Omicron could more than double Covid reinfection risk – but don't panic yet

New data from South Africa suggests that the omicron variant could more than double the risk of being reinfected with coronavirus – Kirsty Wigglesworth /AP

Alarming new data from South Africa suggests that the omicron variant could more than double the risk of being reinfected with coronavirus, leading predictably to calls for tough restrictions to be brought in to stop the spread in Britain.

Researchers from Witwatersand and Stellenbosch universities discovered that reinfections increased substantially between November 1 and 27, just at the time when omicron was gaining a foothold.

Compared to the original Wuhan strain, there was a 2.39 times greater risk of catching the virus again, suggesting it is dodging immunity. So far, so scary.

Yet this data might not be the smoking gun that it first seems. For a start, the authors made the surprising discovery that in South Africa there was a drop in reinfections of about 30 per cent after delta became dominant.

The findings are entirely at odds with data published this week from the Office for National Statistics (ONS), which found people in England had a 36 per cent reduced chance of a reinfection under alpha, with secondary cases rising as delta took hold.

It is a good indication that variants are not playing out the same way in different countries.

This is likely to be caused by a number of factors, including population age, vaccination uptake and different immunity profiles caused by which variants have been dominant.

South Africa has a far younger population than Britain, with an average age of 27, compared to 40 in the UK. In the new study, reinfections were concentrated in adults between the ages of 20 and 55 years.

This may be an important factor because ONS data shows that reinfections are more likely to occur in people who have a mild bout of illness the first time around.

Those who tested positive with lowest viral load were three times more likely to suffer a reinfection, while those with symptomatic Covid were 33 per cent less likely to suffer a reinfection.

So it may be that people who suffered low-level infections in the first wave are now at risk because of a lack of immunity, yet are not picking up severe infections because of their age profile.

This is tricky to establish from the study because the South African authors were not able to to determine the severity of infection in the dataset they were using. However, early anecdotal data from doctors suggest most omicron cases are mild, which is what would be expected in younger, fitter populations.

Undoubtedly the omicron variant looks nasty with its dozens of mutations, many of which are associated with immune escape and extra transmissibility.

And infection numbers are causing concern in South Africa. Cases in Gauteng, the country’s most populous province, have increased by 375 per cent week on week, while hospital admissions have risen 4.2 per cent and deaths by 28.6 per cent.

Yet it is worth remembering that South Africa has very poor vaccine coverage. Just one quarter of the population has had two doses, compared to nearly 70 per cent in Britain.

The National Institute for Communicable Diseases said earlier this week that 87 per cent of hospitilised cases in South Africa were unvaccinated.

Dr Michael Head, Senior Research Fellow in Global Health, of the University of Southampton, said: “The situation should, to some extent, be different with vaccine-generated immunity.

“The immune response from vaccination is much stronger when compared with infection-acquired immunity. Whilst there is likely to be some impact, it is likely vaccines will still provide some level of protection.”

High vaccination uptake in Britain, coupled with high infection rates also may mean the virus has fewer places to go.

Recent research from the London School of Hygiene and Tropical Medicine (LSHTM) suggests England now has the least susceptible population in Europe, with just 62 per 100,000 at risk of hospitalisation compared to 840 per 100,000 in Romania.

It may explain why Britain is escaping the eye-watering European surge which has led to new lockdowns and mandatory vaccination on the continent, and why we might escape a similar fate to South Africa.

Francois Balloux, Professor of Computational Systems Biology and Director at UCL said: “South Africa has a low vaccination rate but a large proportion of the population has been infected during previous Covid-19 waves. The population of South Africa also tends to be fairly young with a median age of 27.6 years.

“As such, the results from this study are not directly portable to other settings such as Europe or North America and more data will be needed before we can make any more robust prediction about the potential threat posed by a global spread of the omicron variant in different parts of the world.”

UK's immunity different to South Africa's

Intriguing new research from Imperial College is also showing that people become “imprinted” with a specific immune profile after encountering coronavirus, its variants and the vaccines, and this dictates how well they will fight off new variants.

In a paper published this week, scientists found that those who contracted the original Wuhan strain had fewer antibodies capable of fighting off the Delta strain, but those who became infected later with Alpha had developed antibodies better attuned to the new variant.

It suggests that in countries like South Africa which have encountered different variants and have far lower vaccine uptakes than Britain, the immunity of the population will not be the same.

Danny Altmann, Professor of Immunology at Imperial College London, said he had been initially terrified after seeing the amount of worrying mutations that the omicron variant carried.

But at a briefing on Friday, Prof Altmann said he had been “calmed” by real world data, showing the majority of hospitalised patients are unvaccinated and his own new research which he said suggests British population immunity is likely to be different to that of South Africa.

He said: “I was one of the people who was quite fast to say I was terrified by the mutations. And I'm still kind of terrified by them. But I'm also kind of calmed by the real life on the ground data as it looks like even in South Africa, with low vaccination uptake, vaccines are holding up to some extent against it.

“What it means for this county, is I think we can calm down, the jury's out. We've got a high level of vaccination and a backdrop of delta.”

Rosemary Boyton, Professor of Immunology and Respiratory Medicine, at Imperial said: “Most of us in the UK will have been imprinted by either the original infection or through two or three doses of vaccination or the Alpha or Delta variant.

“If we travel around the globe to Africa, or South Africa or to Brazil, you'll see populations who have been exposed to different waves of infection, so they'll again be imprinted differently.

“What we're seeing in this study is that it completely and absolutely shakes your subsequent immune response to subsequent variants of concern.”

What it all means in short, is that it is impossible to take data from South Africa and expect it to play out in Britain. We currently have very low levels of omicron in Britain with even Sage scientists admitting in their latest minutes that cases have not been increasing substantially in recent weeks.

Let’s keep calm and carry on until there really is something to panic about.

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