WHO’s five stabilisers+ to handle the Omicron surge

WHO’s five stabilisers+ to handle the Omicron surge
Credit: EU

WHO warned today that the Omicron variant represents a new tidal wave sweeping across the European Region, on top of the Delta surge that all countries were managing until late 2021.

As previously reported by The Brussels Times, Dr Hans Kluge, the regional director of WHO/Europe, said at a press conference on Tuesday (11 January) that at current rate more than 50% of the population in the region will be infected with Omicron in the next 6-8 weeks.

“How each country now responds must be informed by its epidemiological situation, available resources, vaccination uptake status and socio-economic context,” he added.

The Region saw over 7 million newly reported cases of COVID-19 in the first week of 2022, more than doubling over a two-week period.  As of 10th January, 26 countries report that over 1% of their population is catching COVID-19 each week. Mortality rates remain stable and continue to be highest in countries with high COVID-19 incidence, combined with lower vaccination uptake.

Data collated in recent weeks confirms that Omicron is highly transmissible – because its mutations have enabled it to adhere to human cells more easily, and it can infect even those who have been previously infected or vaccinated.

On the positive side, the currently approved vaccines do continue to provide good protection against severe disease and death, including for Omicron, he said.

“But because of the unprecedented scale of transmission, we are now seeing rising COVID-19 hospitalizations. It is challenging health systems and service delivery in many countries where Omicron has spread at speed and threatens to overwhelm in many more.”

Hopefully the surge in daily cases will peak in a few weeks, as already can be seen in some countries, but when it will happen depends on the specific situation in each country and the measures put into place, said Dr Catherine Smallwood, a WHO senior emergencies officer. Asked by Brussels Times about the likely number of severe cases, she referred to recent data received from WHO’s member states.

The set of data comprises 30,000 cases, the majority of which showed mild symptoms. Only ca 1 % of the cases were hospitalised, which does not differ from previous variants. Contrary to previous COVID-19 waves, among those hospitalised, less people required intensive care or ventilation.

This confirms the situation in Belgium, where of those admitted to hospital, only 10 – 15 % are currently referred to an intensive care unit.

But higher transmission rates mean more hospitalisations and more severe cases, especially in countries with low vaccination rates. Societies with high vaccination rates can tolerate a higher degree of transmission, she said.

The booster vaccination with a third shot is currently being rolled out in the EU and many countries have decided to start giving it already after the fourth or fifth month after the primary vaccination because of the waning effectiveness of the previous vaccination. Can we expect to have to take further booster shots every few months during 2022?

“Every country needs to proceed with completing the primary vaccination and to protect its vulnerable population with both primary vaccination and boosters,” replied Dr Siddhartha Datta, Programme Manager at WHO. He pointed out that 40 % of the population in the European Region is still unvaccinated.

While the efficacy of primary vaccination has decreased, boosters resurrected the immune defense. Has WHO a common position on booster vaccination as a way out from the pandemic in Europe?

“We don’t see any contradiction between advocating vaccine solidarity and giving booster shots to protect vulnerable population groups,” Dr Kluge replied. While underlining that Europe is a front-runner in sharing vaccines, he added that no country can “booster” its way out from the pandemic.

Can we expect that the pandemic will cease during 2022 and become endemic? “It may become that in due course but we are far from that,” Dr Smallwood replied. “It would mean that the transmission rate has stabilised. Today, we see unpredictable transmission rates which drive the pandemic around the world.”

WHO’s messages

Dr Kluge outlined three key messages for handling the current situation and managing the impact on health services, economies and societies.

Firstly, for countries not yet hit by the Omicron surge, there is a closing window of opportunity to act now and plan for contingencies.

“We therefore urge these countries to mandate the use of high-quality masks in closed and indoor settings, and ensure that vulnerable individuals have access to them.

People should be supported to get their full vaccine series and booster dose as soon as it becomes available – making sure health workers and other essential workers have early access to booster doses to keep services going.

The public should be made aware of the importance of immediate isolation if experiencing symptoms, as the virus spreads most in the few days before and after symptoms first appear, and that, if needed, they are knowledgeable on how to self-test and know how to inform their contacts if they have symptoms or test positive.

Secondly, where the Omicron surge has begun, the priority should be to avoid and reduce harm among the vulnerable and minimize disruption to health systems and essential services. Lockdowns as during the first COVID-19 wave are a last resort. If required locally, care should be taken to tackle domestic violence, protect mental health and inject financial aid to closed businesses and unemployed people.

Reducing harm means prioritizing vulnerable people for primary course and booster doses, advising them to avoid closed, crowded spaces,  and offering people the possibility to work remotely wherever possible until the infection surge passes.

Where testing is constrained, PCR testing should be prioritized for individuals who are at risk of developing severe disease, health and other critical workers, inpatients in health facilities, and the first symptomatic individuals in a high-risk setting, for example long-term care facilities, of a suspected outbreak. He advised deploying rapid tests more widely.

In the current surge of Omicron cases, where contact tracing is likely to be overwhelmed, he advised prioritizing contacts at high risk of infection and contacts at high risk of severe outcome, i.e., household or vulnerable contacts, and high-risk settings.

Any decision to shorten recommended quarantine or isolation periods should be taken in combination with negative COVID-19 tests and only when considered essential to preserve critical service continuity. Any decisions to do so must be taken with careful weighing of the risks and benefits of doing so.

His third point was about schools. “Keeping schools open has important benefits for children’s mental, social and educational well-being. Schools should be the last places to close and the first to reopen.”

In summary, the 5 plus one pandemic stabilizers that have guided WHOs response in recent months, are as relevant for tackling Delta or Omicron today as they have ever been, he said.

“These remain our mantra: 1. Vaccination, 2. Third doses or boosters. 3. Increased mask use. 4. Ventilation of closed spaces. 5. The application of new clinical protocols. Plus, our overarching drive must be towards vaccine sharing and solidarity - across age-groups, sectors, borders, and political lines.”

The Brussels Times

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