The next wave could be faster and deadlier than Omicron. This is the perfect window for African countries to get ready.

Distributing covid vaccines in Mogadishu, Somalia. Credit: AMISOM Photo/Mokhtar Mohamed.

On 10 January 2022, Africa recorded 46,000 new Covid-19 cases, the highest daily figure since the beginning of the pandemic. Since then, the seven-day rolling average of cases has dropped by about 71%. This suggests that the worst of the continent’s fourth wave of Covid is behind us.

This latest surge of the coronavirus rose to the highest levels yet in Africa, but it also lasted the shortest amount of time with cases increasing for just six weeks before falling again. Similar patterns were seen elsewhere in the world, leading to the conclusion that an Omicron wave is different to past waves.

What can we learn from this experience and what does it tell us about what we could expect from a fifth wave?

Three characteristics of the Omicron wave

The Omicron wave in Africa had three key characteristics.

The first was a quick spike and fall. Cases increased at a significantly higher rate than previous waves due to Omicron’s highly infectious nature and ability to evade protection from vaccines and infection induced immunity. And then, after the peak, this was followed by a similarly swift decline in new cases. This pattern was likely the result of a combination of factors, including the speed of infection. When so many people get infected, a natural decline follows as the virus more quickly runs out of new people to infect.

The fall in cases, however, may be complicated by new subvariants of Omicron such as BA.2. This subvariant has rapidly become the most dominant version of Covid in over 40 countries, with early observations suggesting it is about 30% more transmissible than BA.1. This could lead to higher and longer peaks, or even a temporary reversal of decreases, but is unlikely to immediately cause another wave.

The second defining feature of the Omicron wave is the low proportion of hospitalisations. In South Africa, for example, 1.7% of identified Covid-19 cases led to hospital admissions in the second week of infections, compared with 19% in the same week of the Delta-driven third wave.

The third characteristic was the decoupling of cases and deaths. When Omicron was initially detected, there were widespread fears that the surge in cases would lead to a surge in mortalities, but that was thankfully not the case. While the Delta-drive wave caused over 50,000 deaths in Africa, so far 23,800 deaths have been reported since the beginning of the Omicron-driven wave. Even in the countries hardest hit, a small increase in deaths about three weeks into the wave was followed by a slow and steady decline.

World-wide Covid-19 trends

That is what we know about the behaviour of Omicron. We know less about what the next variant and wave might look like.

Looking at the behaviour of Covid in Africa over the course of the pandemic, however, we can get some clues regarding the continent’s vulnerabilities. It is notable that more people appear to have been infected in each subsequent wave (as seen in figure 1) despite rising immunity from past infections and the vaccine. This points to two important themes: that long-term immunity appears to be limited; and that the virus is constantly evolving.

Figure 1: Daily new Covid-19 cases and deaths per million people in Africa.

Covid-19 is unpredictable and we don’t know whether the next variant will be deadlier or cause different symptoms, nor whether it will last longer or to what extent it will evade immunity from prior infection or vaccines.

This leaves governments and leaders with some key questions to consider. What will we do if the next wave is faster, deadlier and lasts longer than Omicron? Do we have the tools to combat this more deadly variant? How can we ramp up vaccination rates to shield us from further surges and the emergence of new variants?

In much of Africa, two of the biggest vulnerabilities come from low vaccinations rates and low testing and genomic sequencing capacity, but this is the perfect time to fix this. At the moment, cases and deaths are relatively low and health systems are not in crisis. This provides an important window of opportunity in which African countries can focus resources on increasing vaccination access and strengthening healthcare systems, as outlined in our new report.

Global leaders must unite around a credible plan led by the African Union and coordinated through the Africa Centres for Disease Control and Prevention (Africa CDC). This regionally-led, internationally supported effort is urgently needed to bolster vaccination rollouts, increase genomic sequencing capacity, and strengthen resilience to ensure that future waves can be managed.