Is Omicron destined to usher in Israel’s 5th outbreak, or will it ‘downgrade’ COVID?

Government adviser says ‘significant chance’ new coronavirus strain means a phase of high infection, but top doctor thinks it may prove milder, making it ‘the variant we wish for’

Nathan Jeffay

Nathan Jeffay is The Times of Israel's health and science correspondent

Illustrative image: Two COVID patients in hospital (AP Photo)
Illustrative image: Two COVID patients in hospital (AP Photo)

Is this the calm before an intense Omicron-induced storm? Or is Israel on course to carry on enjoying low COVID levels, at least for now?

Government adviser Prof. Eran Segal thinks that there is a “significant” chance that Omicron is likely to become dominant and sweep Israel toward its fifth wave of infections.

“There is significant possibility that we will see a fifth wave due to Omicron, given what we’re learning about the variant,” the Weizmann Institute of Science computational biologist told The Times of Israel. “It could take several weeks, but there’s a significant chance it will happen.”

A vastly different assessment comes from the quiet virus wards of Hadassah Medical Center in Jerusalem, where the head of COVID-19 care, Prof. Dror Mevorach, thinks the current low number of patients could well continue. He is, in fact, hopeful that Omicron could “downgrade the severity of coronavirus illness.”

Both experts are eagerly consuming all the same Omicron news as it emerges, such as information on the unusually high number of mutations that may allow the variant to dodge vaccines. Omicron has been detected in 38 countries, but no deaths from it have yet been reported, the World Health Organization said on Friday.

For Segal, the absence of deaths, the fact that only a few cases have so far been detected in Israel, and the quiet wards are all meaningless in terms of assessing Omicron’s risk.

A health care worker takes samples of Israelis in a drive-through complex to check if they have been infected with the coronavirus, in Modiin. (Yossi Aloni/Flash90)

It takes time for cases to spread, and more time for cases to filter through to hospitals, but it is likely to happen, he predicts.

“Every time, people say ‘oh, cases are low,’ but with exponential growth, once you reach 100 new cases a day, very rapidly you can get to 1,000 within two or three weeks.

“And if you get to that stage, you soon start to see hospitalizations rising. We shouldn’t allow the fact that numbers are now low to confuse us regarding the need to prepare for this. The nature of exponential growth is it takes time, but numbers can rapidly become humongous.”

Eran Segal (courtesy of Eran Segal)

And this will inevitably translate to hospitalizations and deaths, he said, dismissing the possibility that Omicron will prove milder as very unlikely.

Segal said that exponential growth with COVID-19 is normally bad, but with Omicron could be much worse. He commented: “The real concern is there seems to be growing evidence that it will be more transmissible than Delta. So while our R number (the average number of infections caused by each virus carrier) is around 1 it could go above 1. Even 1.2 or 1.3 could be quite bad if it goes on in the long term.

“If it is more transmissible, there is no doubt that it will be the dominant strain here. In theory, that could be bad because if you have a more transmissible strain, even if it’s not more lethal, you’ll have greater exponential growth, which means a higher number of new cases.”

Mevorach, the Hadassah doctor, said that as he enjoys the sight of near-empty wards, he questions whether he is “akin to the man falling from the Empire State Building, who says as he passes the 20th floor: ‘This isn’t so bad.’”

Prof. Dror Mevorach, head of Hadassah hospital Ein Kerem’s coronavirus department, February 9, 2021. (Channel 13 screenshot)

But all things considered, he is optimistic. “After treating more than 5,000 patients in four waves, I know this is a very dangerous disease, yet I am still starting to see some light at the end of the tunnel,” he said.

This is thanks to vaccines, which have been administered to a large number of Israelis aged five and up, along with new antiviral treatments, which together mean that doctors have reached “a new era for fighting COVID.” And he thinks that the absence of deaths and reports of milder symptoms from Omicron than from other variants could give cause for hope.

The European Centre for Disease Prevention and Control reported on Thursday that among the first 70 Omicron cases in Europe, half had no symptoms, the othe rhalf had mild symptoms, and there were no hospitalizations or deaths.

Some scientists say that it makes evolutionary sense for the virus to become milder. Dr. Carlos Del Rio, an infectious diseases expert at Emory University in Atlanta, said in a briefing that “some evidence from South Africa suggests that it may actually cause more mild illness” — though he noted that these cases were among young university students.

Mevorach told The Times of Israel: “On the one hand, Omicron is a menace, but on the other hand it may represent the variant we wish for. What is it that we wish for? One hope is that the disease disappears. But, if it doesn’t, we want a variant that’s transmitted easily but causes only very mild disease.

“It looks now like Omicron could represent this, and I see this possibility. If this is the case, it could transform the disease from something that is very threatening and causes illness and mortality, to something that is more like the flu, which does cause illness and mortality but in smaller numbers.

“I’m optimistic — though I know that in three or four weeks, that could change.”

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