OMICRON SURGE The end of the pandemic, and start of an endemic?

91
omicron
Illustration: LEONARDO A. PUTONG

IO – The Covid-19 pandemic is not over yet. Many countries are still seeing surge in cases and deaths fueled by the ultra-infectious new variant Omicron. First detected in South Africa, it has rapidly superseded Delta to become the dominant strain across the world. 

Since Omicron made a landfall in Indonesia in early 2022, allegedly brought in by international travelers, daily confirmed cases have soared exponentially. In the past month, Indonesia’s daily caseload has skyrocketed. By February 15, it has exceeded the figure of the Delta-fueled second wave in mid-July of 2021, when as many as 57,049 people were infected in a single day. In the last few days, it has even surpassed the 60,000 mark to 64,718 cases as of February 17. If, as many experts predict, Omicron will cause 2-3 times more infection than Delta, then daily cases could soon hit 114,000-171,000. Judging from other countries’ experience, the Omicron wave is expected to last between 37-67 days. (FIGURE-1) 

Table

The island of Java has been the epicenter of the third wave, with Jakarta recording the most cases. However, in recent days, the trend has noticeably shifted to West Java. The province has topped the chart in terms of daily cases and active cases, followed by East Java and Jakarta in the third place. Coordinating Maritime Affairs and Investment Minister Luhut Binsar Pandjaitan believed that Jakarta has passed its peak a few days ago so the number of infections will continue to drop. On the other hand, several provinces that have logged a very low cases are West Sulawesi (54 cases), Gorontalo (65 cases), Aceh (86 cases), and North Maluku (99 cases). (FIGURE-2) 

According to the latest Health Ministry data, positivity rate per February 20, 2022 was 17.3%, a slight drop from 18.59% recorded four days earlier. The five provinces with the highest positivity rates are Banten, Central Java, North Sulawesi, West Java and Jakarta. This has far exceeded the WHO guidance, which is 5%. The last time the country saw positive rate below 5% was in August, September, October and November last year. Positivity rate is the percentage of people who test positive for the virus from the overall population who have been tested. The increase in positivity rate also shows Indonesia’s improved capability in testing and tracing. 

Table

By January 30, the number of people tested was 5.75 per 1,000 inhabitants per week, far higher that WHO recommendation of 1 per 1,000 population per week. As part of the early detection efforts, testing and tracing can prevent further transmission of the virus, as well as emergence of new clusters. It can also detect the early symptoms each individual displays. This is important to avoid delay in case management considering that the highly transmissible Omicron strain tends to be asymptomatic. It is worth noting that the five provinces with the highest positivity rate actually have high vaccination coverage and relatively better health care infrastructure. 

This is also the case with Europe. Even though it has the highest vaccination rate in the world, it was still hit hard by Omicron wave. Does this mean that Omicron can still infect people who have been fully vaccinated? According to virologists, Omicron is at least four times more infectious than Delta, and in most cases, it can penetrate the immunity gained from the vaccines. However, it should also be noted that most of the patients hospitalized with Omicron turned out to be those who had yet been vaccinated. They are six times more likely to be hospitalized than those already fully vaccinated. This confirms WHO findings that Covid-related mortality rate tends to be higher in countries with low vaccination rates. 

The latest data on vaccination coverage in Indonesia is currently at 91.01% for the single vaccinated and 67.2% for the double vaccinated. The government is still working to accelerate the vaccination for 208.2 million people, expected to be completed in March or April this year. (FIGURE-3) 

Table

Currently, hospital bed occupancy rate (BOR) is observably lower than the Delta wave. This is also the case with ICU admissions. This can be seen from the BOR at the Covid emergency hospital Wisma Atlet in Kemayoran, Central Jakarta, which has started to decrease from 47.56% in February 19 to 43.6% the following day. 

The number of hospitalized patients is around 33%. Hospitals are not under strain to treat Covid patients during the Omicron surge. There is no region in Indonesia with BOR and ICU occupancy higher than 60%. In Jakarta, for example, of the 15,313 isolation beds available, only 54.9% was occupied; and of the 921 ICU beds, only 44.1% were filled. This is different during the Delta-driven surge, where hospitals in Jakarta were treating 18,824 Covid-19 patients during the peak of the second wave. Nationwide, the total number of beds stands at 78,825 which can be scaled up to 156,847. For Jakarta alone, BOR in 196 Covid-19 referral hospitals currently stands at 6,496 out of 13,777 installed capacity. When deemed necessary, this can be increased to 21,000. So there is still plenty of wiggle room at the moment. 

Most Omicron cases are mild or asymptomatic and the length of treatment period is also shorter compared to when caused by other variants. This shows the effectiveness of vaccines in reducing the severity level. Thus, the Health Ministry recommends that people with mild symptoms or asymptomatic who do not have comorbidities and are not in the elderly category to merely self-isolate at home or if this is not possible, they can do it at the government-organized centralized isolation facilities. The government also urges people not to panic over Omicron and to take advantage of telemedicine services or report to the nearest community health center (Puskesmas). This way, hospital treatment can be prioritized for patients who need more intensive care due to moderate, severe or critical symptoms, and for those with comorbidities. This is expected to reduce the burden on health workers and hospitals by up to 60-70%.