Comparing data across two countries is an imperfect science, as we have learned with Covid-19. Factors that are impossible to control for—such as age differences, rural versus urban population distribution, attitude towards government, differing models of government, and others—must be considered when digesting the latest data. Otherwise, we risk jumping to conclusions or discounting lessons entirely.

5 surprising things we learned after a year of conducting international research

Thus, as omicron continues to spread, it is worth not only understanding the experiences and responses from other countries as they respond to the variant, but also understanding what caveats to look out for when internalizing each story. Only with this two-sided filter can we better shape our expectations and forecasts here at home in the United States.

Toolkit: Access our resources for an omicron surge

We've taken a deep dive in this article to unveil the omicron experiences and responses from seven jurisdictions around the world, as well as our take on what each one could mean for the next several weeks in the United States.

1) South Africa

South Africa was the first country to identify the omicron variant, and much of the world is now cautiously watching omicron trends in the country of nearly 60 million. Total case numbers skyrocketed from 2,645 on November 25^th to a peak of 37,875 on the 11^th of December, causing international concern. But with total new cases down to only 4,482 on January 9, 2022, it seems like South Africa is over the hump. A slight uptick in deaths in recent days is to be expected almost a month after the initial surge in cases, but recent data suggests that the omicron variant is significantly less severe than previous variants:

• There was a ~27% decrease in patients presenting to the emergency department during the omicron wave versus the country's delta wave.
• There was a ~56% decrease in the proportion of patients requiring oxygen therapy between the two waves.

To combat the surge of infections in late November, the government introduced some measures including a night-time curfew. But because there is growing recognition that quarantine and isolating are ineffective for a variant this infectious, the country is instead focusing on vaccinations.

What it means for the United States: Many are looking at South Africa as the harbinger for the rest of the world when it comes to omicron, where promising data suggests that the variant is less deadly than other variants. But South Africa has a significantly lower average age than countries like the United States (median age of 27.6 years in South Africa, versus 38.5 years in the United States)—and therefore has a population that is less at-risk to serious complications. As such, other countries with older populations should remain skeptical their experience while viewing it with cautious optimism.

2) Israel

Israeli cases have risen to a 7-day average of over 15,000 daily cases, up from 500+ a month ago. Heralded as the model for vaccination early in the pandemic, Israel has stalled at 64% full vaccination (two doses), a rate largely unchanged over the last half year. However, it is betting big on boosters, with 47% of the population having received at least a 3^rd shot and a globally unprecedented 4^th booster being rolled out.

Radio Advisory episode: Omicron—what it means for health care policy

However, leading public health authorities have warned that omicron will probably infect a plurality of the population regardless of potential lockdown measures, suggesting that herd immunity is the likely best outcome. They note that the number of seriously ill, hospitalized patients remains well below levels seen during the summer delta wave, with most models showing that "serious cases" from omicron are unlikely to surpass delta levels.

What it means for the United States: Israel's sluggish vaccination rate mirrors that seen in the United States, suggesting that a combination of boosting the willing and relying on herd immunity is likely the only viable outcome for shifting Covid-19 from pandemic to endemic.

3) The United Kingdom and 4) Canada

United Kingdom: 

Omicron cases among patients ages 18-50 may have already peaked in London, and other regions may follow suit in the coming weeks. The weekly growth rate of Covid-related hospital admissions at the national level is lower than previous days. And similar to South Africa, the U.K. is seeing younger patients who are less likely to need a ventilator than with previous variants.

Despite optimistic outlooks, the NHS is facing a staffing crisis that has been exacerbated by recent spikes in Covid-related absences. These staffing shortages have led to the re-emergence of cancelled or postponed services: 17 hospitals in one region to roll back elective procedures, 24 hospitals declaring that they are unable to provide critical services, 9-hour wait times at emergency departments, and maternity units shutting down.

The national government's response to staffing pressures was to suggest that NHS workers to be "moved around" the health system to meet demand. This familiar mismatch between staff and bed supply and patient demand will continue to exacerbate the United Kingdom's already record-breaking procedural backlog.

Canada:

Omicron cases, hospitalizations, and ICU occupancy rates continue to climb across Canada. At the national level, the most recent data reveals that 6,255 Covid-19 patients are hospitalized and 896 are in ICUs. In Ontario, the number of Covid-19 patients in hospitals more than doubled over a one-week period.

While the raw numbers may seem manageable, especially in comparison to data from the United States, the differentiating factor is Canada's scarce bed supply. Canada only has 2.5 beds per 1000 people, compared to the OECD average of 5 beds per 1000 people (2019). Bed scarcity is particularly concerning in Ontario, where there is only one ICU bed per 6,000 residents. In an effort to spare this limited capacity, the Ontarian government has returned to early-pandemic restrictions.

Covid-19 tested national health systems—and they responded largely as designed

Covid-related absences are also taking a toll on the workforce, rendering the country's already limited supply of beds even more constrained. Similar to the United Kingdom, these staffing shortages have led hospitals to postpone elective procedures once again, close urgent care centers, and declare 'code orange' to enable patient transfers to neighboring hospitals.

What it means for the United States: Yes, the United States has more bed capacity than other developed countries. But an unstaffed bed is as good as no bed at all. The United States risks face similar capacity pressures as the United Kingdom and Canada if health systems do not overinvest in preserving staff and optimizing staffing models.

5) New South Wales (NSW), Australia

Until September 2021, Australia had adopted a "Covid-zero" strategy throughout the pandemic, essentially shutting itself off from the rest of the world. But with the growing acceptance that the country would eventually have to learn to live with the virus, NSW, Australia's most populous state, took a 'light-touch' approach to restrictions as omicron case numbers soared globally. This led to total new case numbers in the state jumping from 477 on December 11 to a peak of 45,098 on January 8. Daily deaths remain comparatively low, with the latest figure of 11 deaths reported on January 6.

But despite deaths remaining low, there is concern that because NSW has adopted a 'Covid-zero' policy for so long, much of the population has not been exposed to the virus at all. This could cause a surge in hospitalizations and, sadly, deaths in the coming weeks. This has led to the state re-imposing certain restrictions and the mass-cancellation of low-acuity surgical procedures.

What it means for the United States: NSW is somewhat of a rarity—it was Covid-zero for most of the pandemic but is now using a "culture of responsibility" approach for omicron. The population's low level of previous infections could drive up case counts and hospitalizations. Conversely, because the United States has seen consistently high Covid-19 infection rates since the pandemic began, its population retains more immunity that is bolstered by ongoing vaccination campaigns. Thus, NSW's case and hospitalization rate may be higher than what we see in the United States.

6) Japan

It's easy to get caught up in the uniqueness of Japan and think that there's little to replicate from their experiences with Covid-19. But omicron might flip that script.

Covid-19 antivirals are here: Here's how to make them 'game changers'

As of publishing this article, Japan heads into its sixth wave. Three prefectures are now in 'quasi-states of emergency' as the country grapples with uncontrolled community spread and a growth curve that is essentially a vertical line.

And while border closing remains a corner stone of their non-pharmaceutical strategy, it's worth watching Japan precisely for their pharmaceutical plans. First the country has encouraged booster mixing and matching to bolster immunity and the national government has agreed in November to pay Merck and its partner Ridgeback Biotherapeutics about $1.2 billion for 1.6 million courses of their drug molnupiravir.

What this means for the United States: Japan offers a window into whether there are tactical adjustments in pharmaceutical interventions that can give the health system additional capacity as it rides out this omicron surge. Systems in the United States should watch for data coming from Japan to confirm, qualify, or discard their own plans to rely more heavily on treatment, rather than prevention, as the virus continues to transform in the near- to medium-term.

7) France

French Covid-19 cases have risen to an unprecedented 7-day average of 260,000+ cases, up from 40,000+ a month ago. With 75% of the population fully vaccinated, including well over 90% of adults, France has one of the highest vaccination rates in the world. Their booster campaign has reached 36% of the population.

France is betting big on vaccination by targeting the small subset of the population that remains unvaccinated, using comparatively coercive legislation. As of this week, citizens will be unable to access leisure activities, dining, or inter-regional transportation without showing a vaccine pass. In an interview this week, President Macron noted that "the unvaccinated, I really want to piss them off," and that his government "will continue to do so, to the bitter end."

However, staff shortages continue to bite, forcing creative solutions. ICU nurses will now receive a 100 euro monthly bonus payment in an attempt to boost retention. Moreover, in perhaps the most radical relaxation of quarantine requirements yet seen, French health care workers can now continue to work if they test positive, so long as they are fully vaccinated and show minor or no symptoms.

What it means for the US: While the United States is unlikely to reach France's high vaccination levels, it is already seeing similar problems with staff shortages. Creating an 'omicron hazard pay' policy, particularly for ICU staff, may be an effective recognition of their difficult working conditions at a time when their labor is indispensable. Additionally, should health systems be overwhelmed by cases, a relaxation of Covid-19 guidelines for health care workers may become unavoidable.

This post was written by Advisory Board's International research team: Paul Trigonoplos, Vidal Seegobin, Alex Polyak, Isis Monteiro, and Miles Cottier.