Have cases of Omicron already peaked in South Africa's hot spot?

(AP Photo/Bram Janssen)

Dare we feel a note of optimism about the end of the pandemic at a moment when pessimism has never been more oppressive?

Maybe. Over the weekend scientists noticed that cases on Gauteng province, the epicenter of South Africa’s Omicron outbreak, seemed to be leveling off. If the worst is already behind them with relatively few hospitalizations and zero deaths then maybe the new variant won’t be a beast after all.

A researcher in Johannesburg is speculating that no country will see its hospitals overrun due to an Omicron surge:

Despite cases exploding there over the past month, South Africa’s case fatality rate is *falling,* which is what you’d expect from a new variant that’s super transmissible but rarely lethal.

Is the pandemic over? Well, hold on.

Experts were watching to see what today’s new case numbers would be. Would the downward drift in Gauteng continue? According to South Africa’s top agency, new cases clock in at under 6,800, the lowest level in a week. Maybe the province really has peaked.:

Cases nationally have also declined over the past few days, a hopeful sign — but one that comes with a catch. The NICD is still working through a backlog of reporting so the recent numbers may undercount the true number of cases. We’ll have to wait a few more days to see if they’re adjusted upward retrospectively.

Meanwhile in Europe, though, scientists are shocked by the speed at which Omicron is spreading. All eyes are on Denmark and the UK, both of which are aggressively sequence the genome of their domestic cases to identify which strains of the virus are circulating. Yeesh:

If Omicron is as mild as Streicher surmises then super-exponential growth isn’t necessarily a disaster. But even a small fraction of a very big number will be a big number; if Omicron hospitalizes a smaller share of infected people than Delta does but ends up infecting half the population, that’ll mean many hospitalizations. And in fact, South Africa is already seeing its numbers climb:

The big worry with Streicher’s confident conclusion that the variant is mild is that hospitalizations always lag cases. Maybe the Omicron wave is still recent enough in Gauteng that a wave of very sick people is on the way but hasn’t arrived yet because the disease hasn’t reached that stage in the newly infected yet.

Scott Gottlieb is concerned that the Brits seem so concerned by what their data is telling them. There are already studies showing that people with three doses are solidly protected from Omicron, but people with two doses or natural immunity may be at risk:

Boris Johnson didn’t mince words in addressing the British population last night. The tone here, based on the considered opinion of British scientists who are studying Omicron, is the opposite of Streicher’s tone:

There’s another complication. Virologist Trevor Bedford explained this morning that it’s not a sure thing that infection by Omicron will grant you natural immunity that protects you from all other variants. Some (including me) have theorized that if the new variant is super-transmissible but extremely mild then it might operate as a sort of “contagious vaccine,” generating immunity in people without any of the nasty symptoms that you experience when you catch Delta. Bedford’s point, though, is that since Omicron seems more capable of puncturing the immunity of people than previous variants were, it may function to some degree as a distinct virus that produces a distinct illness. You don’t gain immunity from COVID if you catch the flu or vice versa, right? Well, the same may be true of Delta and Omicron:

Omicron might not outcompete Delta. It might just operate alongside it, potentially leaving people open to infection by different strains and maybe requiring an updated vaccine aimed at both. Still, if cases really are falling in Gauteng province then it must be that infection from previous variants provides *some* meaningful level of protection against Omicron. Only a quarter or so of South Africans are vaccinated but something like 75 percent or more are estimated to have recovered from COVID. If Omicron is running out of room to run, one would think it’s because those with natural immunity are blocking its path. Let’s hope so, because the last thing we need is two variants spreading instead of one.