Doctors waiting to exhale as Omicron symptoms remain mild

South Africans should have a clear idea by next week if the milder symptoms associated with the Omicron variant are a consistent pattern and if Covid hospital admissions will remain lower than in previous waves, say Gauteng clinicians and hospital executives. The early signals so far are encouraging.

Wits University professor of medicine Francois Venter said: “Every passing day makes it more reassuring that this wave is milder than wave 3 [driven by] Delta and by next week we may be able to exhale.”

Unlike previous waves, only a small proportion of the people infected by the virus in the fourth wave have been admitted to hospitals, data shows.

South African Medical Association chair Dr Angelique Coetzee said: “This wave is not the same as Delta, which was terrible. At this stage the cases are very mild.”

Netcare hospitals were seeing a much lower rate of admission than the rate of transmission in the community, which is the number of people testing positive, said CEO Dr Richard Friedland.

In previous waves, the steeply rising line of Covid infections on graphs was matched by a rising line of hospital admissions. This is not the pattern so far in the fourth wave, with admissions and deaths staying relatively flatter.

“There is a decoupling between cases and hospitalisations. If this continues, the majority of cases could possibly be treated at a primary care level and not overburden the health system,” said Friedland, cautioning however that the wave was still in “extremely early days” and it would take a few more weeks to have definitive data.

“In the first three waves, every case that we admitted was a serious case of Covid. [The lockdowns and curfew restrictions] all aimed to flatten the curve in order not to overburden hospital services and we didn’t run out of beds,” he said.

Now very few hospital patients need oxygen therapy, unlike prior waves when life-threatening Covid pneumonia was common.

Nearly half the 126,000 Covid patients seen by Netcare in the first three waves were admitted to Netcare’s 49 acute hospitals and all of them required oxygen and a quarter of them were treated in high care and ICU.

Venter said of this wave: “Honestly, I haven’t seen anyone with severe disease. The major features seem to be sore muscles and tiredness, and people bounce back after a day or two.”

Coetzee said 99% of the Covid cases she has seen are mild, with symptoms such as body aches, a sore back, tiredness and headaches. “A lot of GPs are reporting the same picture,” said Coetzee, a GP in Tshwane.

About half of the unvaccinated patients seen by Coetzee had more severe symptoms. “As usual, at the start of the wave we saw younger patients but, as the wave progresses, patients are older.”

Reports from the National Institute for Communicable Diseases (NICD) confirm more cases are occurring among older people.

The soaring number of infections means hospitalisations, particularly among those with comorbidities and without vaccination, will go up.

Health minister Joe Phaahla said at a briefing on Friday that seven out of 10 people being admitted to hospital during this wave were unvaccinated. “As things stand the vaccines are showing to be very strong in protecting against severe disease.”

Most provinces, except the Northern Cape, have started seeing increases in hospital patients, said Dr Michelle Groome, head of the NICD public health surveillance and response unit. Most of them were unvaccinated, she said.