“At this point in the pandemic,” notes DR. LaMAR HASBROUCK, Illinois’ former top doctor, “there have been enough variants to exhaust the entire Greek alphabet.”
Alpha. Beta. Gamma. Delta. Lamda. Mu. And now omicron, which the World Health Organization has labeled as the fifth COVID-19 “variant of concern,” its most serious designation.
“Let’s not panic just yet, but definitely raise our guards,” advises epidemiologist AWAIS VAID, deputy administrator of the Champaign-Urbana Public Health District.
“In a couple of weeks, we will have a much clearer picture of the contagiousness of the virus as well as the efficacy of the current vaccines to protect against it.”
Until then, here are a few things you should know about where we stand on this, pandemic Day 630, as told to News-Gazette Editor Jeff D'Alessio by coronavirus experts near and far.
‘Variant of concern’ does not mean variant that leads to a return to remote learning, the cancellation of Christmas or any of the other worst-case scenarios you may have come across on Facebook.
“In short, omicron is concerning because its genetic code and the mutations are similar to what we have seen in variants with greater transmissibility and potential for immune evasion,” says DR. NAHID BHADELIA, founding director of Center for Emerging Infectious Diseases Policy and Research at Boston University.
“That, combined with increased cases in South Africa, is what drove WHO to name this a variant of concern. However, we truly don’t know a lot more about this variant yet as both laboratory and clinical studies are still being conducted.”
“With omicron, we are still in the fog of war,” adds CARL BERGSTROM, a University of Washington evolutionary biologist and noted critic of misleading scientific research. “There is a lot of information coming out very quickly, not all of it is accurately reported, and the pieces don’t fit together cleanly in a way that makes sense. As a result, we don’t have a good handle on what this means yet.
“It’s been a while since we’ve been in that position and if simply not knowing what to expect is scary, yes, this is scary.
“Do I imagine that this new variant will be really bad? It’s in realm of possibility, but there are a lot of other possibilities as well. At this stage, we cannot say anything more conclusive than that.”
Omicron’s emergence in southern Africa — and transmission to countries as far away as the U.S., which on Wednesday reported its first case, involving an inbound traveler — is ‘the most sobering development in the COVID-19 pandemic since the advent of the delta variant,’ says one leading expert.
How sobering is what scientists across the world are spending late nights in the lab trying to figure out, says DR. WILLIAM SCHAFFNER, a Vanderbilt professor and medical director of the National Foundation for Infectious Diseases.
“Several aspects of omicron have already earned it the WHO’s designation of a ‘variant of concern,’ starting with the recognition that it has a series of mutations that make it potentially dangerous, including:
“Rapidity of spread. Omicron has spread rapidly in South Africa, raising concern that it may be as contagious as delta, or even more so.
“Severity of disease. There is a smattering of data suggesting that infection with omicron might predispose to more severe disease than delta.
“Most important, can omicron at least partially evade the protection induced by our current vaccines?
“Along with the latter, might our diagnostic tests perform less well in detecting omicron and are our therapies — particularly monoclonal antibodies and the still-to-be-approved antiviral drugs — effective in treating omicron?
“There are, of course, best- and worst-case scenarios. It is possible that omicron could cause a notable resurgence this winter with a substantial spike in infections and consequent hospitalizations and deaths. That’s all the more concerning because we already are experiencing the beginning of the annual influenza epidemic in the U.S.
“We could have a ‘twin-demic’ impacting our health-care system.”
But no matter what, the worst-case scenario will be better than what we faced in the days before the vaccine.
On the optimistic side, “there have been other variants that raised fears about immune escape in the past, but ended up not doing much because they didn’t transmit very well,” says CHRISTOPHER BROOKE, a University of Illinois associate professor of microbiology. “The same thing could happen here.
“That said, as long as the virus is spreading so widely around the globe, we expect to see new variants with great transmissibility emerge periodically.”
Two other points Brooke believes everyone should understand:
One, “even if omicron is better at evading vaccine-mediated protection, it will not take us back to square one. Vaccination will still offer some protection against this variant.”
Two, “all of the things that can protect against new variants are the same things we should already be doing to protect against the delta variant that is still killing approximately 1,000 people a day in the U.S.: get vaccinated, get boosted, avoid crowded indoor spaces without masks and boost ventilation in indoor spaces.”
The lower the world’s vaccination rate is, the higher the odds are of new virus strains emerging. And much of the planet has a lot of catching up to do — from the continent of Africa (about 6% vaccinated) to large nations like Russia (39.0%, matching the rate of Vermilion County).
“I think the important message here is we will continue to see variants until the majority of the world — not just the U.S. — is vaccinated,” says UI grad and Vanderbilt professor DR. KEIPP TALBOT, a member of the CDC Advisory Committee on Immunization Practices.
“Hence, it is incredibly important for U.S. citizens to be vaccinated and for the U.S. to help other countries with vaccination efforts.”
As President Joe Biden noted Friday while announcing travel restrictions from African countries, the U.S. has donated more vaccine doses to low-income countries than the rest of the world combined.
According to data compiled by the Kaiser Family Foundation, the U.S. has given about 140 million doses to 93 countries, including Pakistan (15.8 million doses), Bangladesh (6.5 million), the Philippines (6.4 million), Colombia (6 million) and South Africa (5.7 million).
Says South African infectious disease physician/scientist DR. RUANNE BARNABAS, a professor at the University of Washington: “We really do need to offer COVID-19 vaccines to just about all 8 billion people on the planet to protect their individual health and prevent the evolution of further variants which could escape vaccine protection.
“The cost not to do so is high.”
Expert opinions are mixed on whether the U.S. halting in-bound flights from Botswana, Eswatini, Lesotho, Malawi, Mozambique, Namibia, South Africa and Zimbabwe is the smart play.
Says REBECCA SMITH, a UI associate professor of epidemiology: “Rather than shutting our borders to South Africa, we should be shipping them vaccines and testing support. At this point, it is unlikely that shutting our borders will have an impact on spread. Increasing vaccination and testing in under-resourced areas will not only limit spread, it will decrease the probability of the next variant developing.
“It is also important to remember that South Africa detected this variant, but it did not necessarily develop there — South Africa just has a fantastic genomic surveillance program, which makes it more likely to detect new variants than even the U.S.”
There will be variants after omicron. Whether they rise to ‘variants of concern’ (more likely to cause breakthrough or re-infections in those who are vaccinated or previously infected) or top out at ‘variants of interest’ may depend on how urgently the world acts in the coming weeks.
“The omicron variant was predictable,” says Hasbrouck, a former CDC senior medical officer who served as director of the Illinois Department of Public Health from 2012-15.
“The threat remains the interplay between three things: the virus, the host and the environment that brings them together — the epidemiologic triad. We can’t directly change the infectivity or virulence of omicron or future variants, but we can manage host and environmental components.
“We bolster host protection through vaccines, boosters or recovering from natural infection. We lessen environmental risks through common-sense mitigations, including masking, social distancing and travel restrictions. Our fire line against the omicron variant is herd immunity, and behaviors that present a barrier between us and the virus.
“Despite omicron, the game plan to fight COVID should not change, but adherence to the game plan should. My worry is that as a society we still don’t seem to get it.”
The global health community has learned from its past pandemic missteps. And that’s a good thing.
Says Vaid: “The international community, including the U.S., have implemented strict safety measures before this variant has spread extensively. This is a good strategy to slow the spread and buy some time to study the virus, an important lesson learned from the slow response to the spread of the delta strain early in 2021.
“Proper masking, universal vaccinations and basic precautions will continue to be our best defense against any new or existing variants.”
For the umpteenth time, get vaccinated if you haven’t already. And if you have, book a time for a booster shot.
“For now, there is no need for people in the U.S. to be overly concerned,” says Professor ANDY PEKOSZ of Johns Hopkins’ Bloomberg School of Public Health. “But if you want to do something, go get the COVID-19 vaccine or the COVID-19 booster. Building immunity in the population will lessen the impact of any COVID-19 variant and is a positive, constructive thing everyone can do.”
“Only when the U.S. moves from 60 to 90 percent vaccinated will the numbers of cases per day plunge to low levels, and life return to normal,” adds Human Vaccines Project CEO WAYNE KOFF.
Pekosz believes the scientific community will have a better handle on how dangerous a variant they’re dealing with in a week or so.
“On paper, this is a very worrisome variant,” he says. “It has mutations that may: one, reduce the ability of vaccine and infection-induced antibodies to block virus replication; two, allow the virus to bind to cells more efficiently and three, allow the virus to start an infection faster.
“What I’m following closely is the number of cases that are being caused by the variant — not only in South Africa but in the dozen or so countries that have reported the variant. The fact that a variant looks concerning on paper doesn’t mean it will necessarily become a global threat.
“We’ve seen variants like beta and gamma flair up and then flame out but we’ve also seen variants like alpha and delta circle the globe like a wildfire. The next week or so will tell us how efficiently omicron is spreading and that will really help us determine how large of a threat it is.”