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“With Omicron, we are witnessing more of another form of epidemic than just a new wave”
January 17, 2022 2.31pm EST
Author
Karine Lacombe
Infectiologist, Head of the Infectious Diseases Department at Saint-Antoine Hospital, Sorbonne University
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Since the spring of 2020, France has experienced five waves of contamination due to SARS-CoV-2 and its different variants (since 2021). What is the situation in the country today? What effect does the arrival of Omicron have, both on hospitalizations and for children? And how has the hospital adapted the care of patients with Covid? Analysis and perspective by Prof. Karine Lacombe, infectiologist and Head of the Infectious and Tropical Diseases Department (Saint-Antoine Hospital, Paris).
The Conversation-France: In France, where are we at with the waves linked to the different variants of SARS-CoV-2?
Karine Lacombe: Since November 2021, we were in a fifth wave where the Delta variant was the majority. It was manifested by an increase in contaminations, which was coupled 15 days to 3 weeks later with an increase in hospitalizations. Until reaching a high plateau, slowly rising, of hospitalizations and passages in intensive care during the Christmas period . There were 245 admissions per day in critical care in mid-December, 285 at the end of December and 345 currently.
And, specific to the present sequence, even before we had a change in contamination and especially in the occupation of intensive care units, we saw the emergence in mid-December with the arrival of Omicron of a kind of sixth wave coming to overlap the previous. Since the end of December, we have witnessed a meteoric increase in contamination, but this has not yet translated into hospitalization : for the time being, the patients who arrive in our services are mainly Delta patients.
We carry out, in hospitalized people, combined PCR tests which detect, among other things, SARS-CoV-2 and influenza viruses. For now, the flu is not yet too present but it will inevitably go up. And in case of co-infection , how will Omicron behave? Influenza ? Will both viruses cause symptoms? We can not know.
TC: It's still early, but what can you already observe regarding the Omicron variant?
KL: It is possible that this variant has different properties from those of its predecessors, such as extreme contagiousness and clinical signs that are not exactly the same. We thus note specificities at the level of the patients: on the one hand we have patients carrying Delta who arrive with a clear Covid at the hospital... and others who arrive with various pathologies and in whom we discover, by testing them upon their arrival in the ER, Omicron's presence went unnoticed. In their case, we cannot really speak of a Covid, since Covid is a disease with well-defined symptoms (the main one being hypoxemic pneumonia, that is to say requiring high oxygen requirements) and here absent, but rather an asymptomatic carriage.
So we have for the moment more another form of epidemic than a simple new wave. But we are at the very beginning of this sixth sequence, so it is difficult to see where it will lead. However, we have the examples of England and South Africa, which have already passed their peak and where it seems that Omicron has caused fewer serious Covid forms. In England, currently, out of ten people who arrive in Emergency for Covid, one goes to intensive care; usually it's one out of five… That's why we sometimes hear that it's twice as pathogenic.
What is it due to? To the intrinsic properties of Omicron… or to the fact that 75% of the population is vaccinated (90% in France)? It is still too early to tell, we will have precise statistics within a fortnight.
TC: Is there already data regarding the symptoms of Omicron?
KL: The first clinical observations that we make are that Omicron would rather give "high" forms of affection: of the pharyngitis and laryngitis type, sore throats which evoke angina, runny nose... things rather affecting the ENT sphere, and not the deep lung unlike Delta. In vaccinated people, especially those who have received three doses, we have many carriers who are asymptomatic or who develop rare symptoms over two to three days – like a kind of flu, with a little sore throat, sometimes a little fever, aches and then it passes.
We must nevertheless remain cautious: the last week of December, 14% of people hospitalized for Covid in intensive care with us had Omicron.
Another point, we have 500 children hospitalized in France for Covid (we don't yet know if it's Omicron or Delta), the highest number we've had – and 80% have no comorbidities. Which is proportionally normal: with several hundred thousand people becoming infected every day, children are inevitably affected. But in this case, it is an epidemic that has been meteoric among them and young adults.
And there is the question of PIMS ( pediatric multisystem inflammatory syndrome ) which can affect children three to four weeks after their Covid. We had a few cases with the other variants, what about Omicron? It is something that worries, and we will not know more before February-March. ( Between March 2, 2020 and December 26, 2021, 826 cases of PIMS were reported, including 745 related to Covid-19. The number of cases has been increasing since the end of November indicates Public Health France , editor's note )
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https://theconversation.com/avec-om...epidemie-qua-une-simple-nouvelle-vague-174713