Netcare’s CEO confirms early optimism on Omicron: fractional mortalities, few admissions, minimal oxygen support

The CEO of leading South African private hospital group Netcare says the 10,000-bed establishment has had just 22 Covid-19 mortalities in the past month compared with up to 50 per day during previous waves of infection. He says early indications are the virus is mutating just like the Spanish Flu did with successive waves becoming increasingly milder until the virus posed little risk to human beings. 

Richard Friedland on Covid-19 admissions in Netcare hospitals 

Admissions have been incredibly low in contradistinction to all of the previous three waves. What we experienced then was, as community transmission increased, so did admissions to hospital, in tandem. We were under enormous pressure, hence the need to flatten the curve and introduce all sorts of lockdown measures. That is not the case at the moment.

On why admissions are lower than previous waves

I think we are seeing a different phenomenon here; a decoupling from the rate of community transmission and that of hospital transmission. It is early days. We’ve been measuring admission since 15 November and, clearly, we have had very few real admissions for Covid-19. Most of them are incidental. I think it is because the new variant is causing mild to moderate disease. In many cases, it’s asymptomatic. We have yet to see the severe form of the disease, which is what we define as people who require hospitalisation; those who’ve got your classic Covid-19 pneumonia and have a life-threatening disease that may lead to death.

Yes, in the elderly. Yes, in those with comorbidities and yes, in those who are not vaccinated. They are still at risk. But for a large percentage of patients we’ve seen, they are mainly incidental findings of Covid-19. What we mean by that is they don’t need any form of oxygen therapy. If you look at admissions over the first three waves, every single patient who came to hospital needed some form of oxygen. Their lungs were infected by the Covid-19 virus. 

Only 15% of our patients are currently on oxygen. The others are coming for surgical or medical procedures [via] emergency, and we happened to discover they have this new variant. 

This is the first time where we have a new category of patients we are classifying as incidental Covid-19 cases. We happened to discover they have Covid-19 and this is a critically important point. If you don’t need oxygen, why are you in hospital? We wouldn’t ordinarily admit someone whose oxygen saturations are in the 90s or in the high 90s. We generally admit those people whose oxygen saturation is below 90 and who have evidence of pneumonia or Covid-19 pneumonia. I think this is the key issue. If this variant persists and it is shown to be fit and it takes over the Delta variant, then we believe certainly – and I know it’s very early days – that this wave of Covid-19 can be treated primarily at a primary care level in community clinics, at your GP or pharmacy. 

On the mortality rate compared to previous waves

Thus far it is, certainly within our hospital setting. I think the one issue to measure in our country is excess deaths. Those have risen. They doubled to the week ending 29 November from 1,000 to 2,000. At the peak of the second wave, In January, there were 15,500 excess deaths a week. We still need to watch what is happening out there in the broader community. I can tell you from the reports that come out from the NICD on a daily basis (as well as our own) the deaths of far fewer than they ever were in any of the other previous waves.

On whether there were any deaths related to the omicron variant

Yes. We’ve had approximately 22 (Friedland said earlier that it was 12, but the correct figure is 22) deaths that we can ascribe to Covid-19. Many of the other deaths were incidental trauma patients or patients with very significant pre-existing comorbidities, such as cancer. 

The deaths that we can ascribe to Covid-19 definitively are approximately 22 since 15 November. That is a fraction of what we were seeing daily during any of the previous waves.

On Covid-19 and virus mutations

[This] is what happens. This is what we saw with the Spanish flu. We call it an antigenic drift. The Spanish flu never went away. It stopped killing people but it morphed into what we know is a very highly transmissible influenza or flu-like virus that is still with us today. One cannot say for certain the Omicron variant is robust enough to become a global phenomenon and that it won’t be outpaced or overtaken by another more severe variant. But certainly, if it remains as such, it augurs very well for the evolution of Covid-19. Again, it’s probably too early to make any definitive views on it. 

On what we know about the Omicron variant

We know that it’s highly contagious and transmissible. There was work that came out last week on Monday out of Japan, demonstrating that it’s 4.2 times as transmissible than the Delta variant, which was over 100% more transmissible than the Beta variant, which itself was substantially more transmissible than the initial strain.

Secondly, we know that it causes mild to moderate disease, and there’s no evidence that it causes severe disease, except in patients who are elderly and have very severe comorbidities. The third that we are uncertain of – but it does appear to be the case is – is this a fit variant? Is it fit enough to take over and outpace existing variants like Delta? Certainly in South Africa, it appears, from laboratory data, that this is indeed the case. 

The fourth element that we don’t really yet understand is how effective vaccination is. It does appear to be effective but there is a debate still raging as to which vaccines, after how many boosters. I think we have got to give our researchers and scientists a bit more time in this regard. I can tell you one thing, 75% of the patients in our hospital who have Covid-19 are not vaccinated. I think that speaks volumes to the point that we should all be vaccinated. The majority of those who have died, of our 22 deaths, are patients who have not been vaccinated.

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