Dr. Stuart Weiss: COVID-19 Omicron Update Tuesday 12-21-2021
Rapid Test Center of New York
Dr. Stuart Weiss, FACEP, FAAP, CBCP
Dec 21, 2021
CoViD-19 News and Information you can trust. Welcome new readers from the Rapid Test Center.
Topics:
- Omicron variant update
- Home Test Kits available
| Several weeks ago, I wrote to you about the Omicron variant after not having written a newsletter for many months. IT was very early on in the course of this new variant but I wanted to present what I thought was going to be a big threat. Since my last news letter, what have we learned about this new variant? For those of you who are wondering why I am writing to you, its because you are a corporate client of ours or you had a CoViD-19 test at one of our testing centers, or we tested you at your place of business or you work on a production that we took care of, etc. OMICRON Variant update Review of Origins The Omicron variant (named after the 15th letter in the Greek alphabet, after 13 previous variants of interest or concern and skipping the letters Nu and Xi) erupted onto the scene 4 weeks ago. It probably started in a very sick person with immune deficiency which led to a prolonged infection and allowed the virus to develop the over 50 different mutations that are seen in this variant. Some mutations have been seen before and are related to evading immune response and some mutations are new. Over 30 of the mutations are in the spike protein which would alter the way the virus looks to our immune system and how it enters our cells. Transmissibility This variant is extremely transmissible. The estimated transmission rate or Rt is at least 3. That means that if I catch Omicron, I give it to three other people. This will cause an explosive skyrocketing number of new cases in the US which will double about every 2-3 days. In New York City, where I am, we have seen new case numbers break records for the past three days. The percentage of cases that are caused by Omicron in the New York and New Jersey area has gone from 13% last week to 97% this week. Although New York leads the country, across the rest of the US, the percentage of new cases caused by Omicron has leapt up to 70-73% over the last week. In our NYC testing centers, we have seen the volume of people getting tested increase by 10x over the past week and the percentage of positive cases has shot up. So Omicron is coming, fast and furiously. Models suggest that it will start spiking case numbers up across the country, similar to New York, between Christmas and New Years. Case numbers may peak by the middle of January. While we have observed this high transmissibility, the cause is only now starting to be understood. Two studies came out late last week looking at this and found the same thing. The first study was done by scientists in Hong Kong who infected human tissue from the bronchial tubes and lungs with Omicron. They measured how fast the virus grew compared to Delta variant. It turns out that the Omicron virus grew 70 times faster than the Delta variant so people would become infectious much faster. Not only does it grow faster, it also evades immunity both from vaccine and natural disease. There have been multiple studies showing this. So even vaccinated people can get infected and spread Omicron. This is especially true with people who have not been boosted. Disease Severity Early data from South Africa suggesting that the new variant only causes mild disease may be incorrect. Some new data from the United Kingdom suggests that disease severity may be similar to Delta. This is still unclear. In the US, although new case numbers have shot up, the national trend of hospitalizations has not shot up yet but it is still way to early to draw any conclusions about this. Even if Omicron is less severe, the shear number of people who get infected will drive up hospital numbers and eventually deaths. Breakthrough Infections in vaccinated people We are definitely seeing many breakthrough infections. This is especially true in people who have only received their primary series of vaccination and not yet received a booster. In a study last week, we learned that two shots of Pfizer are 30-40% effective against Omicron. If you get a booster, this protection goes up to 70-80%. We used to think that after a case of natural CoViD infection, a person was protected by “natural immunity” for a while. That is no longer the case. Data out of South Africa shows that a large proportion of new cases of CoViD infection are in people who had been previously infected. Vaccine Effectiveness It appears that the only two vaccines that reduce your chance of catching Omicron in the first place are Pfizer and Moderna. Vaccines from Johnson & Johnson, Astrazeneca, China and Russia will probably not prevent infection but should prevent severe disease. Today, Moderna announced results of a trial which showed the 50-microgram standard booster shot increased antibodies by 37-fold. The full dose shot, 100-micrograms, increased antibodies 83-fold but caused slightly more side effects. So what we may be seeing early on, is that there are many breakthrough infections in vaccinated people but infection is much less likely if someone is fully vaccinated and boosted with Pfizer or Moderna. If I had a choice, I would get boosted with Moderna, especially if my first shot was J&J. This past week, we saw the CDC walk away a bit from recommending the J&J vaccine in favor of the m-RNA vaccines (Pfizer or Moderna). They didn’t actually say don’t get J&J but it was definitely a statement in that direction. Between the increased chance of blood clots and the decreased Omicron protection, I think its a no-brainer to recommend m-RNA vaccines over J&J. Also last week, the Pfizer clinical trial for kids 6 months to 5 years failed. The testing dose of vaccine worked for kids 6 months to 2 years but didn’t create an adequate immune response in kids 2 years to 5 years. Because of this surprising failure, the authorization process was stopped and Pfizer must switch to a different clinical trial. This will delay the approval and release of a CoViD shot for 6 month to 5 year olds. Testing Effectiveness The CDC has listed tests known to not pick up the Omicron variant on their website. There are a small number that miss this infection. Most tests do fine picking this up. The difference in test relates to sensitivity (how accurately the test picks up a case of disease). rt-PCR tests are the most sensitive and can pick up small amounts of virus. This makes them more accurate to predict infection over a day or two. Antigen tests are less accurate and should only be used on the day of an event. Testing is one of the most effective ways to keep everyone is safe during the holiday season. I am often asked if someone has symptoms and wants to get a test, which one should they get. My answer is if someone has symptoms, they are growing millions of copies of the virus in their nose or throat and any test will pick that up (antigen, rapid rt-PCR or lab based rt-PCR). Treatment There are two CoViD pills that are nearing approval. One is made by Merck and the other is made by Pfizer. Both of them must be started very early in disease progression and long before severe illness. The Pfizer pill is much more effective against CoViD than the Merck pill. Pfizer recently reported that its pill can bind to viral proteins in Omicron just as well as other variants. Travel Last week, the US implemented rules that everyone flying into the US from a foreign country must have a negative CoViD test within 24 hours of the flight. This may be challenging in some parts of the world and the CDC is coming out with guidelines around this issue which may include a “proctored” home test done over video conferencing. Today, Israel added the US to its banned travel list. Due to the changing travel restrictions and unknowns about the new variant, companies should consider temporarily limiting business travel to essential travel only. Masking Masking still provides a strong defense against Omicron and several large cities have reimplemented masking mandates for indoor spaces, especially for unvaccinated people. This is good guidance as wearing a mask reduces the chance of viral spread. We will keep you informed as information changes. Dr. Stu Weiss |
| Expert Consulting for Challenging Times iCrowd is busy helping our clients navigate these difficult times. From deciding which medical accommodations to accept to which policies to adopt, we have the expertise to help you make the right decisions. We are happy to help so please feel free to reach out to us at any time. Home Test Kits We have access to home test kits and we’re thinking about selling them through our centers n New York City. If you or your company needs test kits for your employees, let us know. We anticipate a real shortage soon as testing numbers are skyrocketing and the US Government has bought up 500 million test kits. Drop me an email if you are interested ([email protected]) |
