Although details about the omicron variant are sketchy, a picture is starting to emerge – and it’s not all bad news.
As the omicron variant sweeps across the world and pushes out the delta variant that preceded it, scientists rush to understand how it might change the coronavirus pandemic, entering its third year.
Omicron is highly contagious – roughly twice as contagious as delta and four times more than the original virus.
Experts worry that even if it’s less virulent, which isn’t clear, it could cause enough hospitalizations to overwhelm health care systems here and abroad.
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But this is not 2020. Back then, only a handful of people on Earth had been exposed to the SARS-CoV-2 virus that causes COVID-19. Everyone’s immune system was unprepared.
Today, the majority of Americans have either contracted COVID-19 or been vaccinated once, twice or three times against it. That should – though there are no hard numbers to confirm it – provide people protection against severe disease and death.
“I think we should reassure people that if they’ve been vaccinated with two doses or naturally infected, they’re likely protected against serious illness,” said Dr. Paul Offit, a pediatric infectious disease expert and director of the Vaccine Education Center at Children’s Hospital of Philadelphia.
What’s not clear is how people who have never been vaccinated or contracted COVID-19, or whose protection has waned, will fare if they catch omicron.
An experiment in hamsters, which should see results as soon as Tuesday, will provide the first indication of how people far from an infection or vaccination may fare if they are infected, said Galit Alter, an immunologist and virologist at Harvard Medical School and the Ragon Institute of MGH, MIT and Harvard.
More vaccinated or previously infected people are contracting omicron than they did earlier variants, data shows. Vaccinated people, and perhaps those who’ve already been infected, are probably less likely to pass the virus to others.
It’s still the unvaccinated and unprotected who are providing opportunity for the pandemic to continue, Offit said.
“You have a critical percentage of the population who are unvaccinated and shedding this virus,” he said.
South Africa’s experience
Data out of South Africa, where omicron hit early and which has tracked cases carefully, is incomplete but encouraging.
There, hospitalization rates are much lower than in previous waves of infection, and the people hospitalized are not as sick as those infected with the beta or delta variants, said Salim Abdool Karim, a South African epidemiologist and infectious diseases specialist and member of the Massachusetts Consortium on Pathogen Readiness.
Only 2% to 4% of infected people are ending up in hospitals, compared with about 20% during the beta and delta waves, Karim said. Before, two-thirds of those hospitalized had severe cases; now about one-quarter meet that criteria. Death rates are one-tenth as high as they were with previous variants.
“The clinical picture we are seeing is one of substantially less severe disease,” he said.
Karim said he doesn’t have information on how many hospitalized patients had been previously infected or vaccinated, though he expects to get that soon.
Anecdotally, Karim said, “there’s a preponderance of unvaccinated” in hospitals, probably about 75% of patients. “Is it more severe in that group? What’s the picture? I can’t tell at this point because I don’t have that data.”
The department of public health in South Africa decided people exposed to an infected person but not infected themselves do not have to quarantine.
Karim said he recommended his government reinstitute mandates to minimize crowds. Officials didn’t take his advice. But the general public has followed with their feet.
“Theaters are empty. Restaurants are half-empty with just a handful of people,” he said. “People have come to that conclusion themselves. … Indoor gatherings? No. No.”
Omicron is more contagious than other variants, he said: There were 35,000 to 45,000 cases in South Africa in the first month of the beta and delta waves and 133,000 cases in the first month of omicron.
Denmark has seen similarly high rates of transmissibility and low rates of serious disease.
Unlike other variants, which slowly made their way from country to country, omicron is exploding around the world simultaneously, said Jacob Lemieux, an infectious diseases staff physician at Massachusetts General Hospital.
“In prior waves, we had a few weeks to watch what was happening in Western Europe and other places to know what we were in store for,” he said. Not this time. “We’re not going to have the luxury of watching what’s going to unfold in our country elsewhere in advance.”
The US outbreak
Although it’s still early days in the American experience with omicron, the variant has overtaken delta in the USA. As of Saturday, the omicron variant accounted for 73.2 % of new COVID-19 infections in the nation, the Centers for Disease Control and Prevention reported, up from 12.6% the previous week.
“It’s clear we’re now waist-deep in the omicron wave,” Lemieux said. “The question is how severe is it going to be?”
It may follow South Africa’s pattern that the majority of people get nothing worse than a bad head cold. Or it may cause more hospitalizations, particularly among those who have waning or no protection, potentially overwhelming the health care system, which was already dealing with a wave of delta infections, he said.
At Texas Children’s Hospital, doctors are waiting to confirm how many cases are omicron versus delta, but pediatric COVID-19 hospitalization rates have more than doubled in four days, and the number of patients is in the double-digits.
The rate of positive tests jumped from well below 5% five days ago to 15% Monday, according to James Versalovic, co-chair of the Texas Children’s Hospital COVID-19 Command and the hospital’s pathologist-in-chief.
“These are signals that tell us we have a surge beginning,” Versalovic said. “Every indication now is pointing in the same direction.”
It’s not clear whether children will react differently to omicron than they did to delta. Nor does the hospital know the vaccination status of the children over 5 (vaccinations are not authorized for those younger than 5), their parents’ vaccination status or whether any of the children was previously infected with COVID-19, he said.
Dr. Eric Topol, of the Scripps Research Translational Institute, said he hears anecdotal descriptions that omicron infections differ from delta. People don’t appear to be losing their smell or taste the way they did with earlier variants.
If true, that would be extremely good news, Topol said, because it would mean this variant isn’t entering the brain and would take off the table the risk of neurological problems.
Omicron appears not to get into the lung cells, according to studies from Hong Kong and the U.K. “That was the most distinguishing feature (of COVID-19) until now,” Topol said, and the reason it caused so much lung damage. “I know of a few people who had really high fevers (with omicron),” he said. “No one’s had pneumonia.”
What will happen with the virus remains uncertain.
“The virology community is kind of split 50-50 on whether this creature has big surprises in store for us or whether we’ve seen most of what it can do,” Dr. Jeremy Luban, another member of the Massachusetts Consortium on Pathogen Readiness, said Monday.
He and others were surprised to see how many differences omicron has from its predecessor variants – without any obvious intermediate changes. “The virus may be doing things that are not under our magnifying glass and we can’t actually see,” he said.
It may have given up some of its ability to cause harm when it became more transmissible, Luban said.
Eventually, a variant will become so dominant that no other will be able to outcompete it and the pace of change will slow down, Karim said. Some experts thought delta had reached that point. He expects there are several variants left to come.
Until then, and to combat the lingering uncertainties of omicron, everyone should get vaccinated and boosted, wear masks, open windows and avoid crowds, he and others said.
“We’ve learned the same lesson again and again,” Luban said. “The virus is transmitted in enclosed spaces with lots of people congregating. And masks work.”
Contact Karen Weintraub at [email protected]
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