FAQ: If Omicron causes milder illness than Delta, why do I feel so terrible?

SINGAPORE: While there are “good indications” that the Omicron wave in Singapore has peaked, said Health Minister Ong Ye Kung recently, daily infections remain high with more than 17,000 cases reported on Wednesday (Mar 9).

As more people get infected with the Omicron variant, some have also reported experiencing symptoms that were more severe than they had expected.

This comes even as studies have said the Omicron variant is supposed to cause milder illness than the Delta variant.

So is the Omicron variant really “milder” than its Delta counterpart? And what does it mean if your symptoms persist even after you test negative? Experts answer these frequently asked questions:

Q. How do Omicron symptoms differ from those of the Delta variant?

The Omicron variant is more related to symptoms “higher up in the respiratory tract”, such as a runny nose, nasal congestion and a sore throat, said Professor Dale Fisher from the National University of Singapore’s Yong Loo Lin School of Medicine.

“These are more common in Omicron compared to Delta, while fever, cough and shortness of breath (more associated with the lower respiratory tract) are less common,” he said.

A loss of smell and taste are also less common for the Omicron variant, he said.

Nevertheless, other COVID-19 symptoms, including body aches, lethargy, brain fog and gastrointestinal problems, can still occur, added Prof Fisher.

Q. Why is the Omicron variant considered milder than the Delta variant?

It is considered “milder” in a medical sense because Omicron's symptoms are less likely to progress to “a life-threatening state”, said Dr Nicholas Chew, an infectious disease specialist at Farrer Park Medical Centre.

He noted that for Omicron, the proportion of patients who develop severe lower airway and lung infections – which may worsen to respiratory failure requiring oxygen support – is “significantly lower” compared to Delta.

Dr Leong Hoe Nam, an infectious disease expert from Rophi Clinic, added: “(In) the same scenario, by age, sex, medical ailments, we expected them to have a higher spiking fever, worse breathlessness, and the need for ICU (Intensive Care Unit) care was higher for Delta.

“But in the case of Omicron, many individuals with the same risk factors, did not develop severe complications, e.g. requiring oxygen or ICU care."

Q. Why do I feel so terrible if Omicron is said to cause milder illness?

Some people may feel their symptoms are quite severe because of expectations that Omicron symptoms would be milder, said Prof Fisher.

But despite it causing less severe illness, Omicron's symptoms “are still nasty”, he added.

“Furthermore, there are now many cases, so even though it is milder, with so many people infected you will still get a significant number of people with severe disease and very symptomatic disease, while most still have mild disease,” he said.

Dr Chew added that while most patients generally recover within seven to 10 days, there are many factors underlying the differences in patients’ experiences.

This includes a person's “baseline immunity state”, their immune response, the type of COVID-19 vaccination they got and their tolerance for pain and discomfort.

But Dr Leong reiterated: “When individuals said (the variant was) not mild, they were referring to the symptoms. When doctors said (it was) milder, they were referring to those who required oxygen or ICU care. It is a case of comparing apples with oranges.”

Q. Why do I still have symptoms even though I’ve tested negative?

Dr Leong noted that symptoms such as cough and sore throat may linger even after a person tests negative because his or her organ tissues are still damaged.

“These symptoms reflect the injured organ (the throat), and do not reflect infectiousness,” he said.

Dr Chew also said this may be due to the body’s "prolonged immune and inflammatory response".

On the other hand, Prof Fisher pointed out that rapid tests can also result in false negatives.

"Even if you have isolated for the required time, it would be prudent to minimise social and work-related interactions, and practise good personal hygiene while symptoms persist."

Q. How can I manage my symptoms?

“The short answer is rest, paracetamol, fluids,” said Prof Fisher. “Of course, watch for features of deterioration, especially pneumonia, and do all the right things to prevent (spreading the virus) to others.”

For specific symptoms such as a sore throat or cough, Dr Leong advised giving the throat time to heal, while taking measures to address the injury.

That includes avoiding oily, fatty, spicy or acidic food, talking less, and taking a cough mixture or warm water and honey to heal the throat’s lining.

But if the symptoms are “troublesome and persistent”, one should visit their doctor to be treated, said Dr Chew.