Thread by @ShabirMadh

Reflecting on SA experience with Omricon thus far in Gauteng - the epicentre in SA. 1. Rate of increase per capita much quicker than any of previous three waves. Strongly suggestive of more transmissible than even delta. 2. Positivity rate 30-40% in some settings.

3. Three weeks into resurgence, many adults and children testing SARS-CoV-2 pos in hospital , but COVID hospitalisation remains low relative to community case rate. High % (30%) women in labour coincidentally testing positive. Also,most children testing pos are coincidental Ix.

4. Death rate very low compared to period of same case rate in previous waves. Trend over next week will be informative, but optimistic unlikely to surge. 5. Study in SA and elsewhere confirm omicron 5 fold more antibody evasive than beta., hence many breakthrough and re-Ix.

6. Attenuation of clinical course of illness. Likely explanation is the 73% of population in Gauteng with previous infection and/or vaccine induced underpinning T cell immunity, since omicron largely antibody evasive. Hospitalisation for severe Covid mainly in unvacccinated

7. Unfortunate still delay rollout of 3rd Pfizer dose to older than 60yrs and immuncompromised. Little value doing so after the wave has already peaked probably in next 2 weeks. Likewise no 2nd dose for ALL single dose JJ recipients inexcusable with 15 million vaccines in depot.

8. Health facilities under pressure due to infections in staff, needing to go into isolation for 10’days- despite the isolation (and quarantine) recommendations being outdated and probably obsolete in context of underpinning immunity and widespread infection.

9. IF downturn in infection rate and no massive surge in hospitalisation and death in the next 2-3 weeks, may well mark turning point in pandemic, particularly since SA not boosting to prevent infection and mild illness like HIC are doing (at cost exacerbating vaccine inequity)

10. Gvt response correctly remains measured by not increasing restrictions and not panicking with increase in cases, but seem to rather focussing on COVID ( excluding coincidental Ix) hospitalisation and health facility capacity. 11. Lastly, vaccine coverage still lagging.