By Elizabeth Thompson
The Omicron variant of the coronavirus made a splash in headlines just a few weeks ago, and now the previously unknown COVID variant has caused travel restrictions and concern.
Scientists are rushing to understand what exactly this new variant has in store for us. Early data has hinted that the variant may cause more breakthrough infections among vaccinated people, but it’s still too early to tell how the vaccines will stand up against the variant.
A South African study released Tuesday indicated that the Omicron variant has the ability to get past people’s primary line of immune defense, which could mean breakthrough infections for vaccinated people and people who have already been infected. However, vaccines still did offer some protection, and it suggested that booster shots may be key.
Pfizer and BioNTech announced Wednesday that three doses of its COVID-19 vaccine could offer increased protection against the new variant.
With the holidays coming up, you might be trying to figure out what exactly is happening, whether you should cancel travel plans, and how best to protect yourself.
We reached out to David Wohl, professor of medicine at UNC School of Medicine who specializes in infectious diseases, and asked him about this confusing new variant. Responses may be edited for brevity and clarity.
North Carolina Health News: What do we know about the new variant right now? And how much of a cause for concern is it?
David Wohl: It was detected at a lab in South Africa. Immediately, the researchers alerted the world that they had found a variation of the virus that had been circulating that had mutations that were concerning. Given we have a library of mutations that we’ve been tracking, and some of them have been associated with different functions — including being able to infect people, and perhaps also eluding some of the immune responses that we get, either from getting infected or from the vaccine. So that caused alarm. And so dutifully, they informed the world and shared data on this variant.
Every day, we’re getting more and more data that help us put the pieces together, and what we’re seeing is that in South Africa, where this was first detected, it has caused a dramatic increasing number of cases, including in people who’ve been infected previously.
That is concerning because it means their natural immunity didn’t protect them.
People in South Africa largely are unvaccinated. A pretty large proportion of adults are HIV infected. So that could lead to very different circumstances than we have here in the United States, for instance, but it does look like they saw a big spike and a lot of this is Omicron — but not all.
If there’s any good news, it’s that many of the people that are being infected with the new variants are not severely ill. And we’ve seen the same thing from reports of other countries subsequently that have detected Omicron, largely they’re talking about this mostly in people who’ve been vaccinated and who have no or very mild symptoms. So that’s really good.
On the one hand, I think what we know is that this can spread pretty readily in certain populations. But right now, we don’t have any good indication that it causes any more severe disease than Delta. And some, perhaps, indication that people who are vaccinated seem to not have the severe disease, but this is all extremely preliminary.
NCHN: And when we’re talking about severity and transmissibility, what is the difference between those two things?
Wohl: We should break it down because one thing we want vaccines to do more than anything else is not let us get deathly ill with COVID-19.
A vaccine is successful if it prevents people from getting very critically ill and dying. If we had to bet on one thing that we would like the vaccine to do, that would be it.
In addition, it can do other things, if it’s successful or it’s highly successful, and that would include us not having too many symptoms if we get it — or even better yet, protecting us from getting infected. But the good news is all three vaccines that are available here in the United States do all the above.
Some of them do better than others.
We do know that you can get infected, even if you’re vaccinated, although the risk is much lower compared to not being vaccinated. And that’s a point that some people who are skeptical of vaccines don’t seem to understand: Just because you still can get infected doesn’t mean the vaccines are not offering protection.
People wearing bulletproof vests sometimes get shot and injured. But people who don’t wear a bulletproof vest die. There’s a big difference between wearing a bulletproof vest and not, and a big difference between getting vaccinated and not getting vaccinated. You’re still protected.
It’s not 100 percent absolute, we know that, but just because somebody gets infected, who is vaccinated, that is not a sign of failure. A sign of failure is if they go on and get sick, and then end up in hospital and die. And we see that very, very rarely, and probably in people for whom the vaccine just didn’t take, their immune system didn’t respond to it for one reason or another. So vaccines are highly successful across the board.
A virus being infectious and a virus causing severe disease are two different things. If a virus gets into your system and infects you, but you get mild symptoms, okay, that’s not fantastic, but it’s not the end of the world. In fact, that describes most cold viruses. But making you really sick, like we saw with Delta in people who are unvaccinated, that is a big deal.
We’re not seeing that Omicron can make people largely really sick. Yeah, that’s something we’re concerned about. Worst case scenario would totally be a variant that comes along, and people who are vaccinated, including boosted people get sick, really sick from it. I don’t think that’s what we’re seeing.
NCHN: Should you get a booster now? What would you say to those hesitant about getting one?
Wohl: We know really well that for previous variants of concern, including Delta – which is a really, really bad variant to be clear – we were worried that our vaccine would not protect us against it. It does.
The more antibodies you have, the higher level of antibodies you have can overcome some inherent resistance of the virus to the vaccine-produced immunity. So what that means is higher levels of antibodies overcome some of the ability of a variant to escape from our vaccine protection.
Now is actually the perfect time to get boosted, especially as we are at the foothills of what I’m worried about a mountain of cases that are spreading because of Delta. Let’s be clear, 100 percent pretty much all the virus being circulated right now in North Carolina is Delta. Now is the time to protect yourself against Delta. I suspect and hope that higher levels of antibodies produced by a booster will better protect you against Omicron, which is coming, than if you’re not boosted.
I know people say, “well, but then we’ll need another booster in three months.” We don’t know that we’re going to need a specific booster. If we do in three or six months, then we get that, but that doesn’t mean you shouldn’t be protected now, especially with Delta surge.
Yeah, it’s like people have kind of forgotten that we still have the COVID that we’ve been dealing with, which is Delta even, even though we’re worried or there’s cause for concern with the new variant. That doesn’t mean that Delta has gone away yet.
NCHN: What are things that you should keep in mind if you are traveling and/or seeing family? Should you be canceling those plans? What’s your advice to those people?
Wohl: Throughout the pandemic, people have had to make risk/benefit assessments. Therefore, it really does depend upon your tolerance for risk, your vulnerability to infection and severe disease, and the importance of the event. Clearly, there are going to be life events for which we need to be present and travel happens, whether it be work-related or family-related.
There may be other events that are less important, that are less crucial. And I think people have to make a decision for themselves. We know that travel right now is not risk-free. And we saw a really dramatic illustration when Omicron was first being announced by the South African investigators.
There were two planes with about 600 people from South Africa to land in Amsterdam. On arrival, those planes were halted on the tarmac and people were testing 600 people. Sixty-one of them had COVID, even though they all had to have certificates saying that they had tested negative within three days and boarding the flight.
They didn’t catch it on the plane, they came positive. We know just based on that, that maybe as much as 10 percent of people on a plane are positive, and if we are pulling off our masks at the same time to eat our little snacks or meals, we could potentially spread the virus. So it worries me to travel right now.
If it’s really important for you then do everything to lower the risk, which is making sure you are vaccinated, if not boosted. Make sure that you mask up in the airport whenever you’re around other people. I would try to keep my mask on the whole time as much as possible. If people are served a meal, I want to wait till everyone finishes and then start my meal. My mask is not off at the same time their masks are off.
I’m a big fan of the rapid tests, the tests you buy over the counter. Before entering the household, you can test yourself. People in the household can test themselves. And then if everyone’s negative it means that there’s probably not anyone who has a high level of virus. These are all little things that together, stack the odds more in your favor.
For me, I think the safest bet is to postpone the travel.
NCHN: Do you have any idea about what the timeline is for when we should expect to hear a little bit more about the variant?
Wohl: Folks should really appreciate just how great science is working in our favor. Science has brought us vaccines. We have rapid tests that are fairly good at telling us if we have someone with high levels of COVID in their nose and they’re basically made of cardboard and plastic and available at local pharmacies. We also have treatments that can help people stay out of the hospital, and soon we’ll have pills that also help reduce your risk. And those are going to be really important, especially for those who might get sick from infection.
Every day we’re learning more about Omicron. We will know a lot more a week from now, two weeks from now and a month from now. We will know tremendously more. So more and more data is coming from across the world. We’ll get laboratory data that will help point us in the right direction that will be definitive.
NCHN: How will the treatment pills change the landscape?
Wohl: So molnupiravir is a drug that is an oral therapy. It hasn’t been approved yet, but it’s been reviewed by the FDA and recommended for authorization. It’s a medicine that in treatment trials reduced the risk of getting hospitalized, and people who were at some risk of having severe disease.
It wasn’t as profound as I think we had hoped. Partly, maybe because as the study progressed, people who got placebos did better than they did earlier. So early in the study, there was a stark difference. It’s not that the molnupiravir stopped working or didn’t work as well, it’s just that the comparison group, the placebo arm, started to not have a severe disease and that may have to do with how the study was conducted.
I think the drug works if the drug is taken early enough. I think the drug is going to be important for a lot of people to nip in the bud productive virus infection early on. I think it’s going to be important. It’s only going to be the first of probably many therapeutics that we’ll have out there. And it’s certainly better than nothing.
Monoclonal antibodies are available right now. They probably work much better. But there are hassles to getting them. You have to go to an infusion center, and it can be given under the skin of the belly almost like insulin is given. There’s only a few places that do that. We have to scale.
Soon, we’ll probably have monoclonal antibodies that can be given as a shot. And I’d love to see that introduced into pharmacists’ and doctors’ offices.
If you are at risk for severe disease and diagnosed with COVID-19, meaning you have a chronic medical condition, are overweight or otherwise immune-compromised, Wohl recommended you get monoclonal antibody treatment as soon as possible.
The Department of Health and Human Services has a monoclonal antibodies treatment site finder on its website: https://covid19.ncdhhs.gov/FindTreatment
Or you can find a list of locations offering monoclonal antibodies here: https://covid19.ncdhhs.gov/monoclonal-antibodies-mabs-treatment-sites
There’s another medicine called Paxlovid that, according to one press release, seems to work much more effectively than molnupiravir. But it’s hard to compare across studies. So the devil will be in the details. That could be a game changer in which people would start that and much like we take Tamiflu for flu.
I’m very hopeful. I think therapeutics are the answer to helping us get out of this pandemic along with vaccination. You need both.
We need to turn this around so that we’re no longer the prey of some predator out there and we’re always fearful and running away. We have the tools, and as they scale up and we take advantage of them, we have fewer and fewer people vulnerable to getting hospitalized.
Everything we’re doing right now, all the masking, all the finger-wagging about distancing, being careful in public, all the research and everything going into therapeutics and vaccination is to keep people out of our intensive care units. Our intensive care units are spilling over with people.
If we’re running out of ventilators, if we’re running out of machines to support people’s life functions, that’s a catastrophe. Everything we’re doing is to prevent that from happening. And if we can get to a state where COVID-19 is what we call endemic, it’s just around, it’s circulating but at fairly low levels, and not causing our ICU to overflow or really even be full of people with COVID-19 then we can relax.
NCHN: What’s the best thing you can do for your health right now?
Wohl: Don’t be dumb by ignoring what was in front of you. We make mistakes, but don’t make the mistake of wishful thinking that you’re not going to get it, that you’re not going to give it to somebody else or they won’t give it to someone else.
We are in the midst of a pandemic whether we like it or not. We don’t get to decide. The virus doesn’t care if it’s Christmas, it doesn’t care if you have a ski vacation scheduled or country music festival to attend. It just does what it does. So we have to react intelligently.
Masks work, anyone who thinks that masks don’t work has blinders on or is grossly misinformed. We have to use them as a tool. We have to pay attention to who we’re around while we’re having a surge.
We just have to be smart, get vaccinated and get boosted. There is no good reason for 99.9 percent of us to not get vaccinated and boosted. Wear a mask when you’re in public. Use testing if you don’t feel well. If you have symptoms, don’t blow it off. Get tested. Get your flu shot. They’re just practical things that we could do using the tools we have.