Omicron South African hospitalization increases appear to be mostly an artifact of incidental Covid cases

Early analysis shows that the apparently worrying uptick in hospitalizations for Covid-19 in South Africa is primarily an artifact of hospital policy to test everyone for Covid upon admission to the hospital, which necessarily results in large numbers of incidental “cases” that are probably false positives

The globe went on high alert with the announcement of the Omicron variant and WHO’s classification of this variant as a “variant of concern” — the first since Delta to be placed in this category. Abundant questions about transmissibility and severity remain open, however, even while a number of nations imposed irrational and not evidence-based decisions to impose blanket travel bans on South Africa and surrounding nations.

So how severe is Omicron? Do we know yet? Hospitalization data is the first potentially reliable data regarding severity and some early analysis is shedding light on this issue, suggesting that Omicron may not be very severe at all.

Early analysis of COVID hospitalizations in South Africa, by a doctor who is part of the South African Medical Research Council (SAMRC), supports my suspicions about the apparent increase in hospitalizations from Omicron being due mostly to hospital policy of COVID testing all patients upon admission, resulting in massive rates of incidental COVID (charitable interpretation) or simply of false positives (more likely interpretation, due to the false positive paradox I’ve written about here).

In summary, the first impression on examination of the 166 patients admitted [in South Africa] since the Omicron variant made an appearance, together with the snapshot of the clinical profile of 42 patients currently in the COVID wards at the SBAH/TDH complex, is that the majority of hospital admissions are for diagnoses unrelated to COVID-19. The SARS-CoV-2 positivity is an incidental finding in these patients and is largely driven by hospital policy requiring testing of all patients requiring admission to the hospital.

We’ve seen this pattern in other places too, including California, which I analyzed here in an earlier essay. It may be interesting to readers to know how I found the SAMRC report online: it’s because of my previous analysis of California’s hospital testing policies, which are mirrored in many places around the world, and my twenty years of training as a public policy lawyer, that made me realize how important this single policy is in understanding Covid-19 severity dynamics. This earlier experience made me suspicious of the uptick in South Africa’s reported hospitalizations.

In short, much of the “Covid hospitalizations” data is extremely low quality and suspect because it results in most cases from this single decision to test all patients upon admission, regardless of the presence of any Covid-19 symptoms — and then in many cases to isolate positive test cases patients with other Covid-19 patients, and in some cases at least to then convert false positives into true positives through exposure in these “Covid wings.” This is known as “nosocomial transmission” and is starting to get more attention in the scientific literature.

The New York Times reported on Dr. Abdullah’s analysis of South African hospitalizations in a great article from Dec. 7, 2021, which is a nice reversal of their usual fearmongering.

Webb and Osburn 2021 found similar results in their analysis of pediatric COVID hospitalizations, with fully 87% being incidental or presymptomatic, and they also note that statistically there is no real difference between incidental and presymptomatic cases. Their analysis also supports the notion that we’ve similar massive exaggeration in Covid-attributed deaths in the pediatric population (which they define as 22 years or below), and also in the population as a whole.

My working rule of thumb is to discount all public Covid stats by 90% in order to get a more reasonably accurate picture of what’s actually going on. I and my two coauthors, an ER doctor and a Ph.D, explain in this essay how public Covid stats are grossly exaggerated.

In sum, given the data about Omicron so far there is little data-based cause for concern about a new and more severe wave other than the “casedemic” that follows from the extremely loose “case definition” (that doesn’t require symptoms at all, as historically always been required for a “case”) and the very aggressive and also generally unprecedented decision to conduct massively widespread testing of asymptomatics through large-scale screening programs.

I will update this essay as more data arrives.