WHO scale – “Mild” doesn’t necessarily mean what you think

The appearance of the youngest coronavirus mutant Omikron, identified by the World Health Organization as worrying variant (VOC) is causing a rapid increase in the number of cases worldwide – also because it can infect people who have already recovered and who have been vaccinated. At the same time, however, it seems to ensure less severe gradients than the delta variant, which was dominant until recently. This is indicated, among other things, by two studies from Great Britain, according to which Omicron infections end up less frequently in hospitals.

Carriers of the mutant, which was initially identified in South Africa, can therefore hope for a “mild” outcome. Opinions differ on what that means, however, as Twitter user @SubCaptainGirl writes: “Non-medical practitioners hear ‘mild’ and think of ‘hot chocolate and a film day’, medical practitioners think of ‘will not need assisted breathing to be alive remain.>”

In fact, the word “mild” is interpreted differently by medical professionals and non-medical professionals, as the repost of the tweet on the Instagram profile of US pediatrician Christina Johns makes clear: “My friend from the healthcare sector reminds us again and again that “Mild” sounds like a cold, although it actually means that we will not die, ”one comment said.

Chris Carroll, intensive care physician at Connecticut Children’s Medical Center and professor of paediatrics at the University of Connecticut, put it in concrete terms on Twitter: “A ‘mild’ illness can still be very serious!” It irritates him that “we as a nation” have adopted the intensive care unit definition of “mild” for the pandemic. «’Good’ in the intensive care unit doesn’t really mean ‘good’ – it still means very sick!”

What “mild” means in concrete terms in Covid-19 is not clearly defined. There are different scales up for discussion, each with a different number of levels. In an eight-stage process, a course is still considered “mild” (stages 3 to 4) if the infected person has to go to hospital. At level 3 he does not yet need oxygen, at level 4 breathing must be supported with an oxygen mask on plastic or an oxygen tube. On a ten-point scale, a course is considered “mild” (levels 1 to 3) if the sick person needs medical support but does not have to be hospitalized. From the moment of admission to the hospital, we speak of a “moderate course” (levels 4 and 5). A severe course (levels 6 to 9) is therefore only reached when high-flow oxygen therapy is used. Several liters of oxygen are pumped into the lungs every minute.

All scales have in common that they show that Omikron should not be underestimated. The variant is “not a children’s birthday”, writes the science influencer Marc Raschke on Instagram. Especially not for unprotected high-risk patients who are “still in danger of a severe course”. The WHO also warns against considering Omikron as “mild”. “Just like the previous variants, people have to go to the hospital because of Omicron, and it kills people,” the AFP news agency quoted director-general Tedros Adhanom Ghebreyesus as saying.

In addition, people with a mild course are not immune to Long Covid. Even mild Covid-19 courses leave traces on organs and can impair the functions of the heart, lungs and kidneys, as doctors from Hamburg show.