omicron, oh my
The most important news in healthcare: Friday, December 3rd
Yesterday, multiple new cases of omicron, the newest COVID-19 variant, were detected in the US. Today’s Pulse will be a rundown of everything we know so far, including President Biden’s latest viral combat strategy.
Today’s Pulse is 1000 words, or a 9 minute read.
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COVID-19Numerous omicron cases detected in the US
The pulse:
Omicron is officially in the US. So far, three cases have been detected, two in recent travelers from South Africa. Yesterday, President Biden announced his plan to combat the spread of the latest variant.
I can’t keep up, I thought we were on delta?
We are very much still on delta, which currently accounts for 99% of coronavirus cases sequenced in the US. However, omicron (pronounced OH-muh-kron, for those of you who have been avoiding saying it for fear of being wrong) is officially here, and scientists are wondering if it could potentially outcompete delta and become the dominant strain in the coming weeks.
Where did this variant come from?
Omicron was first detected on November 24th by scientists in South Africa who alerted global health officials quickly. Once it had been identified, South African scientists looked back at recent cases and found positive omicron samples dating back to November 9th. Though it was first identified in South Africa, it is not yet clear if this is in fact where it originated, or if went unnoticed elsewhere first. Omicron cases have now been detected in over 30 countries. There are a number of conflicting theories as to how the strain evolved, which we’ll delve into below.
What makes omicron different from delta?
Variants reflect viruses that have undergone a number of mutations in their genetic sequence. For example, the delta variant had approximately 15 mutations compared to the initial viral strain that began in Wuhan. The omicron variant is believed to have 60 mutations, of which more than 30 are on the spike protein, the part of the virus used to attach to and enter cells and thus the target for our immune systems and vaccines.
Viruses tend to mutate rapidly as they do not have the same type of proofreading and repair mechanisms that humans do when we replicate our DNA. Typically, mutations that allow for increased transmissibility and spread are more likely to be “selected for” as they better allow the virus to propagate. When enough mutations accumulate, a new variant is born.
How did so many mutations arise?
There are currently two popular competing theories as to how omicron evolved.
An immunocompromised patient — People with weaker immune systems, such as HIV/AIDs patients, can have more severe, protracted COVID infections as they are less able to fight back. One possibility is the virus evolved over time in an immunocompromised patient and spread from there. This theory is the most prevalent one currently. South Africa is considered the HIV epicenter of the world, with an HIV prevalence in the general population of 20.4%. Again, while it is not yet known whether omicron originated in South Africa, its more immunocompromised population is more susceptible to chronic infections.
Reverse zoonotic event — It’s become clear that certain animals can be infected with and carry SARS-CoV-2. In fact, most scientists are in agreement that SARS-CoV-2 likely originated in bats. A reverse zoonotic event describes animals becoming infected with a human strain and then passing it back to humans with new mutations. Some scientists point to how unusual the mutations themselves are and how easily the virus jumps between species as support for this theory.
Dr. Angelique Coetzee, one of the first doctors to highlight the possibility of a new variant. Source: SAMA.
So is omicron more transmissible or deadlier than delta?
The truth is, no one currently knows. The fact that there are so many mutations specifically in the spike protein could point to higher transmissibility, as this level of variation may allow the virus to better evade the immune system and our vaccines. As for its severity, this also remains to be seen. However, Dr. Angelique Coetzee, the South African doctor who first raised alarm bells over omicron, notes that her patients with omicron tended to actually be younger and relatively asymptomatic.
Biden’s strategy
President Biden held a press conference yesterday, December 2nd, with his plan of attack. He has already restricted travel from South Africa and seven other countries. Many believe this will do little to stop the spread given the evidence of cases already in the US, and the likelihood that the strain has been spreading for weeks, if not months, undetected.
One new change is that all international travelers, regardless of vaccination or citizen status, will need to test negative for COVID-19 within 24 hours of their flight (previously 72 hours). President Biden has also pressed for widespread availability of at-home COVID-19 tests, which he stated will be 100% covered by insurance in the coming months. Finally, he spoke on the importance of boosters for the 100 million Americans who are now eligible but have yet to receive them. While vaccines have been a major tool in reducing severe illness and hospitalization from COVID, more time will be needed to see how well our current vaccines will work against omicron. Unfortunately, it’s likely that efficacy will take a huge hit. Last week, Pfizer said it could produce an omicron-specific vaccine in approximately 100 days, stating it already has clinical trials underway.
Still, Biden urged calm saying “This variant is a cause for concern, not a cause for panic.”
Bottom line it for me:
Yes, omicron is here, but omicron has also very likely been here for a while. Data on transmissibility and severity remains sparse, but its sheer number of mutations are concerning for reduced efficacy for our current vaccines.