From Delta to Omicron: Will there be a tsunami of patients?

Dr. Pradeep Kariyawasam
Former Epidemiologist/Chief Medical Officer of Health
Colombo Municipal Council

All over the world the Delta variant of the Covid-19 virus has been replaced by the Omicron variant. It is happening in Sri Lanka, too, according to reports issued by the Ministry of Health recently. At present it is said that between 60-90% of patients found in various parts of the country have been infected with Omicron. The percentages are higher in the cities than in the suburbs. This is because the population densities are higher in the cities and the it is easily transmitted from one person to another. The other aspect is the transmissibility of the variants, and it is said that the Omicron variant has a 1.5 times higher transmissibility rate than the Delta variant. I believe that the change from Delta to Omicron took place as there were hundreds of thousands of people infected with Delta virus and the chance of creation of mutations increased with time. Omicron has a higher transmission rate and there could be many more variants that we have to face with and already a sub-variant has surfaced.

The changeover to Omicron has happened but the numbers are low because we don’t have enough facilities to do genomic sequencing to identify the variants. It is only the Sri Jayewardenepura University that has such facilities and not even the MRI seem to be having a facility to do these investigations. This is a wake-up call to our policymakers to have proper laboratories in the country and that is to have at least one laboratory each in the North, South and Central provinces. The Western Province could be covered by the Sri Jayewardenepura University laboratory. It is a pity that no one seems to care to improve the facilities at their own laboratories. I remember meeting Prof. Sirimali Fernando the architect of this Sri Jayewardenepura university Immunology and Molecular Medicine Unit around 15 years ago when she came to see me with Professor Malavige, then a lecturer, most probably, to tell me that the dengue virus had changed to D-3 and that an epidemic was imminent as people didn’t have immunity against the D-3 virus. What I understood was that the Ministry of Health or the Epidemiology Unit were not interested in that and someone had told them to tell me. I took that seriously and started to carry out prevention and control measures. I started to improve laboratory facilities and we had a top-class laboratory then carrying out 53 types of investigations, basically helping the urban poor to get costly laboratory tests done free of charge. We were the first government laboratory to have NS1 test to identify dengue infections. Today, sad to say our laboratory network at the CMC is almost non-existent and there in no proper City Microbiologist in place and the City Analyst unit, too, was without work and hardly any work was done under the Food Act. It is interesting to note that the City Microbiological Laboratory staff are not at all involved in PCR or antigen testing when there is a global epidemic taking place, although it is a Public Health Laboratory where the plague carrier, a flea, was identified around 1918. In the past few years, it had been a difficult task to even get the much-needed chemicals to run the laboratories. The testing of food and water was stopped while such work in other cities and countries in the world are improving. We are going backwards in laboratory investigations, the regulatory work has suffered immensely, and I think we were better off 50 years ago compared with the situation in those countries then. So, forget about finding new variants on time and taking preventive measures like in advanced and not so advanced countries, as we cannot even run a normal laboratory today and provide the needed information to the patients as well as the authorities.

It is a known fact that hospitalisations and visits to clinics by patients amount to only 10% of the total number of patients suffering from a communicable disease. So, when we say there are 1185 patients on a single day now that means our daily total could be as much as 11800! This figure could be more as many of the patients don’t have symptoms as in any other communicable diseases. When one analyses the figures given out by the Ministry of Ministry of Health daily there is an increase of 5-10% of patients and therefore It is obvious that Omicron is in the community and is spreading rapidly. The hospital beds are full and ICU units are running almost at full capacity. Although Omicron is not a killer as such, compared with the Delta variant, the numbers are high and it seems those not vaccinated with the three doses that the government provided free of charge are the ones who have got the full-blown disease. The deaths due to Covid are also climbing slowly and silently and it is expected that by March we will have a break or make situation. Much depends on the vaccinated numbers and I hope the people will realise that they are helping not only themselves but also the society.

Take for example the covid-19 situations in the UK and Australia and compare them with our situation where the spread is mainly due to the Omicron variant. The UK is experiencing the winter season, Australia the summer and in Sri Lanka we are experiencing a dry hot weather. Earlier it was cold and rainy in December here in our country. On the 12th of December, 2021 the UK registered 48,000 patients for the day. Then the numbers rose sharply within three weeks and rose to reach 218,000 on 4th January 2022. That is more than a four-fold increase! Today, the daily number has gone down to 92,000 but it is still high. Now UK’s population is three times that of Sri Lanka. Take Australia a country with a population just above our country. They had just 1843 new patients on that day, 12th December 2021. By 12th January 2022 the number of new cases for the day peaked at 175,000. By the 3rd February 2022, the numbers had come down to 32,000. During this period what were the numbers here in Sri Lanka? On 12th December 2021 we had just 714 new patients for the day. By 9th January the number of cases went down to 430 and then started to gradually go up and by the 3rd of February, 2022, we had 1183. Compared with the numbers in December 2021 this is almost a three-fold increase. But then why are our numbers so low? Very few people get themselves tested for the Covid-19 virus. The laboratory facilities are difficult to get at. The private sector charges exorbitant prices. So, many wait at home, some use Ayurvedic remedies, but others go to work with the runny nose, sore throat, fever, etc. Of course, they check the temperatures at the entrances but the machines are never calibrated. The workers with the infections hide behind the masks and no one knows whether they are infected or not. There is no social distancing at work.This is so even in medical facilities. There are no proper awareness programmes even in the cities. Parties, demonstrations and meetings are held involving hundreds of people disregarding that we might have an imminent outbreak of Omicron here in the country.

What will happen in the near future? My guess is that there will be a sharp increase in the number of patients during the next few weeks and this will go on till the April holidays. The numbers will not be that high like in Aussie land or the UK due to the hot and dry weather conditions that we experience and also as many of the infected citizens will be not going to a medical facility for treatment or a laboratory for testing and we will not know the exact numbers anyway.

The country should not be locked-down at any cost and people should learn to live with it and at the same time take precautions. The tourism industry has just picked up and statistics show that hardly a tourist is infected with Covid-19 according to PCR tests although the southern coastal line has a large number of infected persons. I think it is the local tourists from Colombo and suburbs that travel to the southern areas that take the disease with them. There should be an increased awareness created among people by using the electronic media to get people’s attention to the need of taking preventive measures and staying put if they have the disease.

All government institutions and the private sector as well should first ask their staff members to get fully vaccinated as they deal with first their own members of staff and then the outsiders or customers. They should ask the staff members to keep away from work if they have a runny nose, sore-throat headache etc. The heads of these institutions should see that no infected persons come to work as bringing in one person with the virus can infect all in one division especially, when they work in a closed air-conditioned room or a hall. In each division a health officer should be appointed to check whether any infected person has come to work. If there are many persons down with covid-19 then all should undergo antigen testing. I think it is better if the government informs these institutions to keep the staff levels at work to 50-70 % during the next few weeks and watch the situation. I am totally against road-side antigen testing as that is trying to find a needle in a haystack. It is better to use the same resources to find the infected people in high-risk institutions and offices which will be more productive.

CMC which is spearheading the covid-19 control campaign should start with their own organization first and put the house in order at the Town Hall as a large number of patients are found there. Colombo and suburbs are the most important areas that the government should concentrate in the vaccination drive as almost all the communicable diseases are spread to other areas from the above areas. Take the month of January this year, out of the 200 dengue fever patients in Colombo District, the Colombo Municipality area has 166 patients. Unlike Delta Omicron infected persons’ lungs will be less affected but then if one is over 60 years of age there could be complications. Therefore, booster vaccinations are a must and the service should be taken to the people and not expectT hem to come to the centers.

So, a massive awareness campaign coupled with an intensive vaccination drive that can cover at least 80% of the eligible persons in the next few weeks will slow down the spread of Omicron variant. Government statistics show that 16.7 million persons were given the first dose of the vaccine, 14 million the second dose but only 5.6 million the third dose showing the decline in interest of citizens to get the vaccine. If this will continue the disease will rapidly spread and the numbers will be high and new variants will emerge. In that case we will have to wait it out while doing our normal day to day work risking our lives until 80% of the population has either got the disease or vaccinated to stop Covid-19. If one wishes to take the risk and not get vaccinated then it is that person’s right. But they have no right to infect others. So be conscientious and think of others, get the vaccines and all will be well.