A Doctor Writes: An Omicron Tsunami is Coming, isn't it?

We’re publishing a guest post by our in-house doctor, formerly a senior NHS medic, about the data released this afternoon. Does it support the claim that there’s a tsunami of Covid hospital admissions heading our way? Not really…

I have been asked to give a brief update on some interesting data released this afternoon. I hope readers will forgive a certain festive levity on my part and not consider it too inappropriate. For all I know we may be on the brink of a catastrophe. All I can say for sure is that it didn’t happen today.

Since Professor Whitty predicted at the Downing Street press conference on 15th December that ‘Records will be broken a lot in the next few weeks’, we have been glued to the numbers even more tightly than before. On Thursday afternoons a couple of large data packets are released by the NHS. They contain some surprising information.

Many expert colleagues have been predicting portents of imminent doom on the airwaves in the last week or 10 days. I have heard terms like ‘tsunami’ and ‘avalanche’ used to predict the coming wave of Covid admissions. Being a humble clinician and not an expert epidemiologist, I defer to my specialist colleagues on these points.

Graph 1 shows the extent of the avalanche so far in London, the epicentre of the Omicron wave in the U.K. I have graphed admissions from the community with Covid in London from the December 1st so readers can see for themselves the severity of the catastrophe.

I have been unable to find a quantitative definition of ‘avalanche’ in terms of Covid patients. What we can observe is that the seven-day moving average has increased from 90 patients per day on December 1st to 178 patients per day on the 21st. So about double in three weeks. If it carries on like this, by mid-June of 2022 there will be 91,136 new patients admitted with Covid every single day and the entire population will be in hospital.

There are about 20 acute general hospital Trusts in London, so at the moment about nine Covid patients per day each. Its fair to say that the admissions are not spread evenly across the capital. Most admissions are concentrated in the East and South-East of London. This may have something to do with lower percentages of vaccination in those areas. Anyway, this is clearly the foothills of the impending deluge which will certainly be along soon.

Graph 2 shows Covid inpatients across all hospitals in England as the Omicron avalanche makes its way through the nation with its fabled rapid transmission rate. Readers will observe that numbers have risen a little, mainly due to increases in London, but we are not yet at the peak seen earlier in the year. My expert colleagues tell me that we will shortly have more than the 26,000 COVID hospital patients than in January of 2021. It’s just a matter of time.

Regular readers will recall that in previous waves the serious pinch point was in ICU because resources in high dependency medicine are quite limited and difficult to expand quickly. Graph 3 shows the ravages of the Omicron wave so far. It is important to note that there is a lag between a patient catching Covid and becoming ill enough to require an ICU admission. But that’s just a temporary lull while Omicron gets itself together.

So far there has been a fall in ICU cases in England during December, and there are currently fewer cases in English ICUs than there were in August. ICU Covid bed occupancy in the stricken capital city has fallen from 210 a week ago to 196 this evening.

No one should take comfort from the observation. The tsunami will certainly arrive in the next week. Possibly two. Or maybe three. Professor Whitty says it is “nailed on”, so it will certainly happen, right?

The really interesting data released today was from the Primary Diagnosis spreadsheet. Readers may remember that this distinguishes between people suffering from acute illness with Covid (blue line) and patients admitted for other reasons but with an incidentally positive Covid test (orange line). Graph 4 shows the data for London as the Omicron wave devastates the capital.

Readers will note an increase in cases from December 1st. The fascinating observation is that incidental cases are rising faster than acute cases – the ratio between the two continues to drop. What this means is that although we are seeing more people with positive tests in December, a relatively smaller proportion of them are actually ill with Covid. The rise in patients actually ill with Covid in hospital has so far been relatively modest. Of course, that will not last, according to the SAGE modellers. By this time next week the NHS will be inundated with thousands of desperately ill people with Omicron.

Some doctor friends of mine say Graph 4 shows that Covid “is the passenger, not the driver”. I think they mean Covid isn’t the main reason people are in hospital – but they are the inferior and slightly dim sort of doctors that just treat patients and can only see what is going on at the present time. They are not clever experts in epidemiology and public health who can predict the future. We watch this space with great interest in the next few weeks as the avalanche inevitably picks up speed and overwhelms the NHS.

Graph 5 is particularly interesting and a bit ‘busy’ so I will talk you through it slowly. It shows a comparison between patients admitted from the community with acute Covid in the orange bars and patients contracting Covid in hospital plus admissions in the blue bars. The grey line is the ratio again. Graph 5 shows that Covid admissions have gone up substantially since the beginning of December, but that Hospital-acquired infections have gone up a lot more. This fits with what the experts have told us – that Omicron is a lot more transmissible. It seems to be more transmissible in hospital than in the community. I wonder why that might be?

Graph 6 shows the same data across the whole of England and the trend is even more pronounced than in the London data. Overall, in England, admissions from the community with Covid are flat. However, the number of people acquiring Covid in hospital has increased. I wonder if this is what my expert colleagues mean when they refer to an ‘avalanche’ of Omicron?

As you will have heard on the media, it’s very early days in the evolution of the Omicron variant in the UK. We can assess data from South Africa and several other European countries, all of which show that so far the hospital admission rate is far lower, the requirement for ICU care much less and deaths virtually zero from the new variant compared to the Delta variant. But we cannot extrapolate from those countries to make an predictions about the U.K., right? In fact, all the U.K. data I have seen has a remarkable consistency in suggesting that Omicron is less likely to put patients in hospital, especially if they are vaccinated, less likely to require ICU care, causes a shorter hospital stay and has a much reduced risk of death.

On the other hand, my expert colleagues caution against complacency. I am informed that the British population is different from all the other human groupings so far attacked by Omicron. Britons are older, sicker, fatter and more prone to viral infection than people in South Africa, despite a higher level of vaccination. In fact, the new deadly and highly transmissible Omicron variant can escape vaccine protection. So, it is essential that everyone immediately gets vaccinated.

Various colleagues have taken to describing the Panglossian optimism about the new variant being less dangerous than Delta as “Hopium”. (Some doctors find that pun amusing.)

We are assured that the NHS might still be overwhelmed in the coming weeks, hence it is essential that the entire population stay indoors for the foreseeable future until the danger has passed. Not staying at home is immoral and means you are a bad person. The expert doctors will let people know when it is safe for them to come out. This may take some time.

People experiencing symptoms similar to an upper respiratory tract virus (runny nose, sore throat, headache, etc.) may actually be suffering from Covid rather than an inconsequential seasonal cold.

So, readers must not under any circumstances fall into the trap of complacency. Some of you may be completely unaware that you have contracted this deadly disease, so you must take regular tests to check. That runny nose and tickly cough could be the highly transmissible Omicron variant and you must notify the authorities immediately. Those police officers knocking on your door are protecting the public from hazardous sneezing. Anyone you have spoken to in the last few days must stay at home in case they infect others, lest the ‘remorseless logic of exponential spread’ overwhelm our beloved NHS. If you fail in your obligations as a citizen to protect others, you are an enemy of the state and a danger to society.

Because one can’t be too careful these days.

Next week the tsunami will arrive for sure.