(Image: AAP/Mick Tsikas)

Just when Australia was gearing up for a pandemic-free Christmas, the Omicron variant threatens to throw everything out the window.

The World Health Organization says it is spreading at an “unprecedented rate”, but our Christmas woes aren’t all down to the new strain. They’re down to ad hoc restrictions and mixed messages. 

This morning, New South Wales recorded its highest number of new daily cases since September: 1360. Restrictions eased today; masks are no longer required in shops, and QR check-in codes are only needed at high-risk venues. 

But there are still measures in place that could throw Christmas plans into disarray.

In NSW, fully vaccinated close contacts still have to self-isolate for seven days as contact tracers struggle to get ahead of the rising case numbers. In South Australia, people who have visited an Omicron exposure site must quarantine for 14 days. In Queensland, some regions have yet to hit 70% fully vaccinated rates, and all passengers on two flights have been sent into quarantine over Christmas because of a positive COVID-19 case. 

Experts say this mixed messaging could lead to reduced compliance, and stress that although case numbers will keep rising, Australians need to focus on flattening the curve so hospitals aren’t overwhelmed. 

What do the numbers say? 

The focus has to shift from case numbers to hospitalisations and deaths. Across the past two months the number of COVID cases in hospitals have remained steady across NSW even as case numbers surged — although in Victoria, intensive care unit admissions have doubled in the past two weeks. 

Deakin University chair in epidemiology Professor Catherine Bennett tells Crikey case numbers are probably being underreported as there’s less focus on testing. She says an important factor is how long people spend in hospital — longer stays are more likely to overwhelm health systems. 

“We know in South Africa [hospitalised Omicron cases] are looking at shorter stays on average, which is really encouraging,” she said. 

But she stresses a key concern is the unvaccinated ending up in hospital largely due to Delta. With some people unable to get the vaccine due to medical reasons but now able to go to shops and cafes in some parts of the country, protecting them is key. 

There is limited data about Omicron. Recent studies show that although it might cause milder illness but be more transmissible, the Pfizer vaccine offers only 33% protection against infection, and 70% against hospitalisation.

A number of people have been infected with it in NSW after an outbreak on a Sydney harbour cruise and Newcastle’s Argyle House nightclub. So far just one person with Omicron has been admitted to hospital in Australia. 

But that’s not the case everywhere: on Monday the UK recorded the first publicly confirmed death from Omicron where it’s expected to become the dominant variant by the end of the year as the country attempts to speed up booster dose administration. Norway has introduced restrictions and has banned serving alcohol in an outbreak.

What restrictions should be in place? 

Bennett says although hospitalisations before Christmas is a concern, high case numbers are to be expected and restrictions should ease accordingly. 

“There’s no point stopping people from having Christmas gatherings because that would just push infections into next year,” she said, adding outbreaks needed to be managed to ensure hospitalisations didn’t get out of control. “We need to get the balance right.”

University of Queensland infectious disease expert Dr Paul Griffin agrees. 

“Modelling has shown the 80% vaccination rate was a very safe target to open up,” he said. But letting the virus run rampant wasn’t a solution with Omicron, even if it was proved asymptomatic infections boosted natural immunity. 

“We don’t know for sure that it only causes mild illness and we don’t know what the rates of long-COVID might be after that,” he said. “When we have access to safe and effective vaccines, it really makes sense to try and adopt a herd immunity strategy over natural infection and immunity.” 

The difference in restrictions, especially across states, are a concern.

“There’s so much mixed messaging … and we should get some unity to some of these responses because it’s becoming unworkable,” he said. 

“As we open up, people will be going between different jurisdictions that have completely different rules which affects how people actually adhere to them, which is making the reopening more challenging.” 

What about boosters? 

There is good news. The Australian Technical Advisory Group on Immunisation (ATAGI) has recommended reducing the time between the second dose and the booster to five months rather than six, and this time the doses are available.

Early studies have shown that boosters are effective against Omicron. Pfizer has also said its antiviral pill, given to people infected with the virus, is highly effective too.