Analysis by Keith Rankin.
The mainstream political narrative that emerged in late March 2020 was a ‘narrative of fear’ which set up the Covid19 coronavirus as a ‘tricky’ enemy that was out to get us by finding ways through our defences; and that we had to build collective barrier defences; defences such as lockdowns, border closures, and, eventually, facemask mandates. While the lockdowns, sensibly, were time-limited (albeit extendable), the border closures and over-reaching mask mandates were time unlimited.
The one initial point of optimism from the Prime Minister was, reminiscent of when the United Kingdom entered World War One, “it would be over soon” (eg by Christmas). Total victory would be quickish, we believed, because we – as a species – can be both clever and resolute. In New Zealand in 2020 we subscribed to the mantra that ‘the team of five million’ would defeat Covid through a mix of resolution and kindness. As in the World Wars, the resolution has been largely maintained; though the façade of kindness slipped long ago, with government immigration and travel policy leading the way.
Novel versus Established Respiratory Viruses
The distinction here is critical; the appropriate distinction is the difference between the 1918 influenza pandemic – a novel virus – versus the 2019 influenza outbreak in New Zealand. And we note the distinction between the 1890-93 novel coronavirus pandemic (long assumed to have been a novel influenza strain) and its RNA descendent, the OC43 ‘common cold’ coronavirus. Covid19 was a crisis in 2020 because it was caused by a novelvirus. Omicron appears to be more like the OC43 ‘cold’, which does trigger fatal illness. (See my Respiratory Viruses: Seasonal Mortality Compared, and its follow-up with more countries, for a view of the mortality associated with winter illnesses, both epidemic – eg influenza – and endemic.)
There are two reasons why a novel virus can be a very serious public health issue. The first is that it represents an unevolved virus that has not a chance to adapt to its environment; as such, it may be ‘unintentionally’ fatal to its host population. The second reason is that the host population is unadapted to the new virus. Host adaptation comes from exposure, and may be accelerated through vaccines, when available. Host vulnerability is enhanced by adverse socio-economic factors which may be present. Inequality and performance pressure lead to socially unacceptable levels of homelessness, malnutrition, substance abuse, and ennui.
This is the usual process of a new epidemic: one or more waves of severe illness, followed by a stabilisation as both virus and population adapt to each other. In some cases, the process can be averted by very rapid political action to eliminate a new virus, as happened with SARS in 2003. It turns out that the SARS elimination response was not the best response to the new 2019 virus that was both more transmissible and less severe than SARS; the ‘cat was already out of the bag’, so to speak.
In addition to adaptation or quick elimination, some countries may be able to choose to free-ride on the rest of the world, shutting themselves off while the rest of the world adapts to the virus (including its development of vaccines), and while the virus adapts to the rest of the world by becoming less severe. This would allow a country to open-up to a now-mild virus, and with a vaccine-adapted population. This has been New Zealand’s unwitting strategy, in practice if not in intent, and it may have been successful (possibly more successful than in Hong Kong), despite overt (and misguided) policy attempts to fend off the adapted (evolved, mild) version of the virus. This free-rider strategy additionally piggybacks off the necessarily foreign acquisition of knowledge about the novel virus, and the abovementioned adaptations by both virus and host species.
Delta vs. Omicron
Omicron is the adapted and evolved version of the virus. And it’s a very interesting scientific story which has not been well told. Delta is the last of the under-evolved (and potentially lethal) under-adapted versions of the SARS-COV2 coronavirus that causes the Covid19 disease. It was always likely to be displaced, eventually, by a better-adapted variant. It is the Neanderthal of the covid world.
Take a look at SARS-CoV-2’s family tree. It’s full of surprises. (NPR – National Public Radio of USA – 9 Feb 2022). Omicron’s evolution goes back to a very early point on the virus’s family tree!
The ‘out-of-Africa’ story of omicron-covid may be remarkably like the ‘out-of-Africa’ story of homo sapiens (aka us, modern humans). We may treat the ‘under-evolved’ version of homo – homo neanderthalensis – which predominated in Europe through many ice ages for about 300,000 years as delta-homo. Modern humans may be the homo equivalent of omicron-delta. Delta-covid is analogous to Neanderthal humans, who were displaced (after a few thousand years of coexistence) – in their European and Asian homelands – by modern humans. Modern humans migrated out of Africa, as did omicron-covid.
Of most significance is that omicron-covid evolved directly from the original covid variant (equivalent to homo erectus), and not from homo neanderthalensis or its immediate predecessor variants. That’s why there were so many ‘new mutations’ when scientists compared Omicron with Delta.
This analogy between covid and homo is also useful in allowing us to be prepared for a likely but otherwise unexpectable evolutionary development. Delta-covid continues to linger – especially, but not only, in New Zealand – and intermingles with omicron-covid. Just as we now know that modern humans are in reality hybrids, fused with Neanderthal (and Denisovan) DNA, we should expect the most evolved version of covid to be a fusion – mostly Omicron RNA but with a smattering of Delta RNA. Thus, as with influenza, covid may prove to be a more formidable seasonal foe than are the other adapted coronaviruses which almost all of us (at least in temperate latitudes) have ‘enjoyed’ the company of in the past.
(The 1918 influenza pandemic’s lethal second wave was most likely due to a hybrid novel H1N1 virus, forged on the western front battlefields of World War One. The 2009 ‘swine-flu’ pandemic was due to an H1N1 variant.)
Dr Angelique Coetzee and the Political Pushback re Omicron
My concern to write this present essay was motivated more than anything by this news.com.au article that I read, courtesy of the New Zealand Herald, on 10 Feb 2022.
Before commenting on that, we may note: “Dr Angelique Coetzee became internationally known in December 2021 as the medical doctor who treated one of the first cases of the then unknown Omicron variant of the SARS-CoV-2 virus. She was also one of the first to controversially indicate, and was later proven to be correct, that the virus caused less severe disease than other variants like Beta and Delta.” (Quoted from Daily Maverick, 21 February 2022.)
The assertive South African doctor says: ‘”I was told not to publicly state that it was a mild illness,” she said. “I have been asked to refrain from making such statements and to say that it is a serious illness. I declined.” Asked [by Germany’s Die Welt newspaper] what she meant, Coetzee said “based on the clinical picture there are no indications that we are dealing with a very serious disease”. “The definition of mild Covid-19 disease is clear, and it is a WHO definition”.’ Coetzee was being pressured to make an unscientific political assessment that was contrary to her empirical findings.
And: “According to Coetzee, chairwoman of the South African Medical Association, she came under pressure from scientists in the UK and the Netherlands who said, ‘How can you explain that it’s a mild disease? It’s a serious illness. Look at the mutations’.”
There seems to be a popular view, a sort of Frankenstein view, shared by some career scientists, that mutations are a measure of an organism’s nastiness. While this view may reflect the “arms’ race” hypothesis, mutations in an adapted species are actually indicative of its adaptation. Thus, omicron’s mutations are a key part of omicron-covid being less lethal than other variants.
WHO’s Tedros Adhanom Ghebreyesus says: ‘”While Omicron does appear to be less severe compared to Delta, especially in those vaccinated, it does not mean it should be categorised as mild,” told a press conference. “Just like previous variants, Omicron is hospitalising people, and it is killing people. In fact, the tsunami of cases is so huge and quick that it is overwhelming health systems around the world.” Except that it’s not, unless you are in Hong Kong, where a positive test has so far meant automatic hospitalisation. (The latest weekly figures I have show that the number of people in Hong Kong seriously ill with covid at two per million, compared to ten per million for the world as a whole. Hong Kong’s hospitals are overstretched by admissions, not by serious illness.)
It’s clear from Europe and elsewhere (ref my Seasonal Mortality Comparedand Denmark and Israel) that the coming of Omicron has reduced deaths and hospitalisations, although many people in hospital – including those who have died there – have tested positive for covid. Having covid in hospital is not the same thing as being ‘hospitalised’ because of covid. Further, delta-covid has not gone away, so deaths that can be attributed to covid are not necessarily deaths attributable to Omicron. There is no scientific controversy about the observation that a person with delta-covid has a much greater chance of requiring hospital care than a person with omicron-covid.
The story about Angelique Coetzee finishes with: ‘A US oncologist from the Mayo Clinic this week pushed back on the characterisation of Omicron as mild. Professor Vincent Rajkumar shared data from Johns Hopkins University and the World Health Organisation showing daily deaths attributed to Covid-19 in the US were higher now than any time since the pandemic began in late 2019, with the exception of two months last winter.’ My published charts, showing excess deaths, tell a different story. Professor Rajkumar would appear to have more expertise as a cancer doctor than as an interpreter of statistics. The WHO data are of deaths ‘with covid’, not deaths that only happened ‘because of covid’. My brother-in-law was very sick with covid in the USA this January. At least, as he recovered, he was informed that he had the severe delta-variant.
Delta-Covid in New Zealand
New Zealand, along with a few East Asian countries, has become a delta-variant holdout, thanks to New Zealand’s stringent policy initiates to slow down the displacement of delta by omicron.
According to ourworldindata.org, in the two weeks to January, these countries had more than 11 percent Delta:
- New Zealand (29.1%)
- Lithuania (29.1%)
- Slovakia (22.9%)
- Hong Kong (21.8%)
- South Korea (19.6%)
- Thailand (17.0%)
- Poland (15.3%)
- Germany (11.3%)
In the following two weeks, the only countries so far known to have significant Delta were:
- Hong Kong (10.8%)
- South Korea (10.4%)
- New Zealand (9.5%)
While new infections of Delta, today, are probably less than five percent of all new reported covid cases, of New Zealand’s 22022 active cases (as of 22/02/2022), at least 500 of these will have been Delta infections.
The Push to Downplay the Upside of Omicron in New Zealand
In New Zealand one major area of concern is the narrational fuzzing of the distinction between covid-delta and covid-omicron. The two variants are so different that they could be classified as two separate viruses. Indeed, the process of separate classification opens the door to the (sensible) inclusion of other human coronaviruses and influenzas in a single public health diagnostic framework. One barrier to such an evolution of the covid public health framework is the earlier mischievous and ongoing (re Ashley Bloomfield last year, and Rod Jackson this week) characterisation of Covid19 as a significantly more serious disease than influenza. (This was aways mischievous, because, as noted above, a novel coronavirus disease was contrasted, inappropriately, with established seasonal influenza strains. To slightly misquote Shakespeare [from Hamlet], “methinks the man [Bloomfield] didst protest too much”.)
There is a major ethical problem if New Zealanders with a positive covid test are being asked to assume that they have Omicron. That ethical problem is compounded if clinical information relating to patients who knowingly or unknowingly have Delta is being used to push to a public audience the counter-scientific alternative fact that omicron is ‘not a mild illness’.
Finally, for this essay, we may note this reported case: Covid 19 Omicron outbreak: Virus leaves healthy NZ woman, 36, struggling for breath (NZ Herald, 23 Feb 2022). The article says: “Before her GP called with the results the next day, she knew she had the virus – her taste and smell had gone haywire.” A red flag! Loss of taste and smell are classic symptoms of the Delta evolutionary branch of Covid19, but are not at all characteristic of Omicron. The article states: “she’s never been so sick as she was in the past week after catching Covid – despite it likely [my emphasis] being the Omicron variant, which many people think is mild.” ‘Likely’ here is based on the fact that Omicron is more prevalent in New Zealand, and not on any description of her symptoms.
This poor woman, unlike my brother-in-law, has been led to believe she has omicron-covid, not delta-covid. And New Zealand Herald readers have been likewise misled. While she may have Omicron, the symptoms clearly point to Delta.
We can do better than this. Omicron is good news – global good news, the world’s way out of the pandemic – being peddled as bad news by people who seem happy to perpetuate a narrative of fear. New Zealanders need a narrative of hope, as we move into the winter season. The actual science gives us much hope.
Keith Rankin (keith at rankin dot nz), trained as an economic historian, is a retired lecturer in Economics and Statistics. He lives in Auckland, New Zealand.