Mr. Preiser, you do research as a virologist at the South African Stellenbosch University near Cape Town and were one of the first to draw attention to Omikron at the end of November. How do you spot a variant of concern? Since the alpha and beta variants appeared at the end of 2020 and the delta variant in the course of 2021, it has become clear that new variants of the corona virus can always arise that cause problems. That is why we are analyzing the genome sequences of a large number of PCR samples in a laboratory network in South Africa to see whether and how the virus changes. At Omikron, a private laboratory examined several outbreaks and sent positive samples to the network for sequencing. Such sequences had never been seen before. We took a closer look. Very quickly it became clear: this is something completely new. The mutation pattern alone suggested a high risk of infection from omicron. Wolfgang Preiser works as a virologist at Stellenbosch University near Cape Town in South Africa. Among other things, he researches the effectiveness of the booster vaccination at Omikron. © Source: Private Nevertheless, the number of cases in South Africa had already peaked shortly before Christmas – since then they have been falling again. Is the omicron wave already over after a few weeks? It seems so. At the moment it doesn’t look like the virus will flare up again anytime soon. Maybe we’ll have a few months’ rest now. But that’s not for sure. On the one hand, new variants could come. On the other hand, it’s summer in South Africa right now and since the beginning of December there have been school holidays and in many places company holidays. As a result, many contacts are lost, and private meetings often take place outside. So, after the holidays, could the number of cases increase again? Exactly, but that’s just one of several options. Predictions are difficult. We don’t know what will happen as temperatures drop. It is also difficult to assess the infection situation at the moment. Anyone who wants to be tested in South Africa usually has to pay for it themselves. Only those who come to the hospital get a swab. Even if the course is severe, there is no guarantee that you will be treated in the intensive care unit. Unlike in Germany, people look much more closely at who has the best chance of survival.
Anything can happen with Corona. The world may find out about it much too late.
Do you now know where the new variant came from? That is still unclear. There is no such thing as zero patient. The oldest omicron records to date from South Africa and Botswana were subsequently classified as such and date from the beginning of November. But that is not automatically the source. Omicron could also come from a country where there is little testing and even less sequencing. Maybe the variant was first noticed in South Africa just by chance, because we have our good surveillance system. Shouldn’t more countries then have more samples sequenced? Great Britain and Denmark are at the forefront. South Africa has built the best infrastructure among the emerging countries. Germany and the USA sequence some of the samples that tested positive, but unfortunately there is often a lack of systematic processing. It’s no use pushing ahead with my laboratory analysis without exchanging ideas with colleagues elsewhere. There are still many countries that do not systematically rely on tests and sequencing at all. But we really should keep our eyes open everywhere. Anything can happen with Corona. The world may find out about it much too late.
A pleasing omicron factor
Researchers around the world have been investigating how ill omicron makes people with astonishing speed. That’s correct. After a month and a half, there is a lot of data – laboratory experiments, epidemiological studies with sick patients from different countries, with different vaccination rates and rates of previous illnesses. Experiments with hamsters have shown that the virus does not infect the lungs as easily, but rather lingers in the upper respiratory tract. All the studies are not perfectly meaningful on their own, but overall they point in the same and fortunately relatively positive direction: Omicron causes less severe Covid 19 courses than Delta. How should one imagine the health risk from Omikron now? Those who are vaccinated have much better cards, but can also end up in intensive care. Boosters have a low risk of becoming seriously ill; apart from risk groups in which the vaccination protection has little or no effect. Anyone who has not been vaccinated at all has a statistically lower risk of contracting the disease with Omikron than with Delta. Nevertheless, this is not a harmless cold. A severe course is still possible, even if the risk is lower than with the previous variants. I can report anecdotally from South Africa that at the moment almost exclusively unvaccinated people with omicron infections are treated in our hospital. Some of them die too. The day before yesterday alone, 181 patients died of Covid-19 in this country; almost all unvaccinated. So letting the omicron rush through is not a good idea.
Children and double infections – the open questions about Omikron
When omicron was discovered in South Africa, there was also concern that the new variant could make children more seriously ill. You can give the all-clear. There are isolated cases, but this is the exception. Last week, for example, a toddler died of Covid-19 in our hospital. But that rarely happens. The suspicion that there is generally a higher risk of illness and death for younger people at Omikron has fortunately not been substantiated by data from South Africa. South Africa was also lucky that Omikron showed up in the summer. It’s winter in Europe, so double infections could still be a problem. What do you mean? Dual infections with respiratory pathogens are not uncommon. For example, it could happen that many children get infected with corona and influenza or the RS virus at the same time and have to be treated in the hospital. In the case of Omikron, it is still unclear whether double infections make the disease worse. Are double infections also possible in adults? This can also happen in adults, especially now that the influenza season is starting in Europe. If the corona virus encounters an influenza virus in the body, no new variant can develop. That could only happen if you get infected with two corona variants, such as Omicron and Delta, at the same time. This is also theoretically possible. It would be dangerous if genetic building blocks were mixed together in such a way that a new virus with problematic properties was created. So far, however, such a case is not known. There were tips from Cyprus, but that was probably a false alarm. In Germany there are currently many people without vaccination protection. Is that also a problem in South Africa? Around 45 percent of the adult population in this country are vaccinated – with Biontech or Johnson & Johnson. There is now enough vaccine. But here, too, many people are skeptical, and there are also conspiracy theories about the corona vaccination. Unlike in Germany, however, many people have had contact with the virus. Studies show that around three quarters of the population in South Africa had already been infected with Covid before the omicron wave. This contributed to the fact that the omicron wave was relatively harmless. Whether it’s a previous infection or a vaccination – it doesn’t offer good protection against an infection with Omikron, but fortunately it does against serious illness.
Omicron wave in South Africa: A different approach
So the handling of Corona is different than in Europe? Attempts have been made to contain the pandemic through very strict measures. But the conditions here are different from those in Europe. Unfortunately, it turns out that one cannot protect oneself so well, especially in poorer circumstances: cramped living conditions, large families living together, minibus taxis in which ten to fifteen people drive closely together to work. You can hardly protect yourself effectively against an infection. Which means that you accept high numbers of infections and thus more sick and dead people. Not least because so many South Africans have already died from Covid-19, less severe cases have now emerged. Protective measures would have to be observed even better at Omikron. However, decision-makers in South Africa did not tighten the rules significantly when it became apparent that the hospitalization rate would not increase dramatically. Masks are still mandatory in public, the number of participants is limited at major events. With your perspective from South Africa: What has been learned in around two years of the pandemic? The pandemic is changing some things for the better – hopefully in the long term too. HIV patients, for example, can suddenly pick up medication for several months and do not have to go to the clinic every four weeks and wait a long time. There are also efforts here in the country to set up its own mRNA vaccine production in order to become more independent from the industrialized countries. What connects South Africa to Europe is the realization that health communication does not work well in the crisis and confuses people. The consequences are defensive attitudes that are directed against the state and politics and actually no longer have much to do with protection against diseases. A pandemic is ultimately a natural disaster like floods, volcanic eruptions and others. Neither denial nor blaming helps, but such behaviors have been reported for a long time and are now emerging again.
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