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Australia: ‘Delta is still around': Variant still high among COVID patients at hospitals

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About quarter of unwell coronavirus patients arriving at hospital emergency departments are suspected of being infected with the Delta strain, even though the highly transmissible Omicron variant dominates the tens of thousands of new infections being reported nationally.

Early estimates from the Australasian College for Emergency Medicine suggest cases of the more virulent Delta variant are still making up between 20 and 25 percent of coronavirus hospital presentations.

The college's national president Clare Skinner said healthcare workers were observing "the full gamut of coronavirus presentations", from people arriving severely ill with dangerously low oxygen levels, to those who learn they have the virus after seeking treatment for a different illness.

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"We're seeing people present very, very unwell with low oxygen saturation to the usual viral type symptoms, sore throat, runny nose, fever, vomiting, and diarrhoea, abdominal pain," the emergency physician said.

"And, we're seeing everything in between; the person with a fractured wrist or appendicitis, who just happens to have coronavirus that we pick up incidentally, or those gastrointestinal symptoms, like abdominal pain and diarrhoea, who may not realise they have the virus."

Infectious diseases' physician Paul Griffin said the collapse of lab-based PCR testing systems, which previously allowed for robust genomic sequencing, had severely undermined efforts to track variants.

"We are going by very rough estimates at the moment," Associate Professor Griffin said.

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He said it was now almost impossible to determine the extent of the continued spread of the Delta strain. But he theorised Victoria and NSW, which battled soaring Delta waves, would have the variant transmitting considerably more than other Australian states, which only opened up after Omicron emerged.

Questions about the continued spread of Delta come as general practitioners warn young adults - who make up the vast majority of cases - not to be indifferent to the threat of coronavirus. Anecdotally, there are concerns younger people are less concerned about the virus, based on the assumption they will be infected with Omicron and therefore recover quickly.

Werribee general practitioner Joe Garra was shocked by stories from young patients, who were infected with the virus after sharing drinks at parties and jumping in mosh pits at music festivals, before a ban on dance floors was re-imposed.

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"I really understand people are exhausted by this, especially young people, but there is a worrying level of complacency," Dr Garra said. "I heard about a lot silly behaviour over the festive period. People are thinking, ‘oh well, Omicron is less severe,' and they are forgetting the basics."

In the United States, there has been a growing trend of people intentionally trying to catch Omicron, on the misguided understanding it will get their virus experience over with, something that Royal Australian College of General Practitioners national president Karen Price dubbed a "terrible idea."

Dr Price said she was dismayed by videos circulating social media recently, including from some Australian Instagram ‘influencers' who told thousands of followers they had purposely tried to infect themselves with Omicron.

"For most people Omicron is going to be more than just a cold and for Delta it can be quite severe," Dr Price said.

She warned anyone infected with coronavirus was at risk of "long COVID," a strange and often debilitating post-viral condition affecting millions across the world, including those who did not have severe illness initially.

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"It can also be unpredictable in terms of who gets what degree of illness, so there is a significant need to protect the people you care about who are vulnerable, including older people, pregnant women, and those who immunocompromised."

Australian Medical Association national president Omar Khorshid said, while the focus was understandably on Omicron as it spread nationally, Delta had not disappeared.

"Delta is still around, it's still the dominant form of COVID in many countries," he said. "It can cause serious disease and in particular for unvaccinated people, it can be a very, very severe. The message is: you don't want to get COVID of any sort of if you can avoid it."

Dr Khorshid some chief health officer across the country were now estimating more than 90 percent of their coronavirus infections were the Omicron variant. In Victoria, the latest data suggests more than 80 percent of reported cases are now the Omicron variant.

And, coronavirus hospitalisation continue to surpass daily pandemic records in NSW and Victoria, as health systems buckle under the strain.

On Wednesday, there were a record 953 patients in hospital in Victoria with virus, amid a staffing crisis which is crippling hospitals, wiping out more than 6000 healthcare workers, who were forced into isolation after being infected or exposed to the virus.

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In NSW, there are now more than 2383 in hospital, and like in Victoria, the vast majority appear to less severely ill and are being admitted to general coronavirus wards, rather than intensive care units.

Melbourne emergency physician Simon Judkins said it was impossible to determine which variant a person was infected with when they arrived in the emergency department.

However, anecdotally, he said doctors had observed Omicron appeared to present more with upper airway symptoms, like a sore throat, and was less like to cause severe pneumonia like Delta.

Preliminary clinical data globally suggests that Omicron may be less likely to cause severe illness than its predecessor Delta.

However, health experts have repeatedly warned even if Omicron proves to be milder, the virus is spreading at such a rapid speed it could still result in more people getting severely unwell from COVID-19 overall due to the sheer number of people with the disease.

The implications of the variant on the elderly also remains a crucial unanswered question, with most of the cases studied so far in younger people who have been infected.

As increasing numbers of symptomatic coronavirus patients flood into stretched hospital emergency departments, Dr Skinner wants coronavirus clinics set-up across Australia to ease the extreme pressure being placed on hospitals.

Dr Skinner said standalone coronavirus clinics had been established by the federal government in Canberra and used as a one-stop-shop for testing and assessment of people infected with the virus, with staff able to provide onsite medical advice.

"There are a whole bunch of people who will never require hospitalisation or intensive care, but they do require medical assessment by someone," she said.

The Victorian government announced late last year 20 clinics would be opened this year across the state to allow symptomatic people to receive medical care and screening in a bid to free up capacity in hospital emergency departments. These clinics will be run by general practitioners.

However, Dr Khorshid did not believe it would be logistically possible to open the clinics during the Omicron wave due to staffing shortages.

"I understand where the college is coming from, but our feeling is that the hospitals just don't have the workforce and the junior doctors, or nurses, to stand up yet another type of clinic," he said.

With coronavirus hospitalisations projected to reach levels never seen before in Australia in the coming weeks, Dr Skinner said she was concerned by reports people had avoided emergency department, even when they had urgent or life-threatening symptoms like chest pain, dizziness and difficulty breathing.

"We absolutely encourage them to seek immediate care in the emergency department, and we will do our absolute best to provide the care they need," she said.

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