HERE'S TO YOUR HEALTH: So what have we learned about omicron?

Dr. Wayne Strouse, MD

In my last column, I gave you the earliest preliminary data about the newest Covid variant, Omicron. It was just arriving in the US, and what little information we did have was coming from South Africa, near where it likely originated in Botswana. Lots has been said about it since that time!

Dr. Wayne Strouse

Omicron has been breathtaking in its spread. Essentially unknown in late November, it has spread worldwide in less than six weeks. We now know that it is (by far) the most contagious variant of Covid-19. It seems to prefer the upper respiratory tissue, rather than infecting deep in the lungs. This at once makes it far more easily spread — since more virus is exhaled by someone infected by Omicron. AND, since deep lung tissues are left relatively untouched, the symptoms are not as severe, and there are fewer pneumonias compared to the Delta variant.

This has led, unfortunately, to the misunderstanding that Omicron is not worrisome, or that it doesn't make people particularly sick. Although Omicron is clearly not as severe as Delta, “not as sick” is not the same as “not sick." Omicron has a much lower death rate, but actually has a much higher infection rate, which ultimately causes a higher number of hospitalizations. In that way, it could turn out to have a larger effect on society than even Delta! Let me explain...

It's all about the math (your teacher was right, you will have to use math throughout your life). Omicron is less severe than Delta — but only somewhat less (about 20% fewer going to the ER, and 40% fewer hospital admissions). However, it is much more infectious (two to three times, or 200-300% more contagious). So, where 100 people were infected with Delta, 300 would be infected with Omicron. If all 100 were admitted with Delta, 60% of 300 = 180 would be admitted with Omicron, so the less severe Omicron would actually cause more hospital admissions.

The other issue with Omicron is that it can partially evade the immune system. That is because the spike protein — the protein that the vaccines have in them which is also what allows the virus to penetrate our cells — has about 30 mutations in the Omicron variant. This means that people who have been vaccinated, or who have previously had Covid are more likely to contract Omicron. However, vaccinated people are much less likely to be hospitalized, so once again, if you haven't been vaccinated, it's a good time to start. It also appears that the more vaccinations, the better, so if you are due for your booster, get it right away — it makes a big difference.

So, how do I put all of this together? How bad will Omicron be? Omicron will be ominous. It is setting new and much bigger records in the number of Covid cases. Although we are not seeing many deaths, we are seeing a ton of illness. It has slammed the airline industry, and the NYPD has had a major sickout. Expect to see hospitals, ER's, and Urgent Care Centers to be backed up and likely overwhelmed. The problem is, in addition to an incredible number of new cases (at the time of this writing, over 600,000 cases a day in the US, which smashed the previous record of 250,000), we have the problem of doctors and nurses getting sick because of Omicron. (In the past, their vaccines protected them from getting sick. Now it will protect them from being hospitalized, but they still won't be able to work.) This effectively lowers the number of available beds, since the doctors and nurses are not there to care for people in those beds.

So, what I see is another “lock down,” but this time it will not be government-imposed. It will be more of a “close down” imposed by the loss of workers who are too sick to work. It will likely go on for several weeks to months until enough Omicron-infected workers make it to the “other side” of their illnesses. Then, we will slowly get back to whatever “normal” has become. When we hit peak infection, tests may be hard to find (again) because of the demand, and schools will likely close for lack of teachers (and students). Children have been more likely to become ill and hospitalized with Omicron. The numbers for children are still low compared to adults, but like adults, are increasing rapidly, and there are fewer pediatric hospital beds, nurses and doctors.

What can be done? The same measures that we took when Covid began will work now— mask wearing, frequent use of hand sanitizer, and social distancing. And, as I said earlier, getting vaccinated helps reduce the likelihood of severe illness and hospitalization, which will really help my fellow doctors and our heroic nurses and hospital employees.

If you aren't wearing a mask indoors right now, you are taking a significant risk and almost certainly will not escape Omicron (even if you previously had Covid — remember Omicron can evade “natural” immunity, too). You would also be violating the Governor's Executive Order.

I also recommend giving up on surgical masks and cloth masks. Buy an N95 or KN95 mask and wear it whenever you go indoors. These are the only masks that protect you. We can get through this without everyone getting ill, but we will need everyone to do the right thing.

I know my columns are often rather gloomy. It's not my intention to depress you, but I really want you to be aware of the latest information and science. There is one possible silver lining — a real light a the end of the tunnel. Possibly, Omicron could ultimately end the pandemic and “save the world”.

If Omicron is incredibly infectious (and it is), but not very lethal (so far it is looking that way), we could get infected, survive it, and come out on the other side with widespread immunity — herd immunity. There will be some trying times first (I know, we've already gone through some trying times, but it will happen once again), and then it will start to get better, slowly, over time. We will still need to be cautious about Covid for some time.

If you are sensing a bit of hesitancy as I write this, you are correct. There is no guarantee that another Greek-named variant won't come along and outsmart our immune systems once again. But it is possible that Omicron ultimately may be the miracle we seek. A similar situation is how the 1918 flu pandemic ended. And it just might end Covid. So today, I leave you with that ray of hope. And wish you a Happy and Healthy New Year.

Here's To Your Health!

Dr. Wayne Strouse, MD is a Family Practitioner in Penn Yan.