HERE'S TO YOUR HEALTH: Will Omicron be ominous?

Dr. Wayne Strouse, MD

You have no doubt been hearing a lot about the Omicron variant of Covid-19. Omicron (pronounced AH-muh-kraan, though you will hear other pronunciations) is the 15th letter of the Greek alphabet. All Covid variants of concern are now given Greek letters instead of using the country of origin, partly because you can have several variants from one country.

Dr. Wayne Strouse

Omicron was found first in Botswana, Africa Nov. 11, 2021, so we are very early on in our learning process about this variant. Most cases have been in South Africa, where Omicron is dominating the new cases.

The number of cases of Covid nearly doubled (4,400, increasing to more than 8,500) in one day in late November, which certainly got people's attention. It has spread to at least 38 countries (including ours), and at least 16 States (including ours). This information is as of Dec. 6, 2021, so by the time you read this, all of these numbers will no doubt have increased, possibly many-fold. Clearly, travel bans will not stop the spread at this point.

As this is early on, this column is about 25% fact and 75% “crystal ball” (OK, I don't really have a crystal ball; it's my educated guess as to what we will likely find in the future.) So far, most of my predictions have been accurate for the pandemic.

We need to know three things about Omicron (or any variant):

1. Is it more contagious than the current strain (Delta)?

2. Is it more deadly than the current strain?

3. Are the current vaccines still protective?

Question one may already be answered; the rapid rise in cases in South Africa (which is poorly vaccinated — about 25%) tells us that Omicron is likely much more contagious than Delta (which was much more contagious than the original virus). At this point, it appears that there will be a lot of cases in people who are unvaccinated. If you are one of those people, you might want to re-think your decision and get vaccinated. Interestingly, so far in South Africa, it is the young people who have been contracting the virus, but it is too soon to say if that is just happenstance (more young people travel long distances than old people, and more old people are vaccinated than young people, for instance), or if there is something about being young that makes you more susceptible. In 1918 the Spanish Flu killed many more young people than old people, because young people's immune system reacted more robustly to the virus and caused destruction of more lung tissue than in old people.

Question two (Is it more deadly?) is really unknown at this time. At the time of this writing, no one has died from the Omicron variant (that will certainly change). This may mean Omicron is not that deadly, or it could be happenstance in that young people are getting infected right now and they are less likely to die of Covid in general.

Question three (Will the vaccines still work?) is also an open question. So far, the vaccinated people who were infected had only minor symptoms (the hospitalized patients were unvaccinated), but again, we are talking about young people who tend to get milder symptoms. Due to the nature and location of Omicron's mutations, there is concern that vaccines will work less well in protecting us. There is already an effort underway for a new vaccine specific to Omicron, in case it turns out we need it.

So, I keep saying we need more time to learn. When should we know the answers? About two weeks should get us preliminary answers (by the time you read this we should be close to finding out this information).

So, what is so “special” about Omicron? It first came to attention when there was a sudden spike in cases in South Africa, which is currently in mid-summer and cases had been low. So, when you hear of this rapid increase in cases, remember, it is occurring during a time when cases are usually low. The second “special” thing about Omicron is the sheer number of mutations — more than 50 — with most (over 30) on the spike protein — which is the part of the virus that causes infection to occur, and is also the part of the virus where the vaccines work. It has mutations found on Delta and Beta variants that made them more contagious, as well as mutations in areas that may allow it to evade the immune system.

The timing of this variant is unfortunate — right before the holidays. We are already having a Covid spike in Yates County — about a 70% increase in total cases since the summer, and more people being hospitalized this time around (all of this is caused by Delta, not Omicron). There is a 20% increase in deaths since the summer as well, although our numbers are still low. Even without Omicron, I was expecting to see a lot of Covid in January. If Omicron shows up as well, we could overwhelm our local hospital, depending on how badly Omicron makes people ill.

Between natural disease and vaccination, there is a reasonable reservoir of immunity in Yates County. Omicron may figure out a way around that, but that is speculation at this point.

So, what do I recommend? One way of looking at Covid shots is to think of them the way we think of tetanus shots. You get a series of shots as a baby, and then you get a booster shot every 10 years. The “baby shots” help you to develop the initial cells to protect you against getting tetanus, but then from time to time you boost those shots so you can continue to protect yourself against getting tetanus in the future. Getting a single shot just isn't enough to create long term immunity. In the case of Covid, your baseline is your first two shots (yes, J&J is not really a “one and done” shot — you need a second shot two months after the first one), and then the booster dose increases your neutralizing antibodies to prevent getting infected further out from your baseline series.

Some of my patients have asked why they need to get a shot if they've had Covid. The answer is that you need a shot even after illness to develop the neutralizing antibodies. Talk to your provider about whether you have to get two shots if you've already had Covid. It may be acceptable to get only one shot after Covid disease, assuming you can document you really had Covid (with proof of Covid testing). Boosters will still be needed in the future, in particular if you are 60 years old or greater, where boosters are very helpful.

To avoid unpleasant memories of the holidays in January (ie, getting sick with Covid), get vaccinated if you haven't been, get tested the day of the large family gathering with a rapid test (now available in drug stores), try to have really large gatherings outside, and stay home if you are sick (even if it's not from Covid).

Here's to a happy holiday and new year, and Here's To Your Health!