Omicron is Here. Now What?

What do we know about the Omicron variant?

The Omicron variant, first observed in South Africa, is a highly-mutated variant of Covid-19. There are over 30 known mutations on the spike protein itself. While other variants have been more closely related to one another, this variant appears to be most closely related to the original (or wild) strand of Covid-19.

Right now, it appears that the Omicron variant is more contagious than the other variants we’ve seen, including the Delta variant, but it also appears to be less severe. Dr. Jordan Vaughn says, “This variant seems to be behaving exactly as we’d predict a more contagious variant to behave. Almost all single-stranded RNA viruses, such as Covid-19, will become less lethal as they become more contagious.” In Alabama, while we’re seeing more cases of Covid than we’ve ever seen before, hospitalization and death rates remain far lower than what we’ve seen in previous waves.¹

Symptoms of infection with the Omicron variant are consistent with other Covid variants. These symptoms include low-grade fever, headache, fatigue, sore or scratchy throat, cough, and runny nose. Those who are hospitalized with the Omicron variant appear to be experiencing less severe disease. Fewer hospitalized people are requiring supplemental oxygen and the average hospital stay is much shorter for these patients.²

The Omicron variant can also be detected without full genetic analysis or sequencing. Dr. Vaughn says, “This variant was actually discovered through ordinary PCR testing in South Africa. Typically, the PCR analyzer will check for three distinct portions of the spike protein. With Omicron, one of these spike proteins drops out, making it very easy to identify with PCR testing.”

Should we be concerned that there's another new variant with so many mutations?

The news makes it sound like a new variant with numerous mutations should be terrifying, but Dr. Vaughn says that this really shouldn’t be frightening news at all. Almost all viruses mutate and change. And in the case of the Covid variants, these mutations are actually a good thing.

He says, “The mutations we’re seeing with each variant are actually making the virus more infectious but less dangerous. Because the vaccines that are available right now don’t prevent you from getting or transmitting Covid, this variant is actually a good thing. It makes it possible for people to get Covid and get the immune protection with the least amount of disease.”

In a typical flu season, there are three or four strands of flu circulating at any given time and scientists never know which strain will be dominant each year. These variants are different from the flu strains that circulated in the previous year. In the same way that we’ve been unable to eliminate flu, we will likely be unable to eliminate Covid-19 as well.

According to Dr. Vaughn, “We’ve never been able to eliminate a coronavirus before, so it’s reasonable for us to expect that Covid-19 is going to continue to mutate and become endemic. And the best endemic disease is one that doesn’t cause much morbidity, like the common cold. We live with all kinds of other coronaviruses that aren’t deadly, so we’d love for Covid-19 to get to that place -- but it won’t happen without mutation.”

Are vaccines effective against Omicron?

The mRNA vaccines, which targeted the spike protein, were relatively ineffective at protecting people from infection with the Delta variant. Since Omicron has so many more variations on the spike protein, it’s very likely that the vaccines will be even more ineffective.

Dr. Vaughn says, “The mRNA vaccines were developed for the wild type of Covid that we originally observed in late 2019 and early 2020. And they’d be quite effective if that was the variant that was circulating, but it just isn’t. And the further the variants get from wild Covid, the less effective these vaccines are going to be.”

Vaccine makers are currently working to create a booster targeted for Omicron, but by the time these boosters are released, the Omicron wave will have likely subsided. As for the boosters currently available, Dr. Vaughn says, “There’s a lot we don’t know about booster effectiveness and Omicron. As a result, we can’t really advise anyone to get it or not get it in light of the new variant. As for prior infection, that immunity seems to still be durable, but again, there’s a lot we still don’t know.”

Regardless of how prior immunity or vaccines fare against Omicron, it’s important to remember that this variant already appears to be much less severe than previous variants of Covid-19.

How will Omicron impact kids?

So far, the impact of Covid-19 on children has been less severe than the impact of a typical flu season. Since January of 2020, fewer than 800 children in the United States have died as a result of Covid-19.³ While the death of a child is always tragic, Dr. Vaughn says it’s important to put that data into context.

“First, remember that this is two years of data, so that’s an average of less than 400 pediatric deaths due to Covid-19 each year. In a given year, over 800 children drown in bathtubs or backyard pools. And over 600 children under the age of 12 died in motor vehicle crashes in 2019. Riding in a car or swimming is riskier for children - even children with pre-existing conditions - than Covid-19.⁴”

Children have typically gotten very mild infections and have proven to be poor transmitters of the disease. Omicron appears to be even milder. In most cases, parents have no need to be afraid of their children contracting Covid-19.

For children who may be at risk of complications due to Covid-19, such as those who are immunocompromised or who have a clotting disorder, Dr. Vaughn says that parents should talk with their child’s medical providers and have a plan in place for treatment if they do get sick.

Are there any treatments available for Omicron?

Treatments are available for the Omicron variant. After testing positive, you can immediately begin an at-home treatment protocol to help reduce your symptoms, speed your recovery, and prevent the spread of the virus among the people you live with. This protocol includes the use of an oral and nasal rinse as well as over-the-counter medications and supplements.

Additionally, anyone who is at high risk for complications from Covid should get a monoclonal antibody infusion as soon as possible after testing positive. While not all monoclonal antibody treatments work for Omicron, sotrovimab, the monoclonal antibody treatment from GSK, is effective at treating this variant.

These treatments are abundant, and there is very little out-of-pocket cost due to government subsidies. Dr. Vaughn says, “We have enough of these treatments in our clinics that everyone who is eligible can receive an infusion.”

In addition to monoclonal antibodies, early treatment options are available. While over-the-counter fever reducers and fluids can help, there are other effective outpatient treatments such as nebulizers, steroids, anti-inflammatories, and anti-clotting medications. Doctors can also prescribe home-based supplemental oxygen. Aggressive outpatient treatment has been proven to significantly reduce the risk of hospitalization and death from Covid-19.⁵

Dr. Vaughn says, “We know how the virus enters the body, how the body responds to infection, and how the virus destroys cells in the body. We can intervene at any and every one of these phases with treatments that work with proven medications.” These treatments are especially important as the vaccines continue to be less and less effective at preventing infection.

The FDA has recently approved two antiviral treatments, Molnupiravir and Paxlovid, for Emergency Use Authorization. These treatments will soon be available by prescription. Both antivirals work by inhibiting the ability of the virus to replicate, and these should be effective for all variants.

What can be done to prepare for Omicron?

According to Dr. Vaughn, the most important thing you can do is to talk to your doctor and have a plan in place for if you get sick . “Whether you’re vaccinated or not, you’re at risk of contracting Omicron. But regardless of the variant, make sure you know where you’re going to get treatment if you do get sick.” While Omicron does appear to be milder than other variants of Covid-19, it’s impossible to predict who will have a severe case.

If your doctor tells you that there are no treatments available for Covid, you might want to talk with another doctor. Treatments reduce your risk of severe outcomes from Covid-19 to well below the risk posed by flu. Dr. Vaughn says, “Vaccines have been an important part of our toolkit for fighting Covid, but they are not and cannot be the entire solution. We need a diverse strategy for treating this disease.”

While you should expect to see the Omicron variant spreading rapidly, you should also expect to see a milder illness. Symptoms of Omicron are consistent with a mild upper respiratory infection, so even if you’re vaccinated, you should get tested at the first sign of sickness. But there’s no need to panic if you do get sick. Treatments are available, and MedHelp doctors are willing to aggressively treat Covid in an outpatient setting.

References:

¹ Covid Act Now: Alabama. Retrieved 04 January, 2022. https://covidactnow.org/us/ala...

² Maslo, C., Friedland, R., Toubkin, M., et al. Characteristics and Outcomes of Hospitalized Patients in South Africa During the Covid-19 Omicron Wave Compared With Previous Waves. December 30, 2021. doi:10.1001/jama.2021.24868

³ CDC: Child Passenger Safety Fact Sheet. Retrieved 04 January, 2022. https://www.cdc.gov/transporta...

⁴ CDC: Provisional Covid-19 Deaths: Focus on Ages 0-18. Retrieved 30 December, 2021. https://data.cdc.gov/NCHS/Prov...

⁵ McCullough PA, Alexander PE, Amrstrong R, et al. Multifaceted highly targeted sequential multidrug treatment of early ambulatory high-risk SARS-CoV-2 infection (COVID-19). Rev Cardiovasc Med. 2020; 21: 517-530. DOI: 10.31083/j.rcm.2020.04.264