A month of Omicron

Submitted by martin on 23 December, 2021 - 3:09 Author: Martin Thomas
Covid variants

A month on from the Omicron variant of Delta being identified by scientists in South Africa, more is known about it but much remains, and is likely to remain, unclear.

Immunity from vaccination or previous infection works less well against Omicron. Probably, however, it makes eventual infection milder.

More or less certainly, Omicron can transmit faster than Delta. We don't know whether that is just because of immunity-evasion, or it would spread faster anyway in a population new to Covid.

Probably, it produces somewhat milder symptoms. We don't know how much this result is down to Omicron arriving in populations with high levels of vaccination or previous infection, and how much it is a property of the virus itself.

The experience in countries where Omicron has hit early is mixed, and we don't know how to explain some of the variations.

South Africa and Botswana, where Omicron was first detected, have low vax rates (but probably fairly high levels of immunity from previous infection). Case counts have spiked in South Africa a bit higher than in previous surges. Since mid-December they look like falling again. Death counts there have risen, but much less than in previous surges. South Africa has maintained its "level 1" covid-distancing measures (mask mandates, early closing, curfew, nightclubs entirely closed) in force since 1 October 2021.

Case counts have been erratic in Botswana, which has little testing capacity. Death counts there have not risen markedly.

Norway seems to have been the first country hit by Omicron in Europe. Previously Norway had done better with Covid than perhaps any country in the world other than some which could and did close their borders rigidly. Norway has had a big case-count spike, now tentatively subsiding. It has had a death-count spike higher than any previous, though still lower than most countries' spikes. That looks like levelling off.

Norway brought in new restrictions from 16 December 2021 (mask mandate, limits on size of events, distancing rules in cafés and bars, recommendation to limit household mixing).

The Netherlands has had probably the world's biggest Omicron spike so far. From 28 November it closed shops, cafés, bars, etc. from 5pm to 5am. On 18 December it started a lockdown as sharp as or sharper than its early-2020 rules (shops, cafés, bars, museums, cinemas entirely closed; outdoor gatherings limited to two people), which will run to 14 January. The case count is now decreasing. Its death count increased to about half its early-2021 peak and a third its early-2020 peak, and is now decreasing.

The UK's case count has now risen above the Netherlands' peak. The UK does much more testing than any other big country, maybe six times as much as the Netherlands. That increases the reported count. In the UK, though, there is no sign of the case-count rise levelling off. The rise has been linear rather than exponential, but a very rapid linear rate.

The UK stands out in Europe, as it has done most of the time since July, in having only weak covid-distancing rules and relying almost entirely on high levels of tests and booster vaccinations. (The UK has done almost four times as many boosters as the Netherlands, proportional to population; almost twice as many as Norway; one-third more than Germany).

Much of the UK's heavy toll is probably down to "structural" issues:

• The NHS and social care being run on pauper budgets, so that the NHS was overstretched even before Omicron and winter arrived. (The UK has only half the EU average of hospital beds per population.)

• Low or zero rates of isolation and sick pay; lots of workers on zero-hours contracts (which are illegal in Norway, for example)

• Much overcrowded housing, and no public provision of quarantine accommodation for those otherwise trying to "self-isolate" in overcrowded housing

• Poor levels of workplace safety. In New York, for example, all public schools had to get (and publish) engineers' reports and fix their ventilation if necessary before reopening. In the UK, we have only vague recommendations that more ventilation would be good, without funding for improvements.

The Tories have preferred to spend billions on supposedly quick-fix testing and booster schemes, rather than commit to social improvements bringing longer-term costs and longer-term shifts in the balance of power, or deploy covid-distancing rules.

The fact that the UK's case count is still zooming up, while countries earlier-hit by Omicron and with lower or zero booster rates look like levelling off their Omicron spikes, makes a strong case that all those other governments which have introduced or maintained stronger covid-distancing rules have made a better choice. The argument that it is better to act quickly once an emergency becomes inevitable - as it did with Omicron already in late November - rather than wait until the emergency is in full flood and then try to calm it after the event, is irrefutable.

Exactly which covid-distancing rules is a tricky business even for the best-qualified scientists to recommend. It's impossible to do proper experiments to test them. Drawing conclusions from the varying effects of varying rules in varying populations at varying times is difficult because each effect has to be deduced from outcomes which are whirls of dozens of factors. I think we have been right when we have consistently refused to claim expertise here or to latch on to this or that measure as a "magic bullet".

However, we have no choice but to attempt some intelligent comment.

Firstly, the proposal for short "circuit-breaker" lockdowns makes no sense. It has been advocated by scientists, but never, as far as I can trace, with reasoned argument.

Wales tried a "circuit-breaker" lockdown between 23 October and 9 November 2020. That reduced case counts a little towards the end of the period, as you'd expect; but, as you could be pretty sure would happen, the case counts jumped right back up again after 9 November. There is no evidence of lasting gain.

Lockdowns do not "break" the circuit, unless they are in areas with extremely low case levels in which every individual contact of an infected person can be traced within a few weeks. They only delay the circuit of the virus. Delay is often valuable, allowing time for more vaccinations, avoiding peaks which overwhelm health-care, and so on. But that usually requires longer-lasting, more sustainable restrictions. A quick-fix short lockdown will not do the job.

Second, the one thing that almost certainly reduces transmission is lower levels of contact between people, and smaller numbers of large, crowded gatherings.

We know that from arithmetic rather than experiment. If you have ten close-ish contacts with other people each day (as was the average in the UK before March 2020), then that is 20 transmission opportunities. If the average goes down to 2.5 (as, in fact, without new rules, it did in early December), then it is 5.

If those 30 people meet in 15 pairs, that is 30 transmission opportunities. If those 30 people mingle in a crowded room, many of them talking face to face and all of them, anyway, exposed to the same air which will contain virus particles if one of them is infected, that brings 870 transmission opportunities. With 40 people, crowding together rather than meeting in pairs increases the transmission opportunities from 40 to 1,560.

Specific measures largely have as their aim to reduce contacts. Each individual measure will usually have (as far as we can tell) limited effects. For example, a recent paper from London School of Hygiene and Tropical Medicine scientists guesses the impact of a mask mandate in shops and on public transport as a 7.5% reduction in transmission. Other scientists guess the impact of a closure of bars and cafés as 12% (as long as people don't all meet instead in crowds in each others' homes, in which case the closure may actually increase transmission).

The limited effects are far from worthless. An area with a R-number of 1.2 is likely to see case-counts doubling each fortnight, increasing 4-fold over a month. Reduce R by 12% and again by 7.5%, then it is down to 1, and cases don't increase at all.

On top of the notional R-reducing capacity of each measure, another consideration is how well it can be implemented. A rule that shops, cafés, etc. must close by 5pm, as the Netherlands had before full lockdown, seems puzzling at first. The virus does not become more transmissible after 5pm. But the early-closing is a simple, easily-enforced rule to reduce contacts and crowding.

We have long agreed with the many scientists who argue that school closures should be a last option, introduced only if closures of bars, cafés, nightclubs, cinemas etc. had proved inadequate, or if Covid is spiking so fast as to make it obligatory to "throw everything at it". Fortunately, that argument from the scientists now seems to have won ground almost everywhere. It won in Europe from as early as spring 2020. In the USA and the Americas, it remained common well into 2021 for schools to be shut while bars and cafés and nightclubs were reopened, but the argument seems won there too. No-one now is arguing for schools to be closed as a first response to Omicron (though there may indeed be a case for delaying January start of term, for example).

The simplest expedient (and most widely adopted by a variety of governments, of different hues) is closure or restricted operation of nightclubs, bars, cafés, cinemas, etc. The labour movement must demand such measures are accompanied by furlough payments. The expedient has social costs - working-class people lose out by not being able to go to cafés, bars, cinemas, etc., as well as their owners losing profits - but there is a fair amount of evidence for it being effective.

"Vax passports" (or rather vax-or-test-result passes) for big events and nightclubs, as in the Tories' Plan B, or for bars, cafés, shops, etc. as in many other countries, have three aims: to reduce the number of infected, and especially of high-infected, people in crowded spaces; to reduce the numbers in those spaces overall; and to push hesitant people to being vaccinated or at least tested.

Despite big demonstrations against it (dominated by the far right), the French government's "pass sanitaire" increased vax rates there a lot, and even reduced vax-refusal attitudes (the percentage of adults saying they would refuse vax went down in France from 44% in January 2021 to 24% in September, while it increased in Britain, from 18% in December 2020 to 22% in September 2021).

There is no guarantee of the same results everywhere, but there is no strong civil-liberties case against this measure. Getting vaccinated, like driving on the correct side of the road, not driving while drunk, or following workplace safety rules, makes life safer for everyone around you as well as for yourself. There is no absolute individual right to be reckless about your infectiousness to others.

The argument in principle is no different from compulsion on childhood vaccinations. Those are compulsory in France and in all the states of the USA, but not in Britain. Some countries, notably Portugal and Sweden, have achieved high childhood-vax rates without compulsion, but socialists have not (and rightly not) objected in principle to governments introducing compulsion if they can't achieve those high rates otherwise.

I can't, therefore, see much sense in the stance of those left Labour MPs who voted against the vax-or-test mandate for large events and nightclubs.

The vax mandate for NHS workers, which some left Labour MPs also voted against, is a different issue. It is not an "emergency brake" measure on Omicron. It does not come into effect until April 2022, by which time the Omicron surge will have passed.

Although the vax mandates for care and NHS workers have been among the issues taken up by the far right on their anti-vax street protests, they haven't been central there. However, health and careworker unions and professional groups have been both vehemently pro-vax and hostile to, or at least reserved on, vax mandates. As far as I can make out, most health and care workers have the same attitude.

A simple argument on "individual liberty" falls down: frontline health workers in various sectors already have some vax mandates, for example for hepatitis B. But there would have to be a very strong argument for the vax mandates for us to support them against the will of the workers and unions concerned. They argue that the reduction in care capacity resulting from non-vax workers quitting or being redeployed will outweigh any benefits. Such nuanced arguments have weight, justifying the left Labour MPs who voted against the NHS vax mandates.

I think we were right in November when we wrote:

"Trying to impose vaccination of recalcitrant minorities is... difficult. Compared to improving pay and conditions in the NHS and care, it may not be the best use of effort. By April health and care workers who haven’t been vaccinated are almost certain to have been infected instead, and to have not-very-different immunity that way...

"There is no overwhelming case for socialists positively to back the government’s vax mandate moves in England, or to press Wales and Scotland to follow. But there is equally no case to see stopping vax mandates as a good focus for trade union action".

Left Labour MP John McDonnell has proposed the following plan:

1. Circuit breaker lockdown

2. Furlough & business support

3. Sick Pay increase

4. Restore £20 Universal Credit Uplift and include legacy benefits

5. 10% pay rise for NHS & Social Care...

Points 2 to 5 make sense. Point 1 doesn't, but stronger restrictions modelled, say, on Norway's or Sweden's do. It's a pity that John McDonnell doesn't include other measures, like requisitioning all whole private health-care facilities and staff and bringing them into the NHS.

Clive Lewis, another left Labour MP, has written a long article on Covid, with some good points like "patents and intellectual property rules on Covid vaccines and medical technologies suspended so that vaccine manufacturing can be scaled up" (though why not make it simple: requisition Big Pharma?)

There are some odd bits in the article, though. He writes that "Labour can and should start making the case for adaptation as well as mitigation". (That is unclear. It could mean: take longer-term social measures such as we have argued for since early 2020. But it also sounds a bit like the right-wing "learn to live with it" line.) He complains about "the creation of a constant state of emergency". (Never mind constant, we have a state of emergency now. And there will be new variants like Omicron, though let's hope less drastic, for years yet, whatever we do. Even with the best policies, new Covid emergencies are likely to arise for years yet, though with any luck at a decreasing tempo.)

Lewis explains that he voted against the Tories’ Covid passport scheme out of general distrust of the Tories. The argument doesn't make sense, because he hasn't (and rightly hasn't) had an attitude of voting against all Covid restrictions since early 2020, any more than socialists have had a general attitude of voting against all traffic rules.

He also cites a recent report from the House of Commons Public Administration and Constitutional Affairs Committee (PACAC) as his authority. But that is not a scientific source: it is a political report from a committee chaired by a let-the-virus-rip, ultra-hard-Brexit Tory MP, William Wragg. The Labour MPs on the committee seem not to have produced a minority report, but they should have done. In any case, the report was well before Omicron.

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