Countries Around the Globe Deluged by Delta, as Omicron Threat Grows

Nations around the globe report a significant rise in the Delta variant of COVID-19 while, in the United Kingdom, the Omicron variant seems poised to deluge that country’s health care system. Those are just 2 of the findings of a meeting of prominent infectious disease experts conducted by the patient advocacy organization Health Watch USA. (The author is the founder and board chairman of Health Watch USA.)

Medical experts from the United States, Singapore, Australia, Germany, and Peru were in attendance. The meeting also included a short narrative update from the United Kingdom. Overall, all nations are reporting a significant rise in cases due to the Delta variant.

Kevin Kavanagh, MD

Vaccination rates have soared in Australia, with some states such as New South Wales having up to 93% of eligible citizens being fully vaccinated. As a result, much of the country has abandoned many of its stringent public health strategies, including some cities no longer using tracking apps to register with QR codes to enter restaurants and supermarkets, along with loosening of travel restrictions into the country.

Those entering the country who are vaccinated may need to isolate for 3 days; others must quarantine for 2 weeks. There is also a reduced effort regarding mask wearing. These changes are causing rising concern as the Omicron variant is starting to take hold in the nation, almost doubling its numbers every 2 days in New South Wales.

Germany is a federated nation. Only 69% of its population is fully vaccinated with a 2-dose vaccine. In the State of Hesse, masks are now mandatory in most indoor spaces and in crowded outdoor settings. A medical grade mask—surgical or N95—is required in indoor spaces. In schools, students are tested 3 times a week. Other measures may need to be implemented as the Delta wave is surging and Omicron is starting to take hold. Germany requires full vaccination or recent recovery (within 6 months) from SARS-CoV-2 to participate in certain activities such as nonessential shopping, indoor dining, gyms, and theaters. It was noted that this policy was implemented pre-Omicron.

Singapore has several important interventions which I feel the world needs to take note of. First, it is not assumed that just because you are vaccinated you do not need to follow public health advice, such as masking and testing. There is a very high rate of full vaccinations in health care workers, greater than 98%. However, vaccinated health care workers are still required to test via antigen rapid test (ART) twice a week, and the unvaccinated need to undergo daily testing.

In the US, the mandate to test unvaccinated workers once a week is unlikely to have a large impact on curtailing transmission of the virus. Similar to the US, the cost of health care directly related to COVID-19 has been covered at 100% by the government.

However, recently, Singapore has enacted a new policy to not provide full COVID-19 financial support to those who are unvaccinated by choice. Such patients will not receive 100% cost coverage, and instead will be covered under the regular national scheme of government subsidies supplemented by patient co-payments, as for any other types of illnesses. Those who are fully vaccinated or those who cannot receive the vaccine due to medical reasons will continue to receive 100% coverage for COVID-19-related health care expenses.

The US may need to follow the financial model of Singapore. Unlike Singapore, a substantial portion of the US population is not becoming vaccinated and/or is not following prevailing public health advice. If there is a safety net of 100% payment from public money, there is no tangible disincentive against promoting and/or engaging in dangerous behavior.

Singapore requires mask-wearing outside of the home (indoors and outdoors) for people above the age of two. There is a vaccination requirement for those over 12 years of age to enter shopping malls and attend large public gatherings, along with mandating the use of a tracking app or a tracking device to enter public places and shopping malls, to help notify individuals of viral exposure and augment effective contact tracing.

Dining at restaurants or food courts is limited to 5 vaccinated people per group, and household visitors are limited to 5 per day. Travel restrictions have been lessened recently. If vaccinated travelers arrive from a low-risk country, they can participate in a Vaccinated Travel Lane (VTL), whereby quarantine is not required, but they must be tested before departure and within 7 days after arrival. Other travelers must quarantine, duration depending upon the risk category of the country where they arrive from.

In Peru, the health care infrastructure is at a breaking point. Oxygen is even in short supply. Although vaccines are starting to become available the distribution network is not in place to fully vaccinate the population.

Presenters expressed concern over Omicron. Presenters expressed concern over Omicron. Even though the disease may be less severe and may not have as high of a case fatality rate, the infectivity being 3 times higher than the Delta variant creates a grave risk to nations. Overstressed and filled health care systems may collapse which will not only increase the COVID-19 case fatality rates but also markedly reduce access for urgent care of other major diseases. Excess death rates will be expected soar.

The financial cost of the pandemic is staggering. As of the end of September, the Centers for Disease Control and Prevention (CDC) reported that there were an estimated 7.5 million hospitalizations for COVID-19. Fair Health estimates that the insurance “allowable” cost of each COVID-19 hospitalization ranges from $84,000 to $117,316 for complex care (ICU and/or ventilation) and $20,013 to $38,135 for non-complex care. Just for inpatient care we are spending hundreds of billions of dollars. This does not include the cost of testing centers delivering almost 800 million COVID-19 tests, home testing, nor the cost of outpatient therapeutics. And it does not include the cost of prolonged treatment for the millions who have developed long COVID-19.

The US, similar to other countries around the world, has little or no reserves to muster to confront an onslaught of hospitalizations due to the highly infectious Omicron variant. Unlike South Africa, our population is older, heavier, and vaccinated far earlier with resultant waning immunity, so we may not fare as well with the Omicron variant. Unless the US starts to embrace public health advice, COVID-19 may become a catastrophe both in lives ruined or lost, and money spent

Videos of the presentation can be viewed at: https://youtu.be/QOgZcBPqBEk

Presenters:

• Germany: Sebastian Hoehl, MD, pediatrician and aspiring virologist at the University Hospital Frankfurt am Main, Goethe University.
• Australia: Imogen Mitchell, MD, clinical director of the Australian Capital Territory COVID-19 Response, and Executive Director of Research and Academic Partnerships, Canberra Health Services.
• Singapore: Matthias Maiwald, MD, consultant and the Head of Service, Microbiology, at KK Women’s and Children’s Hospital, and an adjunct associate professor at the Department of Microbiology and Immunology, National University of Singapore, and at Duke-National University of Singapore Graduate Medical School.
• Peru: Patrick Palmieri, DHSc, MSN, DPhil(Hon.), Universidad Norbert Wiener, Lima, Peru.
• United States: Noel Eldridge, MS, and Kevin Kavanagh, MD, MS, Health Watch USA.