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Group size curbs should be retained given high transmissibility of Omicron variant, say experts

SINGAPORE — While the Covid-19 Omicron variant may be less severe than Delta, its sheer transmissibility will still pose a threat to hospital capacity, infectious disease experts told TODAY. Most agreed with the Government's decision to retain the present group size restrictions over the Chinese New Year period.

Group size curbs should be retained given high transmissibility of Omicron variant, say experts
  • The Government on Wednesday said group size restrictions will be kept over Chinese New Year due to the threat of the Omicron variant
  • Infectious disease experts agreed that the sheer transmissibility of the variant means it will still pose a threat to hospital capacity
  • However, some experts said that the approach reflects an "abundance of caution"
  • Data from overseas show that those with the variant have a lower chance of hospitalisation
  • Experts cautioned that not enough is known about Omicron to conclude that it is a mild illness

SINGAPORE — While the Covid-19 Omicron variant may be less severe than Delta, its sheer transmissibility will still pose a threat to hospital capacity, infectious disease experts told TODAY. Most agreed with the Government's decision to retain the present group size restrictions over the Chinese New Year period.

However, two experts said that the approach reflects an "abundance of caution", and think Singapore's healthcare system, coupled with the lower severity of Omicron, could mean it is ready to handle higher infection numbers should measures be relaxed. 

All the experts noted that Omicron represents a different threat than Delta given that it spreads faster than the earlier variant but appears to result in a lower percentage of hospitalisation and severe illness. Still, a smaller proportion of much larger numbers could still mean challenging overall numbers of severe cases, they added.

Associate Professor Alex Cook from the National University of Singapore's Saw Swee Hock School of Public Health said that in the worst case scenario, more people could require intensive care unit (ICU) treatment at the peak of the Omicron wave than the current ICU capacity here.

According to the Ministry of Health's (MOH) website, as of Friday (Jan 7), 13 Covid-19 patients were in ICUs, while 213 ICU beds were empty. 

However, Dr Cook said that in the "worst case scenario", the number of ICU patients will not exceed the capacity that Singapore can step up to. 

Health Minister Ong Ye Kung said last year that up to 1,000 ICU beds can be opened up if needed. 

This worst case scenario... does not account for the new therapeutics such as monoclonal antibodies, and in the better case scenarios the wave could be less severe overall than the Delta wave.
Associate Professor Alex Cook from the National University of Singapore Saw Swee Hock School of Public Health

"This worst case scenario... does not account for the new therapeutics such as monoclonal antibodies, and in the better case scenarios the wave could be less severe overall than the Delta wave," said Dr Cook. "Greater uptake of boosters would temper the impact of the Omicron wave."

On Wednesday, the authorities had also projected that the impending Omicron wave could result in up to 15,000 cases a day in Singapore. 

Agreeing with this projection, Dr Leong Hoe Nam from Rophi Clinic at Mount Elizabeth Novena Specialist Centre said that data from other countries showed that the Omicron variant has three times the peak numbers of Delta.

"We had about 3,000 to 5,000 cases at the peak for Delta, so we should expect similar numbers (of up to 15,000 cases a day)," he said. 

A DIFFERENT THREAT THAN DELTA 

Given the high projected numbers, Professor Dale Fisher, a senior infectious diseases consultant at the National University Hospital, said that the threat posed by Omicron is "very real" and at the same time is different from concerns over Delta.

While Singapore has been worried thus far in the pandemic about ICUs being overwhelmed by severe Covid-19 cases, the issue other countries are facing with Omicron is that significant proportions of their population are being infected in "a very short space of time", said Prof Fisher.  

"If 5 per cent of the population has Covid at the same time then this also means 5 per cent of our essential workers will be in isolation and unable to work," he said. "This includes healthcare workers, power, water, sanitation... Most organisations cannot afford to lose so many at once." 

If 5 per cent of the population has Covid at the same time then this also means 5 per cent of our essential workers will be in isolation and unable to work. This includes healthcare workers, power, water, sanitation...
Professor Dale Fisher, a senior infectious diseases consultant at the National University Hospital

He added that this also means that a higher percentage of patients who are being admitted to hospital for various non-Covid reasons may also happen to have the virus, and this poses a further strain to the healthcare system. 

"They are not there for Covid but still need to be isolated," he said. "We are starting to see this now in our hospitals." 

'AN ABUNDANCE OF CAUTION'

However, some experts said that Singapore is well positioned to deal with the impending rise in Omicron cases, and that there has been an "abundance in caution" in the Government's response to the variant. 

Dr Leong said that Singapore is "better positioned than ever" with more Covid-19 treatment facilities, new treatment options such as monoclonal antibodies and a higher proportion of the population vaccinated. 

"We are being extremely cautious... If you look at the numbers of new cases daily from Omicron, the feel on the ground is that the disease is not rising as fast as other countries exposed to the Omicron variant," he said. "That gives me a better sense of optimism." 

Agreeing, Professor Paul Tambyah, president of the Asia Pacific Society of Clinical Microbiology and Infection, said that the estimate of 15,000 daily cases is a "worst-case scenario", much like how the 5,000 daily cases projection for Delta last year occurred on only one day. During that week in October last year, the seven-day average for the number of cases was lower, at 3,690. 

He added that hospitals have improved their services, such as being able to treat patients at home, and will be in better stead to deal with the current wave than they were with Delta. 

We are being extremely cautious... If you look at the numbers of new cases daily from Omicron, the feel on the ground is that the disease is not rising as fast as other countries exposed to the Omicron variant.
Dr Leong Hoe Nam from Rophi Clinic at Mount Elizabeth Novena Specialist Centre

"There was a period we had more than 500 hospitalisations a day not too long ago," said Prof Tambyah. "The system has coped in the past so there is no doubt that it will be able to cope again." 

BETTER TO PLAY IT SAFE AMID UNKNOWNS

Reports from overseas suggest that the Omicron variant is less severe, resulting in lower rates of hospitalisation and ICU admission. 

The BBC reported that in the United Kingdom, Omicron patients are up to 70 per cent less likely to need hospital care compared to those infected by previous variants.

United States broadcaster NPR reported from a study that found that across the US, emergency room presentations dropped from about 15 per cent of infections during the Delta surge to 5 per cent during the early Omicron surge, and the risk of being hospitalised halved from 4 per cent to 2 per cent.

While the evidence suggests that Omicron is less deadly than Delta, Associate Professor Hsu Li Yang from the NUS' Saw Swee Hock School of Public Health said that it does not mean that the variant is harmless. 

He cautioned that hospitals in UK and US are being "stretched by sick Covid-19 patients as a consequence of the huge wave of cases they are experiencing". 

"Although our vaccination rates are much higher compared to these countries, it is difficult to be certain that our healthcare system will not get overstretched if we allowed the virus to spread more freely in the community," Assoc Prof Hsu said. 

"It is therefore wise not to step down from current restrictions for now, particularly during CNY where we expect more people to come together and be in close contact." 

He added that even if Singapore's healthcare system is able to cope with a surge of Omicron cases, it will be "good to let our healthcare workers have a relatively peaceful CNY break". 

Agreeing, Professor Tikki Elka Pangestu, a visiting professor at NUS’ Yong Loo Lin School of Medicine, said that it is a "misplaced and dangerous perception" to see Omicron as a mild virus. 

"The situation in Singapore has its own unique contexts and one needs to be careful in assuming that what is seen elsewhere will also hold for Singapore," he said. 

For instance, Singapore has a "significant" presence of migrant workers living in close quarters, and is also a population-dense state that is 80 per cent urban. 

"There are learning experiences from other nations that can be used to inform Singapore's response, but just be aware that this is a complex, multi-factorial problem which requires a holistic and integrated approach... it’s a ‘moving target’ in that the situation is changing almost weekly," he said. 

Related topics

Covid-19 coronavirus Omicron coronavirus Delta variant Chinese New Year

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