Many patients are asking me about Covid and should they be concerned. I suspect this is because of the increasing number of Omicron cases (22,577 new cases today in NSW) and the often-conflicting messages from politicians, journalists, and doctors and nonsense comments on social media.

I suspect the varying messages have to do with differences in bias, background, and agenda.

I have my own bias. I am motivated by the wellbeing of my patients and their unborn babies. I am an experienced specialist medical doctor. I am very widely read on this topic. I believe I have considerable discernment.

But I am not a virologist (specialist in study of viruses and the diseases caused by them) or an epidemiologist (a person who is an expert in the branch of medicine which deals with the incidence, distribution, and possible control of diseases).

Omicron is different

While there is an exponential increasing incidence in the number of people infected with Omicron, there is not an exponential increasing incidence in the number of people hospitalised or in ICU or in ICU on ventilators with Omicron.

As well, the hospital admission numbers can be misleading, as they all may not be due to Covid. If someone is admitted to hospital for another reason and is found coincidentally to have asymptomatic Covid they will be included in Covid statistics even though that is not the reason for their admission. As well reported Covid death statistics may be misleading. Someone may die because of another reason but is Covid positive and so is reported as a Covid statistic death.

Those who are unvaccinated are more likely to get sick with Omicron, need hospitalisation and even need ventilation. It is the unvaccinated who are at risk from Omicron, not the vaccinated. This is except for the very elderly or those with significant comorbidities.

An increase (though not exponential) in the number of hospital admission is expected with more Covid in the community. Of the 109,197 current active cases today in NSW only 901 are in hospital (latest NSW Health report (1)). The majority of Covid hospital admissions and ICU admission are unvaccinated people. Almost three quarters Covid ICU admissions in NSW are unvaccinated. There is no extra information online about the vaccinated admissions, but I suspect most are very elderly and / or have significant comorbidities. The current challenge with hospital health care and Covid is not beds but staff. There has been more pressure on the health care system because of the increasing number of staff in isolation with Covid or as close contacts. NSW Health has just relaxed the rules about isolation for health care workers, and this will have positive impact on healthcare workforce numbers.

In other countries there is an exponential increase in Omicron Covid cases without a corresponding marked increase in very sick and in deaths due to Covid as has been the case in the past. It can be concluded while Omicron is more infectious it is less virulent than previous mutations of Covid virus. Anecdotally, from reports of people I know, including patients I have found the same. For those who are vaccinated they are often asymptomatic (no symptoms) or have mild cold or flu like symptoms. None have needed to go to hospital.

In contrast, those who are unvaccinated are more likely to get sick with Omicron, need hospitalisation and even need ventilation. But even then the incidence is less that in the past with previous Covid variants.

Should you have a booster Covid shot?

Yes, most definitely

It is safe for you and your baby and will give you and your baby increased protection. The booster will reduce the likelihood of you getting Covid, being unwell with Covid and of infecting others with Covid.

 Is Omicron infection dangerous for a pregnant woman?

If you are double or triple vaccinated is unlikely you will be unwell with a Covid infection, and it is very unlikely it will have any adverse implications for your pregnancy outcome.

You do not need to attend hospital unless you are sick. You do no need to attend for baby monitoring. If you are well and baby is moving normally do not be concerned. If you have a mild fever then paracetamol is safe to take

If you decided not to be vaccinated, you are more likely to be unwell and your baby’s wellbeing will be at risk with a Covid infection. If unvaccinated, when infected you will have less resistance to the virus, have a much higher viral load in your body and the virus is more likely to have adverse implications for you and your baby. So please get vaccinated ASAP.

Personally

I am triple vaccinated against Covid. I am not worried about getting sick in the unlikely event I am infected. Most likely, I would not have any symptoms or have a mild brief cold like illness. But I am worried about the practice implications if I get infected. Getting infected or being deemed a ‘close contact’ would mean I would have to self-isolate and so not be able to see patients or deliver their babies during that period of self-isolation. Not only is this a NSW Health requirement, I would not want to infect patients, family or members of the public.

I, my wife and family and staff continue to be diligent. I suggest you do the same. Avoid gatherings of people, continue to wear a face mask indoors except with your family, continue to social distance and to hand sanitise. My wide recently had a birthday. Rather than go to a restaurant we have a takeaway delivered.

Moving forward

Because of the exponential increasing number of people infected with Omicron and the ridiculously long cues to get PCR testing the Federal and NSW Government have overhauled Covid screening, the definition of close contact and home isolation requirements of infected or a close contact. As well the hospitals have overhauled the Covid screening requirements for pregnant women. The details have already been provided (2).

There will be a much greater reliance on Rapid Antigen Testing (RAT) for Covid screening. The RAT is about 80% accurate in detecting Covid. It should not be relied on if you are symptomatic. If the RAT is positive, you will need a Covid PCR swab.

Dr. Anthony Fauci Chief Medical Adviser on COVID-19 to the United States President states he believes Omicron cases likely to peak by end of January in USA (3). I am confident this will happen in Australia. That means in February 2022 it is likely the incidence of Covid in Australia will be significantly less than now and continue to gradually fall away. In South Africa where Omicron started it has already peaked and the incidence is on the decrease.

The Omicron strain has a positive aspect. The easy spread of Omicron may help countries achieve herd immunity. It is likely this mutation happened because of the low incidence of vaccination in South Africa. The low vaccination rates continue to be a problem in many countries and so there increases the possibility of new Covid mutations. New mutations are less likely if Omicron continues to spread throughout the world, and there is mass global vaccination through mild Omicron infection. As well it is in the virus long-term survival interest to be easily transmissible and cause less severe disease. While Covid will still be around I suspect in 2022 we will farewell our major Covid health concerns.

(1) COVID-19 Monitor COVID-19 cases, variants, vaccines, hospitalisations and deaths 16 December 2021  https://aci.health.nsw.gov.au/__data/assets/pdf_file/0004/697270/20211216-COVID-19-Monitor.pdf

(2)  CHANGES TO COVID checking OF PREGNANT WOMEN 31st Dec 2021 https://www.obstetricexcellence.com.au/blog/changes-to-covid-checking-of-pregnant-women-31st-dec-2021/ 

(3) Fauci predicts omicron Covid wave will peak in U.S. by end of January  https://www.cnbc.com/2021/12/29/fauci-predicts-omicron-covid-wave-will-peak-in-us-by-end-of-january-.html

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