Doctor who detected first omicron case: ‘I don’t think it will be on the same scale of severity as delta’

At the end of November, a man in his thirties visited Dr Angelique Coetzee’s office in Pretoria, South Africa, suffering from intense aches and pains and a headache that medication wouldn’t budge. He thought recent physical exertion might be the cause, although he also felt flu-like symptoms, which was strange in the early days of the southern hemisphere summer.

As a preventive measure, Coetzee ordered a PCR test to rule out a Covid-19 infection, not believing he would test positive as the national incidence of the virus had dipped to barely 2% of tests coming back positive.The next day, Coetzee alerted a network of South African health care providers that her patient had tested positive, but that the result did not match the delta variant. It was the first known case of the omicron variant in South Africa, which two weeks later is registering more than 20,000 new cases per day for a positivity rate of 26.8%. The omicron strain has since been detected in more than 50 countries.

Question. How is the situation right now in your clinic?

Answer. What we are seeing is still mild disease, and so only half the patients that we are seeing with symptoms on a daily basis will be positive. So it is nothing that we can’t handle at the primary health care level, they are mild cases, we’re not really sending people to hospital. We do know that our hospital cases are starting to rise, and mostly, according to the stats, they are unvaccinated people. The few that are vaccinated, we’re not sure whether that is omicron or delta, we don’t have that specific breakdown of the stats.

Q. The latest figures show a 200% increase in hospitalizations.

A. The hospitals are not overburdened at this stage; however we know that we’re going into our festive season and we know people are not going to listen. So again, we keep on saying the next week or week and a half will be crucial regarding severe cases. On the mild cases, we are all on the same page.

Q. Are you finding new symptoms or confirmation of any initial theory that you had at the beginning?

A. It’s still the same with the major clinical symptoms: headache, body ache, fatigue, that’s the main thing that they will come and complain about. Maybe a blocked nose, maybe a scratchy throat. We don’t really see high temperatures, and we don’t see anyone needing oxygen, even in the hospitals. A lot of the people who were admitted there for whatever reason, they come in and then test positive, but they didn’t go in because of Covid-19 symptoms, so most do not need oxygen.

Q. Is there still a big difference between those who are vaccinated and those who are not?

A. Those who are vaccinated get mild symptoms and experience less pain, though quite a few of the patients with mild infections are unvaccinated. I must say that the headache is quite intense, you know, we say it’s a mild disease, but for the patient it is a really severe headache or body ache. These symptoms are much more severe in unvaccinated people than in vaccinated people. So I still think that the vaccines protect you, even with breakthrough infections, because we see that they don’t get that sick.

Q. And how do you think that the variant is going to evolve?

A. It’s a difficult question. If we look at what you currently see, we think it’s going to be mostly mild cases. We’re certainly seeing severe cases, but I don’t think it’s going to be on the same scale of severity as delta. Delta is a really very dangerous variant.

Q. With the data that we have, can we say omicron is not as severe?

A. It is not that severe. It is mostly mild cases, but there will still be severe cases, people should not get us wrong. With delta, I remember that we at the [South African] medical association, in the third week with delta, we were starting to ask the government to please start closing schools or closing buildings because we saw people who were very, very sick. But not now.

Q. So why do you think we are going to see severe cases?

A. Because any respiratory infection causes inflammation in the respiratory tract, so what happens if you are unvaccinated, your immune system is not nicely primed to defend, especially if you have co-morbidities. That’s how it started in the public sector hospital. The first few admissions were predominantly young male persons with co-morbidities, unvaccinated.

Q. What recommendations will you give to the population as a doctor?

A. I will just keep on saying wear a mask, make sure that you’ve got a good mask, and wash it every day. Don’t use a dirty mask and stay away from groups of more than 10 or 15 people, and get your vaccine or your booster, whatever your guidelines for your country are around vaccines.

Q. How are you coordinating yourselves? Has omicron made you move to some kind of rapid, real-time reporting system?

A. We’ve got a network of general practitioner doctors and in total, we’ve got about 90 percent of all the general practitioners in the country. Most of the symptoms are mild, so we do communicate and we do ask: is anything changing in the clinical picture or are they more hospital admissions from general practitioners? It doesn’t really seem so, some GPs are sending patients to hospital but it’s very few.

Q. How do you feel about being the first doctor who alerted the world to the omicron variant?

A. Well, I’m happy that I was able to realize with the patient that I saw that day that something was different. And you know, that’s the experience of years and years of practice. It’s very interesting that when I made my diagnosis, the first patient, he saw my face, and I was actually shocked because I immediately knew what it meant.

Q. Did those first few omicron patients recover well?

A. They were all mild cases. I haven’t admitted one single patient [to hospital] and I have now seen 70 of them.