- First reported to the WHO by South Africa on Nov. 24, the Omicron variant is now classified as a variant of concern (VOC) and has been identified in 15 countries.
- Preliminary reports suggest an increased risk of infection, based on the rate of rising cases in South Africa.
- Still, there is still no good data yet to confirm this or whether the new variant is more deadly or will ‘escape’ vaccines as feared.
- Current PCR tests can detect the variant, and scientists are encouraging people to wear masks to stop its spread.
- Although Omicron may have the potential to overcompete the Delta variant, it is just as much likely that it will not.
The world is again dealing with a new variant of the novel coronavirus, this time called Omicron.
Many countries have swiftly imposed border restrictions and flight bans to buy some time as scientists try to decipher this new variant’s implications for public health.
The variant has a “very unusual constellation” of mutations and many of them, which has raised widespread concern, especially with regards to the protection afforded by vaccines.
Although many fear the worst-case scenario, no data indicates the variant is any deadlier.
Here is a breakdown of what we know so far and what experts think.
The first confirmed COVID-19 case with the Omicron variant — identified as B.1.1.529 — dates to Nov. 11 in Botswana.
Meanwhile, South African scientists detected a small number of the variant in samples collected between Nov. 14-16, prompting them to report their findings to the World Health Organization (WHO) on Nov. 24.
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As of Nov. 29, 15 countries have reported cases with the Omicron variant, including Australia, the United Kingdom, Canada, Israel, and Hong Kong.
According to media reports, there are now about 100 confirmed cases with the Omicron variant in South Africa.
Omicron may be responsible for close to 90 percent of new COVID-19 cases in Gauteng province, which includes Pretoria and Johannesburg. The rate suggests that Omicron may have overtaken Delta in that area.
“The data still are early and sparse, but in and around Johannesburg, South Africa, Omicron is out-competing Delta. This is one of the reasons that the WHO has designated Omicron a variant of concern (VOC), rather than just a variant of interest (VOI),” said Dr. William Schaffner, professor of preventive medicine and infectious diseases at Vanderbilt University Medical Center in Nashville.
COVID-19 infections rose sharply in South Africa over the past 7 days to reach 2,465 daily cases last week, recording a more than 90 percent increase from Nov. 24 to Nov. 25. However, not all have been confirmed to be infections with the Omicron variant.
The variant has an unprecedented 32 mutations on its spike protein, which is double the amount of Delta. It also has 10 mutations on the receptor-binding domain (RBD).
All viruses go through mutations, some of which can change the virus’ ability to spread, the severity of disease it causes, and affect the performance of vaccines.
The mutations detected in Omicron will change the shape of spike protein, which was the vaccines’ primary target. This could make the virus less recognizable to antibodies, and as a result, help it evade our immune defenses to cause infection.
Dr. Angelique Coetzee, chair of the South African Medical Association, first spotted the Omicron variant in the country. She said the symptoms seemed mild so far.
“Currently, there is no reason for panicking, as we don’t see severely ill patients,” she said.
However, early studies indicate that the Omicron variant has a reproduction (R) rate of 2 — which means every person who acquires it is likely to spread it to two others, which possibly makes it more infectious than Delta.
Dr. Monica Gandhi, MPH, a professor of medicine at the University of California San Francisco, underscored that concerns with the Lambda, Mu, Delta plus, and other variants were all assumed to be “more transmissible than Delta when they were first identified, but none were able to outcompete Delta.”
Because only 24 percent of the population is fully vaccinated in South Africa, it’s difficult to tell whether Omicron is outcompeting Delta as there is not a lot of immunity yet, Gandhi said.
The rise in COVID-19 cases in South Africa has coincided with the emergence of Omicron as well as the beginning of summer in the southern hemisphere. This is not what experts would have expected, which could mean the variant is more transmissible.
But the consensus, so far, is that we will have to wait and see.
An exceptionally large number of mutations could blunt the vaccines’ response to the Omicron variant, but scientists believe vaccines will still provide sufficient protection against severe disease and death.
“The question about escaping immunity is emerging from the variant having more than 30 mutations across the spike protein, but there are some reassuring data from South Africa in this regard that Omicron-related disease is occurring among the unvaccinated,” said Gandhi.
The current data from the Chris Hani Baragwanath Hospital shows that 65 percent of the patients were unvaccinated, and 35 percent were partially vaccinated.
Professor Rudo Mathivha, an ICU doctor at the hospital, also noted an increase in younger patients in their 20s and 30s hospitalized, which could be a trend to watch out for.
Gandhi said it was easy to see parallels with previous variants when it comes to hospitalization: “A variant causing disease among the unvaccinated is the same pattern that was seen with Delta.”
The fact that only 24 percent of South Africa is fully vaccinated also supports this.
We don’t know what will happen when it hits a highly vaccinated country such as the United States, United Kingdom, Canada, or Germany, for example, Dr. John Campbell, a retired nurse teacher and A and E nurse based in England, said during an online presentation.
Vaccine manufacturers are testing out tweaks
The four major manufacturers of vaccines — Pfizer, AstraZeneca, Johnson and Johnson, and Moderna — are quite readily able to tweak their vaccines.
Both Pfizer and Moderna previously worked on an updated formula of their COVID-19 vaccines against the Beta variant. Still, they saw that there was no need as the current formulation provided robust protection.
Pfizer now has said it needs 2 weeks at most to assess how well its mRNA COVID-19 vaccine works against the Omicron variant. The company also said it could produce and ship the tweaked version within 100 days.
Moderna has also announced that it is working on an Omicron-specific booster.
Gandhi expressed hope that the existing formulas of the current vaccines would still provide good protection against severe disease.
“Existing formulations should be able to protect against severe outcomes since B cells, produced by the vaccines, can produce antibodies directed against the variant they see if they see a variant in the future,” said Gandhi.
“[T] cell immunity across the spike protein is [also] very robust so,” she continues. “It should not be knocked out entirely by 30-33 mutations, and the vaccines produce polyclonal antibodies that work against multiple parts of the spike protein. I am hopeful that we will still have protection against severe disease with vaccinations as seems to be occurring in South Africa,” she further explained.
Schaffner agreed, saying that the immune response generated by the current vaccines will offer some protection against both infection and serious illness.
He said that the degree of protection remains to be determined.
Although some scientists agree border restrictions could stifle the spread of a variant if imposed early, others believe it is often too late for such measures to work.
“Once a virus has been found in multiple countries, like the Omicron variant, travel restrictions are unlikely to be helpful. A highly transmissible respiratory virus is not usually stopped by border restrictions,” said Gandhi.
Although Schaffner believes travel curbs could buy a little time to prepare, he stressed that it was impossible to pull down an “iron curtain” to keep out highly contagious respiratory viruses, like SARS-CoV-2.
Gandhi maintains that widespread vaccination would be the most helpful tool to prevent new variants and help stop Omicron.
She said that with the Delta variant, a high number of cases did not translate to an increased number of hospitalizations in areas with high vaccination coverage, such as San Francisco.
“There are two strong reasons to be vaccinated and/or boosted right now. First, recall that Delta is in every U.S. community, spreading and causing serious disease primarily among unvaccinated persons. Second, vaccination and boosting will optimize the degree of protection that the current vaccines can provide against Omicron.”
– Dr. William Schaffner
Studies have shown that therapeutic antivirals such as molnupiravir or Paxlovid are still effective against variants with mutations in the spike protein.
Gandhi explained:
“The ‘variants’ of SARS-CoV-2 develop mutations along the spike protein because that is the protein that interfaces with the host cell. The protein that links a virus to the host cell is always heavily subject to mutations, like the H and N spike proteins of the influenza virus.”
She noted that such mutations were not concerning for antiviral therapeutics as their working mechanism differed from vaccines.
As for Omicron, Schaffner said the effectiveness of forthcoming antivirals was currently under study.
“Here the tentative news is good – we expect them to work against Omicron,” he said.
How can I protect myself against Omicron?
Experts recommend following a multistep approach to protect yourself and others:
- Get fully vaccinated and receive boosters.
- Wear well-fitted face masks.
- Practice good hand hygiene.
- Practice physical and social distancing.
- Avoid crowded spaces.
The Omicron variant is an international concern, but for now, it is no more than that.
Because of widespread measures and vaccines, it is not possible for the world to go back to square one as it was in March 2020.
But as with all infectious diseases, it pays to be cautious as scientists keep a close eye on the new variant.
As for protection against Omicron at an individual level, “vaccination with boosting, wearing masks in public places, requiring vaccination as well as testing with negative results at family and other gatherings can all combine to reduce the risk of exposure substantially,” said Schaffner.
The Omicron variant initially appears to be more transmissible, and it likely is not causing severe disease in the vaccinated, but there is no good data to confirm this.
Scientists need more time to assess all areas of risk with the new variant.
“All these data will be forthcoming over the next 2-3 weeks, helping us to get a more complete assessment of the Omicron variant and its characteristics,” said Schaffner.