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Q & A — Are Omicron's symptoms different and why are so few COVID patients in hospital

Ottawa Citizen logo Ottawa Citizen 2021-12-21 Blair Crawford
University of Ottawa Raywat Deonandan is an associate professor in the Faculty of Health Sciences.    Handout photos © Provided by Ottawa Citizen University of Ottawa Raywat Deonandan is an associate professor in the Faculty of Health Sciences. Handout photos
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With the highly infectious Omicron variant overwhelming the city’s capacity to test for COVID-19, University of Ottawa epidemiologist Raywat Deonandan offers some advice on what to do.

Q: There are reports that infections with the Omicron variant of COVID-19 are different from infections with Delta and other variants. Early studies show that coughs are less common as is the loss of the sense of smell or taste. Do we need to update our knowledge about which symptoms to watch for, especially now that PCR tests are so difficult to get?

A: Are the Omicron symptoms different? That’s yet to be determined. Yes, we have some reports out of South Africa suggesting that maybe you’ll get a sore throat, the sniffles and some body aches. I’ve not seen any reports out of the U.K. suggesting anything particularly different.

We have anecdotal reports from here in Canada — I have friends here who’ve had Omicron and said they can’t get out of bed for a week. They’ve got headaches. It’s all over the map. If you were to look at a Venn diagram of Delta symptoms and Omicron symptoms — and even flu symptoms — there’s a lot of overlap. It’s a blurry circle.

What do you do with that information? It’s hard to say. We still have Delta in the country. The majority is Omicron, but it would be a mistake to take out the Delta symptoms from your symptoms ranking.

Q: So what should people do?

A: What does it mean for individuals trying to diagnose themselves? I think we have to use a variety of techniques. If the testing doesn’t work, maybe there’s a checklist of symptoms to determine the likelihood of having COVID. That’s the clinical model, but we’re not quite there yet.

With high suspicion (of infection) you should be isolating. And frankly, even if you’ve got flu symptoms, you should be isolating. It doesn’t really change what we do.

You also have to look at the likelihood of exposure. If you have a child and your child is in a classroom where there is a confirmed exposure and your child is showing symptoms, then there’s a strong suspicion they’ve got COVID, regardless of whether it’s Omicron or Delta or something else. So it’s wise to act as if that child has COVID, which means that the entire family should be isolating or seeking testing — though I know testing’s not available.

If you’ve been exposed and you’re not showing symptoms, then well, be a bit more circumspect in terms of your exposure. But whether or not you need to isolate is still up in the air.

Q: So how do you know if you have COVID or just a common cold?

A: If you’ve got symptoms but no exposures, then you’ve got a quandary. Is it the flu? Is it the common cold? Is it something else? So you act responsibly and you isolate anyway. The bottom line is cast the net widely to capture all the common variants, and maybe even catch cases of the flu. That’s the best we can do at the moment in order to hold transmissions during this crisis.

Q: One of the most serious threats to our hospitals and health-care system with the Omicron variant spreading so rapidly is the possibility that large numbers of health-care workers are going to be off the job and in 14-day isolation. Is it time to rethink those rules?

A: I think we do need to rethink that. For essential workers, there are different things we can do. For essential workers, you can reserve some rapid tests for them. You give them a PCR test when exposure is expected and you have to wait a number of days for the PCR test to be returned. In that interim, if they’re not showing symptoms, just rapid test them every day or every second day. If it comes back negative, then great, let them keep working. If it comes back positive, then we reassess the situation. But we have to use the tools in a more creative fashion to lengthen the time that essential workers can remain in the field.

(Ottawa Public Health guidelines do provide exemptions for essential health-care workers to stay on the job if they are asymptomatic, but they must isolate at home when not working.)

Q: Ottawa’s case numbers keep going up, but there are still very few people in hospital. Ottawa Public Health reported six people in hospital on Tuesday with none in intensive care. What are we to make of that?

A: We don’t know. It could be that there is a lag time (before serious illness). It could be true that Omicron is milder and less likely to result in hospitalization. It could be the effect of our remarkably high vaccination rate in Ottawa. All those things can be true. But I also think you have to err on the side of caution. Even though our proportion of unvaccinated in this city is lower than other parts of the province, we still have sufficient number that it could create a challenge to our hospitals.

We have to brace for impact. But I’m optimistic. I think our rates of vaccination will protect us very well from catastrophic hospital failures, at least in this city.

(Note: In an email Tuesday afternoon, Ottawa Public Health says the situation with Omicron is still evolving and it will update its website as more federal guidance become available. “Currently we cannot rule out any certain symptoms, especially as they can vary from person to person. If you are sick, assume it is COVID by isolating, staying home, and seek testing.”)


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