The advance of Omicron in the last weeks of this year is almost unstoppable. Although Delta is still dominating on the European continent, this will come to an end very soon. But what exactly do we know about this latest Covid villain? Very little. But the fact that it is spreading at full speed among vaccinated people does not bode well. Many governments have decided to be on the safe side. This December week was marked by further tightening of restrictions for many countries.

But exactly how significant is the threat? Specific details on a nationwide level remain difficult to estimate. A lot of research is needed for this. Starting with the basics: monitoring a sufficient number of Omicron patients. But how do you tell them apart from the rest? Using scaled-up germline surveillance (or variant gene sequencing), a handful of countries are trying to crack the Omicron code as quickly as possible. This week, the bulk of all new cases had “just gotten infected” with the dastardly Delta strain.

Over the past seven days, there was no question of an acute pandemic apocalypse in the Netherlands and Belgium. The infection figures are showing a clear decline, most likely due to the extra measures. Nevertheless, the pressure on the healthcare system remains as high as ever, as this decrease is not reflected in the proportion of positive tests and both countries are still well above the European average.

At least the colors are less ominous on the refreshed weekly chart than they were three weeks ago. However, a similar change in hue on the heat map showing the weekly numbers across the border since August is going to take a much more substantial decrease.

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    Two pandemics in one

    What did the week of 9-15 December look like on the weekly continental map? The instense hotbed in central Europe seems to be quieting down a bit, while the numbers towards the north and southwest are actually on the rise. A detailed comparison can be made with the one from four weeks ago on the slider chart. The worst of the corona flames appear to have wafted off toward the north and southwest.

    

    The trail of Omicron

    To say that Europe is continuing to be overwhelmed by an impressive amount of new infections seems to be an understatement. The effect of the acrimonious lockdown in Austria that came to an end last week can be seen very clearly from the latest weekly figures. In France and Spain, on the other hand, things are rapidly heading in the wrong direction. In the Low Countries, the route to lower rates seems to have been cautiously set in motion.

    Denmark has been the continental corona frontrunner since this week. There is also a clear reason for this: Omicron. This new variant is spreading through the country at a breakneck pace. Something similar is afoot in at least two more countries. Can you spot who this concerns, based on this week-versus-week map? Pro tip: note the yellow outlines and dark pink colors.

    

    Yellow outlines

    The sizeable peaks around London, Oslo, Copenhagen and Glasgow can all be traced back to the spread of the Omicron variant. Norway and Great Britain are as such, the correct answer to the question posed in the previous paragraph. Along with the Danes, they are currently on the front lines of mapping out this emerging threat.

    Whether these are the only hot spots is not known. After all, the insidious thing about corona is that it can spread exponentially under the radar for a long time. The fact that this is indisputably true in the three countries mentioned above is due to a very obvious and logical reason. They – as opposed to many others – have their quantity of samples for germline surveillance in excellent order.

    The European Centre for Disease Prevention and Control (ECDC) and the global database of the GISAID are trying to map the new offshoots as best as possible. This is also the case with Omicron, a new specimen that is spreading at a furious pace, but due to its novelty, there is still very little data available on it.

    The table below shows where most of the reports have come from. Given that the number of reports registered is still quite modest at the moment, the countries have been sorted in terms of absolute amounts.

    The needle in a haystack?

    Baddest boys in the class? Quite the opposite. Since the Danes, Norwegians and British want to be one step ahead of the virus, they have scaled up their research into the genetic code of virus particles. Spotting a new variant is like looking for a needle in a haystack when the 'old' one is spreading at the same time. Thanks to this fast detective work, a solid basis seems to have been formed that should reveal how sharp the Omicron needle really is.

    Considering that corona causes a great deal of suffering especially among the elderly, and that it needs to be clear how effectively the vaccines are providing protection, the initial data from South Africa told a very limited story. Although the country has its epidemiological expertise up to scratch, the research there paints only a limited picture of the risk in societies with much older populations and higher vaccination coverage. Nothing to worry about, in other words? Not at all. From the infection rates that are flying through the roof, it is obvious that some concerns are more than justified.

    How likely it is to cause overcrowded hospitals and severe symptoms among the elderly is hard to tell from the findings in a country where the average resident is decades younger than in Western Europe. Moreover, only a quarter of South Africans have been fully vaccinated, making research on the effectiveness against omicron especially difficult. How is it possible that the new variant suddenly seems to be calming down a bit in the South African province of Gauteng? More detailed and reliable research is needed for that, which is only feasible with a rock-solid source data of a certain magnitude.

    The antennae of Europe

    Since the beginning of the corona crisis, viral offshoots have been tracked in the GISAID database. How many samples are submitted varies tremendously from country to country. In Norway, 1 in 3 positive PCR tests were studied in more detail. This transparency and cooperation should help ensure that the whole world can keep an eye on the latest threats. Such foreknowledge could have prevented a lot of suffering about two years ago, when a new mysterious lung disease started to spread in the so tightly closed China.

    Bringing a pandemic under control is a team sport. Yet not everyone considers participation in the global microscopic genealogy a top priority. In Denmark, special PCR tests that can also identify the genetic code are now being used. The website of the Statens Serum Institute shows how this method has already been used to uncover thousands of Omicron infections.

    The skimpier the sample size, the greater the chances are that exponential disaster from a society-disrupting mutant will not show up on the radar until it is far too late. The Netherlands is a lot less zealous about doing anything about this. The chance that the details of your positive PCR test will be reported to the global genealogy has remained at a slim probability of 1 in 240 for the past 30 days.

    The skimpier the sample size, the greater the chances are that exponential disaster from a society-disrupting mutant will not show up on the radar until it is too late. The Netherlands is a lot less zealous about doing anything about this. The chance that the details of your positive PCR test will be reported to the global genealogy has remained at a slim probability of 1 in 240 for the past 30 days.

    Prevention > cure

    In Denmark, they prefer to intervene sooner rather than later. With the help of an impressive testing capacity, adequate track and trace investigations, clear crisis communication and an energetic vaccination campaign, heavy measures have hardly been called for so far, while the number of fatalities and the economic damage have remained limited.

    No deviations from this basic principle are being made at the moment either. The government did implement a number of stricter measures, but while Copenhagen is the scene of an Omicron outbreak, there is still more to do there in the evening than there is in Amsterdam. The fact that December 2021 marks the highest infection rates in Europe for Denmark is not per se a disaster, as it happens. Even the record increases of the past few weeks did not lead to problems for the testing lanes.

    In fact, even at the end of this week, the percentage of positive tests remains well below the WHO's 5 % threshold. Many other places in Europe are exceeding this by a factor of two to five. In the German state of Thuringia, almost half (a staggering 49.5 %!) of the PCR tests carried out this week were positive. The higher this percentage, the slimmer the sample, the greater the chance of unpleasant surprises and viral peat fires smoldering under the radar.

    

    Third line of defence

    The stormy and unpredictable developments concerning Omicron prove once and for all that a double dose no longer provides adequate protection. Yet there is still a glimmer of hope. After the third shot, the risk of serious medical issues after an Omicron infection still seems to be significantly lower, albeit markedly less so than against Alpha or Delta. Since September, tens of millions of Europeans have already stopped by the vaccination clinic for a third shot.

    Administering boosters also seems to be more important than ever during this phase of the pandemic. Despite the declining efficacy of the vaccines, the British are fortunate to have already embarked on their booster campaign at full capacity since September. The fact that Denmark is also at the top of the list in the booster race will come as no surprise to many.

    After all, the step-up in pace pledged by the Netherlands is becoming more and more noticeable. This is still far from impressive, especially after the months of procrastination. Nevertheless, Latvia will most likely be passed in the next few days. Whether this dawdling is the cause of the highest excess mortality rate in Western Europe is not known.

    Side note: Are the Danes really doing everything so perfectly? Definitely not. They made an unbelievably apalling mess of the culling of millions of corona-infected mink at the end of last year. The then Minister of Agriculture had already been forced to leave, but now it appears that this tragic zombie mink drama could also have a nasty aftermath for others. Prime Minister Mette Fredriksen must soon answer questions at a hearing about the deleted app conversations with colleagues and dubious legal basis for this controversial operation.

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