.

detailed analysis of UK data by the Imperial College London suggests a 40 to 45 per cent reduction in hospitalisation risk when compared to the Delta variant.

This data suggests that Omicron is less severe, but bear in mind that being so much more infective means that it still can put many people in hospital.

What about the Sinovac vaccine and Omicron? There is no real-world data, unlike Pfizer and AstraZeneca, and we have to rely on laboratory antibody studies, which may not reflect what will happen.

Studies from the University of Hong Kong showed that two doses of Sinovac produced insufficient antibodies against Omicron. This was also the case for a Sinovac booster dose. The University of Hong Kong team recommended that Sinovac vaccine recipients receive a Pfizer booster dose.

In summary, Omicron will infect many of us, some of us will be hospitalised, and certain vaccine boosters offer protection. We have no idea at present of Omicron’s long Covid risk but experts in the United States do not expect it “to be any different than previous variants”.

What Are The Concerns For The Health Care System And Society?

The concern of a new Covid-19 wave will put stress on our health care system. Health care workers are beyond the point of exhaustion, and ICU beds are limited. Another wave will increase bed usage, put additional strain on the system, and limit health care for other medical conditions.

We should also worry about our children, especially those aged below 12. They are unprotected and will be difficult to shield from the very infectious Omicron variant.

Their schooling may be disrupted again. We need to seriously consider using the Pfizer vaccine, originally meant for teenagers and adults, at a smaller dose for children aged 5 to 11, as well as improve classroom ventilation.

What Can We Do to Improve Our Protection (Reduce Our Risk)?

None of us are looking forward to any form of a lockdown, as it will further harm the poor, the economy, and the mental health of all. In medicine, we often talk about a return to basics, and that is what everyone needs to do.

We know that this virus is spread by an airborne mechanism. We need to tighten all our well-established prevention measures, which include:

1. Masks: Improve The Quality Of Fit And Filtration

Masks work, but with Omicron, when we are in poorly ventilated environments, we need to invest in FFP2 equivalent or KF94 masks. This is especially true for all those who work as frontliners (including those who work at food and shopping outlets). 

Some countries are making them available for those over 60, or making them required for use in indoor public places.

2. Ventilation: Improving Indoor Workplace Ventilation

Malaysians have yet to adopt good ventilation practices en masse at their workplaces. Perhaps Omicron might just be the impetus to get this critical measure implemented urgently.

3. Reduce Your Contact Time With Others And Limit Travel

Notice how both the Malaysian and Singaporean governments have paused the quarantine-free border entry. Continue to be vigilant and avoid unnecessary gatherings or crowds, and also travel.

Continue working from home if that option is open to you. Having a Christmas or New Year party may not be the best idea, even if held outdoors.

Testing is an option, but remember that with Omicron’s rapid doubling time, you need to test almost daily, to have any value in prevention (not to mention that testing depends on sample quality).

4. Get Your Boosters

Vaccines do appear less effective, but boosters will help to some extent. Remember that Delta is still circulating, and may outlive the Omicron variant.

After two full years of living with Covid-19, we are all tired of this long-drawn pandemic. We need to work to encourage each other to go the distance and to maintain vigilance.

As always, it is the people supporting the people that will make the difference.  

  • This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.

You may also like