"This wave will peak in early February. The numbers will be high, but the plateau will last much shorter and the epidemiological curve will go down quickly. We'll have a fairly uneventful spring and summer, and we'll finally go back to normal life. We'll probably take off our face masks, because it seems that corona's running its last lap with Omicron," Professor Radmilo Janković, anaesthesiologist and deputy head of the Niš University Medical Centre, said in his interview with Kurir.
That sounds really optimistic.
"Omicron has managed to achieve the natural evolutionary goal of the relationship between a virus and its host – co-existence. The virus will be transmitted between people, but it won't be life-threatening. In an indirect sense, it won't cause trouble for the planet in terms of normal movement and economic life. Having said that, we'll wait until winter is over in the Southern Hemisphere and see if we have a new mutation in store for us. These optimistic predictions notwithstanding, I don't rule out the possibility that a mutated strain of the virus emerges in one of the coming seasons and that it's much more pathogenic and similar to the Delta variant, but with greater transmissibility. However, the apocalyptic scenario that we can see in science fiction films – a very pathogenic and virulent strain spreading and practically destroying the earth – isn't possible."
What is the profile of a patient infected with Omicron at a Covid hospital?
"It's very hard to estimate how many patients there are that are infected with Omicron really, and how many there still are with Delta. The patients admitted in the past couple of days, as well the past two to three weeks, mostly require intensive care. They are elderly, often over 80, with a number of chronic conditions. They mostly have a severe double pneumonia, and their Covid is systemic. They will need oxygen and often also a systematic administration of biological and antiviral therapy, as well as corticosteroids – very much like in the previous waves."
Although Omicron has a milder clinical presentation, hospitals are slowly filling up. Are you worried that we may have thousands of hospitalized patients again?
"No, I don't think that will be the case. We know that the actual number of new infections is two to 2.5 times higher than the number announced every day. If we assume that there are 20,000 new infections daily, in the 20 days of January we've already had 400,000 infections. If the hospitalization rates were similar to Delta or the original – more severe – Wuhan strain, by now we would have already had no fewer than 40,000 patients in hospitals, which would have brought down our healthcare system. The situation would have been similar in any other country. It's beyond doubt that Omicron has a milder clinical presentation, which is clear after the 20 or so days since we identified the first cases. The disease is causing fewer and fewer cases of medical complications which resulted in death. Here I mean above all a general inflammatory response, which resulted in a cytokine storm and severe double pneumonia, which then caused global hypoxemia (low blood oxygen). Also coagulation disorders, which were the most common cause of death. We need to be cautious, of course – I still have reservations regarding whether Covid complications occurring with the previous strains will appear in Omicron as well."
But the number of hospitalized patients is increasing?
"It's increasing slowly. In about 20 days, the total number of patients in Serbia has gone up by a little over 600. That said, given the number of discharges and deaths, new infections stand at 1,500 for January. This means that Omicron has been dominant for the past 22 days. I don't think that the total number of patients will go over 3,500 to 4,000 – a bare third of what we used to have in every previous wave. In the next two to three weeks, there will more pressure on Covid clinics."
Some people see Omicron as an opportunity to get immunity easily, so they get infected on purpose.
"That is sheer madness. Also, I myself am not familiar with such cases. Younger people will certainly have milder symptoms, but we must always bear in mind that the over-70s, even the over-80s, are the highest in the total number of hospitalized patients. There's always the danger of this epidemic wave hitting mostly the elderly, which would result in far more dramatic symptoms and far more deaths. Omicron does spread like a tidal wave, and so it makes no sense for anyone to do it on purpose. We can do little now to stop the tidal wave as it is."
Flurona has been identified too. Should we be scared?
"I'm not an expert in this area, but what common sense and medical knowledge suggest is that it's impossible for two powerful pathogens to be circulating around the world. It's not possible to have a flu pandemic and such high Omicron caseloads. I think it's more of a story for the headlines and that it isn't going to be a problem really. Of course, I can't rule out the possibility of one person getting infected with two viruses, but I really don't think that this would develop into an epidemic. Minimal epidemiological measures – face masks and social distance – are more than enough to prevent a flu from spreading."
Would you say that we are really going for developing herd immunity, since we cannot increase the vaccination rate?
"I wouldn't say that we're going for developing herd immunity. The nature of this wave is such that it's difficult to curb the virus with anything other than a strict lockdown, the absolute strictest measures imaginable. Even so, we'd only be flattening the speed and height of the wave, but we certainly wouldn't avoid a scenario in which a huge part of the population gets infected. I don't think anyone is intentionally doing this assuming that the symptoms will be milder, people's health less severely affected, and that in this way we'll be solving the problem in the long run, so to speak. Omicron's mutations have given the disease a whole new character, this is no longer the same Covid-19. I sometimes even think that the pathogenic mechanism is perhaps entirely different. On the other hand, these mutations have allowed it to bypass the immunity by vaccination and by having the disease. What often happens is that people who have had three vaccine doses and those who have had corona once, even twice, get infected. Even those who have had both the vaccine and the disease. It's frustrating, in the sense of finding a way to motivate people to get the jab. Vaccination is necessary, no question about that. Almost all patients – and I'm not saying this to tell a lie and call on people to get vaccinated – who are in ICUs now and almost all those who have died recently haven't been vaccinated. Vaccines may not be efficient enough now to prevent getting infected by Omicron, but they do prevent severe forms of the disease and severe clinical presentations."
What is the future of the vaccines?
"The future is probably vaccines containing antigens of all the variants that have caused waves. But it isn't enough to just have an efficient vaccine, and it isn’t enough to vaccinate only the world's richest countries. In order for immunity by vaccination to have any effect whatsoever, it needs to be achieved in a short timeframe and be global."
Kurir.rs/ Jelena S. Spasić