While most of us were pretending to enjoy some dry turkey and long forgotten family members over the Thanksgiving holiday, news of the latest threat to humanity, the omicron variant of the coronavirus, lit up our phones and computers. Most newscasters on television assured us that we should absolutely panic over this one. As of this morning, the virus has been detected in over 60 countries. In the USA, it has been detected in 20 states, including Maryland.
So, should we jump in and panic with everyone else? Should we go buy lots of toilet paper and paper towels? Maybe get some extra canned yams for the fallout shelter? Admittedly, no one knows exactly what to expect from corona du jour, but we can take some educated guesses. From preliminary accounts, the virus is highly transmissible, with case numbers of Covid -19 in South Africa spiking by a factor of 10 over a one-week period. But the virus, by early accounts, does not seem as dangerous as the Delta variant, based on lower incidence of death and hospitalizations than expected from the high case counts. This makes sense from an evolutionary point of view, as it is more advantageous (and more fun) for living things to replicate, but not die. So, a mutation that enhances replication but does not kill its host is like winning a gold medal at the virus Olympics. Also if this variant was really lethal, say like Ebola, we probably would have heard about it by now.
The omicron variant seems to have originated in South Africa, and has crossed the border into Botswana, Namibia, and now other countries in southern Africa. By commercial air travel, it has made its way to most populated continents around the globe including North and South America, Asia, and Europe. Outside of South Africa, numbers of the cases of Omicron are still quite low, compared to the Delta Variant which still has its hold on most of the world. I would not expect omicron to become a major issue here until after the New Year.
Will omicron become the dominant variant in the USA? This is not a slam dunk answer. The Delta variant is badass. It has taken over the world. It is sensitive to the immune response produced by the vaccines, but only if you are well vaccinated with 3 shots of an mRNA vaccine on board. In South Africa, only about 25% of the population was vaccinated, so when omicron hit it had the ability to spread through the unvaccinated population quickly. In the US, the vast majority of the population (80-90%) has some immunity to Covid-19 either through vaccination or previous infection. The ability of omicron to spread through a mostly immunized (not in the Aaron Rodgers sense) population is unknown. The ability to displace Delta is also unknown. Additionally, in South Africa, 13% of the population is infected with HIV. (Not rated one of the 10 best places in the world to receive a blood transfusion) It is unknown whether HIV patients, who have some degree of immunocompromise, are playing a role in the rapid spread through an inability to fight the virus.
How effective are the current vaccines for delta and omicron? As I have indicated in previous emails, they are very effective if you get a booster shot, on time. Preliminary data released from Pfizer yesterday shows good efficacy of their vaccine against the omicron variant in patients that have received a booster, but not much if they had only received two shots. This makes sense. The current vaccines are not made to handle omicron, which has developed more than 30 mutations on the spike protein compared to the original virus. All vaccines are targeted to attack the spike protein, so there may be problems with efficacy if mutations have changed the Spike protein structure. But it is likely that high antibody levels to the original spike protein, provoked by booster shots, can render the omicron virus weakened or inert. Think of the Alfred Hitchcock movie, The Birds. Your antibodies are the birds, and the virus is Tippi Hedren. If Tippi had encountered one bird, there would never have been a movie. But a hundred birds, and Tippi is toast. Lots of little antibodies can overcome a stronger, more resistant virus.
If you have not yet received your booster shot, and are eligible, (You are 18 or over and received your last regular vaccine dose 6 months ago or more) please get your booster shot now. Right now, 125 million Americans who are eligible for a booster have not received it yet. To make the omicron variant an afterthought, this will be what is necessary. We are seeing another wave of infections go through the northern United States now, but hospitalizations and deaths are proportionately lower than in previous waves. This is likely because under vaccinated people, who have not received boosters, are getting reinfected, but not getting as sick. The vaccinations do wear out, now 20% of hospitalized patients have received their first two shots up from about 10% two months ago. There are virtually no patients being hospitalized who have received a booster shot by an article published in the New England Journal yesterday.
Doubters of vaccine efficacy are circulating a message that the vaccines do not work, as evidenced by the recommendation that even more vaccine doses will be needed because the old ones are ineffective. Arresting this pandemic is like building an airplane while we are flying in it. It is not easy and not every therapy will be perfect. We may require new vaccines every 6 months or so to keep ahead of it. But so what? Isn’t it worth getting a shot to prevent another 5 million deaths around the world and the constant threat of worldwide economic collapse? No one seems to object to yearly flu shots, though they are about 1/5 as effective as the mRNA Covid vaccines.
So, get your booster shots and live your life. And if another booster is needed in a few months, get that one too. It is a small price to pay to bring this plague to an end.
Stephen Katz, MD, Adult Internal Medicine
Severna Park Medical Associates
Concierge Medicine for Annapolis
31 Robinson Road Severna Park, MD 21146