The Omicron Variant Is Spreading Fast, And Delta Is Still With Us.
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“I am extremely concerned that the number of people hospitalized with COVID-19 in the County has increased 37% since last week, reaching over 200 patients on Monday for the first time since February 2021. Whatever it is, the way you tell your story online can make all the difference.” - Dr. Ernest Carter, Prince George’s County Health Officer.
When the Maryland Health Department was unable to report COVID-19 data, due to an alleged cyberattack, locals suspected that something was wrong. When Dr. Monica Goldson, CEO of Prince George's County Public School system, decided to switch in-person school to virtual, it solidified, at least for some, that we may be in for a COVID-19 surge. When the Maryland Department of Health returned to publishing COVID-19 data, it further confirmed that not only was Prince George’s County experiencing a COVID-19 surge, but also the state. Since then, infection rates have further risen, and Maryland hospitals are overcrowded with people who are infected with COVID-19. Dr. Ernest Carter, a Prince George’s County health official, said in a press release that he was deeply concerned about the rise of the infection rates and the increase in hospitalizations.
After Dr. Goldson decided to switch to virtual, and after she defended her decision at a press conference against Gov. Larry Hogan's ill-informed accusations, I decided to see if I could get some answers as to how this new variant, Omicron, was spreading. Dr. Andrew Pekosz, professor of microbiology at the Bloomberg School of Public Health, agreed to talk with me. Pekosz is a virologist by training and has been studying respiratory viruses; how they replicate; and how they cause disease for about 20 years.
“ It is very clear that this variant can spread faster than any other variant that has been identified to date.”
DH: What is known about the variant so far?
AP: It is very clear that this variant can spread faster than any other variant that has been identified to date. It is nearly astronomical in terms of how quickly it is moving through multiple countries. It seems to be displacing the Delta variant in countries where that variant was causing a large surge of infections, like the U.S. Furthermore, it has started new SARS- CoV-2 outbreaks in countries where there were relatively low numbers of cases (infections). It is spreading like wildfire, and that may be an understatement.
We know that it is capable of infecting people who have been previously infected with SARS-CoV-2, as well as people who were [fully] vaccinated. It appears that when researchers look at the antibodies that have been generated by the vaccines, most of those antibodies don't recognize the Omicron variant. But if you get a booster vaccine on top of your two-dose vaccine, then your antibodies tend to recognize Omicron much more effectively. We hope that will translate into greater protection for individuals who have received a booster vaccine (a third dose). I say that realizing that there are some people who have received their third dose of the vaccine but gotten infected. However, right now, it looks like it's a lower number of people in that category that are getting infected with the Omicron variant.
Finally, the thing that is still a bit unclear is whether the Omicron variant is more severe - in terms of its infections - compared to other variants. It's been infecting a lot of people who have some immunity to it. That immunity, in the populations, maybe dampening the disease severity. What will really need to see is how this variant does in unvaccinated individuals, and the numbers of people who are unvaccinated, who have been infected are somewhat low. We have to wait at least 21 or so days to see the severe disease in those populations. It is still not clear how severe of an infection it causes. But, there are signs that it is a little milder than other variants that have come before it.
DH: And that we will be in terms of the vaccinated vs. unvaccinated people. Is that correct?
AP: Certainly, in vaccinated individuals, this is a milder disease. What we don't know is how this disease will behave in the unvaccinated populations because we don't have enough of the unvaccinated people who have been infected. The disease takes about 2 to 3 weeks, sometimes, to show in terms of that disease severity, people just haven't gotten to the stage where they would be expected to be showing that severe disease based on being infected with Omicron.
“Although, it is good to remember that the people who are going into the hospitals right now are probably infected with Delta. So we are in an odd place here in the United States. We are seeing new infections with Omicron, but the severe infections are probably driven by the Delta variant. This makes it very difficult to gauge how severe an infection Omicron causes because all these variables are sort of moving all at the same time.”
DH: You talked about it is displacing the Delta variant. What do you mean by that?
AP: When you look at the new infections, most of the new infections are Omicron. They're not Delta. Two weeks ago, 100 percent of the infections were Delta. Now the vast majority, I think the number I saw yesterday was 73 percent of U.S. infections, are Omicron. (It must be noted that this data point was an early prediction by the CDC. It has been reduced to 58 percent). It is rapidly becoming the virus that is responsible for COVID-19 cases. Although, it is good to remember that the people who are going into the hospitals right now are probably infected with Delta. So we are in an odd place here in the United States. We are seeing new infections with Omicron, but the severe infections are probably driven by the Delta variant. This makes it very difficult to gauge how severe an infection Omicron causes because all these variables are sort of moving all at the same time.
DH: This seems to be a complicated situation. Are you saying that some of the people who are going into the hospitals are infected with the Delta variant and not the Omicron?
AP: At this time - yes!
DH: Are people also being infected by the Omicron variant that is causing the severity of the infections? Or are those two different infections?
AP: Those are two different infections. So it doesn't seem like, to date, a lot of coinfections. It is probable that you're going to get one or the other. But the severe cases are driven by people who were infected two weeks ago because there is a lag before you show the severe symptoms after infections, you know. We won't be seeing a lot of severe infections from Omicron until maybe a week or two from now. That is the subtlety that is important to note, right? The hospitalization rate right now is probably still being driven by Delta. But the case numbers are being driven by the spread of the Omicron variant.
DH: So you're saying the new positive infection cases are driven by the Omicron variant?
AP: Yes.
“Omicron has probably a dozen mutations within it that will reduce the ability of antibodies to bind to it. It doesn’t eliminate all the antibodies, but it eliminates a good percentage of them.”
DH: That seems like a key distinction to make. You said earlier that the antibodies don't recognize the Omicron variant. Is that only in vaccinated people? If this is the case, why is this?
AP: That goes for the vaccinated people as well as people who were previously infected by SARS-CoV-2. Omicron has probably a dozen mutations within it that will reduce the ability of antibodies to bind to it. It doesn't eliminate all the antibodies, but it eliminates a good percentage of them. Importantly, it does eliminate neutralizing antibodies, which are the ones we think are playing a very important role in protecting from infections.
DH: You talked about the range of speed. Excuse me if this is an ill-informed question, but is there a way of calculating that speed, in terms of how fast it is actually spreading? I ask because you used the metaphor of wildfire to explain how fast the Omicron variant is spreading.
AP: One way that we are trying to quantify how quickly Omicron is moving is to give it, what's called, a doubling time. We ask: How many days does it take to get twice as many cases (infections)? With Omicron, that seems to be averaging 2 to 3 days. So in every 2 to 3 days the cases numbers double. With previous variants, it usually took 3 to 5 days before you saw a doubling of the number of cases (infections). So that may not seem like a lot, but if you do the math, very quickly, that becomes huge numbers of cases at a much faster rate. Essentially, you're doubling every two days instead of every four days. It is almost as twice as fast as it is spreading, at least right now.
DH: What has been learned from South Africa and Botswana about the Omicron variant?
AP: We know about how we can test for it. We know how well it is spreading. We got the first idea of that from South Africa. South Africa was the first country to report that the Omicron variant was able to evade a lot of these antibody responses. What South Africa found has now been verified by multiple countries around the world. The country's research also gave us a head start, in terms of, figuring out ways that we could use to specifically detect the Omicron variant in our populations. That's usually the result of the sequencing that tells us what variant a person is infected with. We were able to gear up our sequencing efforts since Thanksgiving to be prepared to deal with a large number of cases coming through and a large number of samples that need to be sequenced to determine exactly what is infecting people.