Hello Omicron

Omicron puts scientists on red alert

Back in December the Deputy First Minister warned that Omicron will hit Northern Ireland “like a ton of bricks”.  “Once again we find ourselves dealing with what potentially is going to be the worst time through the whole of the pandemic,” she added. ‘We are continuing to work around the clock with public health officials to understand the impact because there are things that we currently know, but there are also things that we do not know.’ 

The Chief Medical Officer for Northern Ireland said that he was ‘more concerned than at any previous point in the pandemic’. The Chief Scientific Advisor said that it was inevitable that cases would double every couple of days.

In Dublin the Health Minister said that ‘the reality is the situation is very stark.’  Asked about the comment of the English Chief Medical Officer, Chris Whitty, that hospitalisations will be as bad if not worse  than last winter, he said ‘we could well see that, yes.’  Leo Varadkar warned that the situation was ‘beyond our worst feras’

Mike Ryan of the World Health Organisation has said that Omicron will ‘fill the hospitals up, we will fill the ICUs up.’ Similar warnings were made by politicians and health authorities across the world.

A month later the tone has changed. The Ministry for Health in Northern Ireland has admitted Omicron has not been the threat anticipated, now acknowledged in the South as well.  Learning to live with Covid has been accorded greater weight alongside recognition that lockdowns cannot continue forever. There are now more prominent questions about exactly what the threat from Covid-19 is, and just how many in hospital have been admitted with Covid or for something else but just happen to also be infected.  

At the end of last week it was reported that 44 per cent of those in hospital In the Irish State were diagnosed with Covid only after being admitted, some of whom will not have been admitted due to its effects. While nearly 1,000 Covid related patients are in hospital with the infection almost 500 patients are awaiting discharge from hospital but have nowhere to go, filling beds and potentially posing a risk of further infection.

The need for adequate social services is a longer story than ‘War and Peace’ and as unfinished as most people’s efforts at ‘Ulysses’.  The health service bureaucracy complains that services are under threat from Covid but the real problem is its own failings, in capacity and organisation.  In the South there was much dismay at news that five times more senior managers were recruited in the second quarter of last year than medical staff.

These senior managers complain about staff absences due to Covid but many of these staff are not actually sick but following the isolation rules recommended by them.  And this is not the only part of their lockdown strategy which is worse than useless and is falling apart.  Useless, because testing results take so long when people are most infectious in the first few days.  Useless because many people have been unable to get tests when they want, Useless because to be effective tests would have to be carried out continuously in a way that cannot be performed.  At €200 per PCR test it is an expensive waste.  Falling apart because testing cannot meet demand so it is not even a reliable indicator of extent of infection. It has been estimated that between 300,000 and 500,000 infections went unrecorded last week, up to about 10 per cent of the population. In what possible way could testing act as any sort of measure of control? 

The argument between the National Public Health Emergency Team (NPHET) and Government about whether hospitality should close at 5pm or 8pm now looks laughably pointless, while widespread use of derogations calls into question the whole policy as does reduced periods required in isolation.  At the end of the first week in January there were fewer people in ICU than before Christmas. What is happening is that lots of people are now getting natural immunity.

Even in December it was still clear that infection was primarily an issue for elderly people and especially those unvaccinated.  In mid-December it was reported that 68 per cent of deaths related to Covid in the previous week were among those with an underlying condition and two-thirds were among those aged 65 or older.  This age group accounted for 50 per cent of hospitalisations while the unvaccinated accounted for 45 per cent of patients in ICU.  The unvaccinated were more likely to be in hospital and had a higher death rate. The majority in ICU over the last month have had the Delta and not Omicron variant.

When warnings were first made about the new Omicron variant it was stated by the CMO in England, Chris Whitty, that ‘there are several things we don’t know [about Omicron] but all things that we do know are bad’, which wasn’t true.  The administration in the North and Government in the South took their cue from these warnings.

When the Taoiseach Micheál Martin warned that the projections by NPHET were ‘sobering’, one journalist noted that ‘nobody pointed out that NPHET’s projections have frequently been almost drunkenly inaccurate.’  He admitted that this might not matter given the large numbers involved but this brings us back to Whitty’s remark about all the things known about Omicron were bad.

It was widely argued that the danger of hospitalisation, requirement for ICU, and death – let’s call each of these ‘ Z’ – were all a function of cases, let us call this ‘X’.  The severity of the Omicron variant was known from South Africa to be significantly milder but when the sheer number of cases was taken into account a milder variant with a lower severity – let’s call this level of severity ‘Y’, meant that a much bigger X multiplied by a lower Y still meant a very large Z, i.e. large number of hospitalisations etc.  All making perfect sense in algebraic terms but pretty meaningless in real terms.

If the severity of infection was lower there could be no assumption that a higher number of infections with a mild disease would be a calamity rather than a lot of people suffering a mild infection; but as we see, Whitty and those following simply assumed that a higher number of cases would almost inevitably bring a higher number of hospitalisations, requirement for ICU, and deaths.

Given the much increased transmissibility of Omicron and large numbers forecast it is hardly justified to believe that any general lockdown was going to work, an inadequate testing regime would be relevant, and that a strategy bases on protecting everyone could possibly work.  A policy of focused protection of those known to be most vulnerable is the only one to make sense but hostility to this, in the form of the ‘Great Barrington Declaration’, has been widespread for a long time and defaulting to it would have opened up those responsible for the existing approach to questions.

The reason not to do so, as at the start of the pandemic, was the claim that with so much uncertainty about the new virus the precautionary principle was required: assume the worst and prepare for it while perhaps hoping for the best.  Unfortunately, this explanation doesn’t convince.

If it must be assumed millions would be infected then it should have been obvious that generalised lockdown could not work, even more obvious now with Omicron.  The precautionary principle would require that an optimistic view of its efficacy could not be assumed.  The precautionary principle would also mandate a serious analysis of the prospective harm caused by generalised lockdown and I’ve yet to see any.

Relevant also is the fact that right from the start of the pandemic it was not a question of complete uncertainty – some things were known and should have been acted upon but were effectively ignored.  This was that the real threat to the population was highly correlated with age, with the more elderly suffering a risk multiple times greater than of younger people, which would point to a focused strategy of protection.

Instead of precaution, the real reason was the assumption that the health system could not cope with a sudden increase in cases but, since these were overwhelmingly those at risk, this too was no answer to those advancing the argument of an alternative approach.

Forward to part 2

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