Thiruvananthapuram As the State braces for a potential spread of the Omicron virus variant, multiple plans and strategies are being planned so that the health system saturation does not happen and that non-COVID-19 care does not take a hit as it did during the peak of the Delta wave.

“It is a different set of challenges that we might be up against this time if a community transmission were to take place. While there is no need for a knee-jerk reaction, there are huge uncertainties whether we should anticipate that the situation involving Omicron may turn out to be as bad as Delta was,” says a senior public health expert.

Till now, the Scientific Advisory Group for Emergencies, U.K,, said that there was nothing to suggest that Omicron was any less severe than Delta. But the latest study from Imperial College, London, concludes that the chances of Omicron-infected people being hospitalised is 20-25% less than that of Delta and that the chances of having a hospital admission of more than a day are less than 40-45%.

However, it also says that this could be upstaged by the greater transmissibility of Omicron, which can infect a large number of people all at once, especially the vulnerable — elderly, those with comorbidities and the immunocompromised — much faster than other variants did.

Public health experts point out that Kerala, where the previous Delta wave never went down to the baseline, would be facing a unique situation of having both Delta and Omicron in circulation. Going forward, either of these two or in combination can become a problem if test positivity rate goes over 10%.

“Rather than case numbers, the key metric that we should be monitoring is how fast hospital beds, ICU beds and oxygen requirements are moving. Once community transmission of Omicron starts, it will run through everyone (the doubling time is just two days). One major concern would be that if health-care workers are affected in large numbers, all patient care will break down,” says R. Aravind, Head of Infectious Diseases, Government Medical College, here.

Even if Omicron might bring a less severe disease, it is possible that a large number of patients might turn up in hospitals. The challenge would be to ensure that mild cases are managed by peripheral institutions so that tertiary-care institutions are free to handle serious cases of both COVID and non-COVID diseases.

“There is a category of people — those above 60 years, multiple comorbidities, the immunocompromised – for whom Omicron need not necessarily be mild. Another main challenge is the high immune escape potential of Omicron, which can evade both monoclonal antibodies (mAbs) and antibodies generated by vaccines or previous infection. This means that none of the mAbs currently used as life-saving drugs to prevent serious infection (Delta) in the vulnerable will work for Omicron infections,” points out Dr. Aravind .

The picture emerging from both the U.K. and Denmark shows that the initial surge in hospitalisations are beginning to stabilise and that the projected worst case scenario has not played out anywhere yet. But scientists are cautious because they are not sure whether the variant is intrinsically less virulent or if the reduced severity is because cases have so far been concentrating on the younger population.

Public health experts point out that Denmark’s Omicron experience — 1% of the Omicron-affected required hospitalisation and 0.1%, needed ICU care — is something that should be taken note of by Kerala. Denmark, with 77% background vaccination rate and a high level of previous natural infection – a situation akin to Kerala – was one of the first nations in Europe to experience the Omicron surge.

The Health department’s focus should be in ensuring that COVID care does not follow the pattern it did during the previous Delta wave and that non-COVID care does not suffer.