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COVID-19 Update 12/8: The Latest on Omicron

December 9th, 2021 | 9 min. read

By Steve E. Bishop, M.D.

On this week's COVID-19 update, Dr. Bishop continues to updates us on the latest on Omicron.  Watch the update below and read on for a recap. 

Is Omicron More or Less Dangerous?  

A couple of interesting things that have come out about Omicron over the past week, which I think are both interesting and reassuring, is that it continues to appear that Omicron is going to be a relatively mild illness. We haven't really seen big spikes in mortality or morbidity from the Omicron variant as far as we can tell so far, and that is, again, consistent with what the health authorities in South Africa and some other places were seeing when they originally started noting the variants, so I think that that's a really good sign.

Do Vaccines Protect from Omicron?

Other good news about Omicron is Pfizer actually put out a small study today that they had done some testing on their current vaccine on three doses of the vaccine and tried to look and see, "Okay, is it going to keep working fine?" and they think probably yes, that it will keep working fine. Again, that's very preliminary, a small piece of data. There was a reduction in what's called the "neutralizing titer," meaning that the vaccine is not as good at neutralizing the virus as compared to, say, Delta variant, Alpha, or Beta variant, but it still was sufficient and should work just fine.

At some point, again, we may need a variant-specific booster or an updated booster at some point for COVID, just like we do every year for flu. I suspect that will be the case at some point down the line, but it appears that A, Omicron appears to be relatively mild in terms of COVID and how bad it can be. The vaccines seem to be working and those that are getting Omicron who are vaccinated are doing fine with it for the most part, just like the other variants, so that's all really good news.

How Fast is Omicron Spreading?

On the flip side of that, we have the fact that Omicron is everywhere. We talked about that last week. As soon as these variants take hold, they really take off, and they spread extremely rapidly. We talked a little bit about why that is last week, but just to reiterate, essentially, once one of these variants appears and it looks like it has a replication advantage in terms of replicating faster or transmitting easier, then it out-competes all the other variants that are out there and then takes over as the most common strain. Delta did this with the Alpha strain and the Beta strain, and now Omicron is doing this to Delta.

This will keep happening. We'll keep having more variants that out-compete the prior variant, right, and then they will become the dominant one. This is how viruses work and this is how viruses interact with their host. They tend to change over time. They adapt to their hosts over time. Transmission often becomes more efficient, but sometimes it doesn't mean the viruses any worse in terms of its lethality or its morbidity. It just transmits more easily. Oftentimes, things become less lethal over time. We've seen that in other pandemics. The Spanish flu had a similar trajectory. First couple of waves were pretty bad and then it petered out after that because some parts of the population had immunity and because the virus continue to change over time. I think we'll probably see that with COVID, too. New strains will become a little milder over time. That seems to be what's happening with Omicron. We'll see more data. More time will tell, of course.

How Do Variants Like Omicron Develop? 

The interesting thing about Omicron is one piece of data that came out of South Africa was that one of the reasons that we think is so different from the Delta variant is it actually picked up some genetic material from another coronavirus out in the wild. If we remember back, all we've been talking about is COVID, COVID, coronavirus. Remember, COVID is one of many, many, many, many coronaviruses. Coronaviruses have been around for as long as humanity's been around, all right? It's a cold virus. Coronavirus is a cold virus, and often, it circulates at odd times of the year. When people hear about, "I got a summer cold," often that's coronavirus, okay? These coronaviruses are always circulating.

Well, it appears that what happened was someone in South Africa got co-infected, so they got infected with COVID and they got infected with another coronavirus, a cold virus, essentially, and the two viruses swapped some genetic material around and created something a little bit different. This happens, again, all the time with different viruses. Flu virus, this happens very commonly. This is what happens with the flu virus in terms of you hear about swine flu, bird flu, that sort of thing. What happens is a bird flu and a human flu co-infect the same person and the viruses swap genetic material around. This is the same kind of process, essentially, a little bit different mechanism if you want to get into the nitty-gritty of how it exactly works, but same idea. They're sharing genetic material, and so you wind up with something that's a little different, so it's got some genetic material from another cold virus. That probably has spurred some of the changes and the differences between Delta and Omicron.

Bottomline It for Me. 

Very interesting stuff, but again, bottom line: Omicron, you're going to continue to hear about it. It's going to be everywhere pretty quickly and pretty much already is in most places and most places where they think they don't have it, they probably just haven't detected it yet. It's probably there. It tends to apparently be mild, the vaccines continue to work, and so that is all good news, and we're going to keep seeing these variants over time. I don't think there's any reason to despair, any reason to be overly anxious about the Omicron variant, I think it's just another phase of this pandemic that we're going to keep seeing over time as it keeps playing out.

Just keep being responsible, wash your hands, don't touch your face when you're out in public, try to avoid getting it. If you haven't gotten vaccinated for COVID, go ahead and do it. Now is a good time. You're going to get exposed to Omicron at some point here in the next few weeks to few months, so better to be vaccinated than to be unvaccinated for the vast majority of people. Other thing that's really continuing to circulate pretty strongly is flu. We're seeing a lot more flu than COVID at this point, so go ahead and get your flu shots. I know I said that last week, say it again this week: Get your flu shots if you haven't done that. That would be great.

Do Vaccines Reduce Natural Immunity?

"Do the vaccines and boosters decrease our natural immunity for new variants and other illnesses? I've heard this from several epidemiologists, especially due to the large number of serious hospitalizations of patients fully vaccinated."

Yeah, that's a good question. The short answer is no, not exactly. A vaccine or a booster, what they're going to do, because of the way these vaccines work, they only create antibodies to that one particular protein. It's not like older vaccine technology where, say, you use a whole virus or a large part of a virus that's either dead or weakened. You're going to make antibodies against multiple protein targets, maybe hundreds or thousands of protein targets in the virus, so you have this whole portfolio of different antibodies. When you have either a natural infection, same thing, right? You have a natural infection, or you make a vaccine out of the whole virus or a killed virus, or something along those lines. You're going to get a whole wide portfolio of antibodies.

When you target a vaccine to a particular protein like we're doing with the mRNA vaccines, you're going to get a much narrower portfolio of antibodies that are targeted just to that one protein. You maybe get more than one antibody type to that one protein, but you're only going to get a much narrower portfolio of antibodies. They use the word "portfolio" because it makes the most sense. It's not just one antibody, it's many types, but it's a much narrower portfolio profile for antibodies from the mRNA vaccine just because of the way it works.

Now, that doesn't decrease your immunity to new variants, but what it may mean is that you may get infected, right, anyway, we've seen that, lots of breakthrough cases, you may get infected with COVID, anyway. The spike protein antibody is going to mitigate the illness and minimize the illness in that person, allowing them to live through and create more actually natural immunity to the variant, so in many ways, getting vaccinated and getting a natural mild infection would be the best of both worlds in some ways because you're going to have that initial immunity from the vaccine that's going to keep you from dying or having a really, really bad outcome from COVID, and then you get the natural antibodies from the illness.

Now, there's certainly are hospitalizations of fully vaccinated patients. The vaccines aren't perfect. Especially older people and people who have underlying medical conditions, they do need to get boosters because the protection is wearing off after six or eight months or so, so that is a concern for those folks. I think that that's the population where getting a booster really does make a difference. I hope this answers your question. It was a long answer, but, but hopefully that addresses the question you have there.

How Worried Should I Be? 

All right, so just to recap, Omicron is everywhere. You don't need to be overly worried about it. Get vaccinated if you haven't been, get your flu shot if you haven't had that done, either, and just keep a watch and wash your hands when you're out. Don't touch your face. This is general good respiratory virus season hygiene. We're going to keep seeing variants. It's going to keep happening. If one does pop up that seems to escape vaccine control entirely, the scientists that work for the vaccine manufacturers have made pretty clear they can make a new vaccine within a hundred days, so if something does pop up that looks serious, then we have a tried-and-true method at this point for creating new vaccines to keep people safe. That's the news for this week. A lot of encouraging news, I think. Let's just keep being safe and responsible out there.

 What Caused the Recent Spike?

"What has caused the rise in cases in Virginia recently?"

Yeah, great question. I think what you're seeing again is seasonality. The virus has seasonality to it. We've been watching this over the last almost two years now. There is a seasonal component to the virus, and so you're going to keep seeing ebbs and flows of infections, especially because it does not appear that the vaccines totally prevent transmission. Again, that's pretty clear at this point from the data and from what we've seen, so we're going to keep seeing cases and they're going to happening for the indefinite future, as long as we're using this type of vaccine technology to deal with the illness, because again, it does not totally prevent transmission. That's really all there is to that, unfortunately.

Now, what we have seen still is that even though there's been a bit of a rise in cases, I don't think it's out of the ordinary for what you would see this season. We saw this last year, right, after Thanksgiving, and we'll probably see the cases continue to climb into December, and then it'll probably peak late December, early January, and drop off again. Now, what we hope and what we want is that each of these subsequent waves is smaller in amplitude and gets smaller over time until, eventually, the majority of the population's probably going to get infected at some point and then we'll reach some sort of herd immunity status. We can talk about that for a good while, but that's going to keep happening, so my suspicion is, again, seasonality is why we're having the case rises.

How to Get Tested for Antibodies?

"If I wanted to get tested for antibodies and my doctor does not want to do it, where could I go to get tested?"

Good question. If your physician does not want to order an antibody test for you, if you're curious about getting COVID antibodies, there may be some tests you can order yourself, but actually, one of the easiest ways is actually to go to the Red Cross and donate blood. They, I believe, are doing antibody testing and telling you what your antibody status is, so that's one way to get that done.

Jane says... Oh, Red Cross is not doing it anymore. Okay, bummer. I know they were doing it for a while. I guess they decided to stop, unfortunately. That's unfortunate. If you are trying to get an antibody test, I mean, the easiest, best way is to ask your physician to do it if you are really curious about that. That's probably the best thing to do.

Actually, I was just doing a quick search. It looks like CVS minute clinics are doing a finger-prick antibody test if you want to go there and get it, so that's interesting, but that's the only other thing I know of right at this time. Best thing to do would be to get it from a blood draw from your doctor's office if you are curious about it.

What is Pfizer Reporting about Omicron? 

"I heard this morning Pfizer showed good results from third vaccine in regards to Omicron."

Yes, that's correct. Yep, exactly right. We talked about that early in the video. Even though the neutralizing titer, meaning it's not quite as good, was a little lower, but it still seems to work just fine for an Omicron variant, so nothing to worry about there.

Should I Mix Vaccines? 

"I just read that mixing the vaccines might work for better protection if you do decide to get the booster. Have you read this?"

Yeah, again, that's speculative. We don't have good large-scale trials for testing the efficacy of mixing vaccines. I don't think there's any harm in it. I don't know that it provides any "better immunity" than just sticking with the horse you rode in on, so that's where we are with that right now.

When is the next update? 

The next update will be on Wednesday, December 15 at 1:00 pm on our Facebook page. For those without Facebook, we will post our written recap on Thursday. 

Steve E. Bishop, M.D.

As a board-certified internist and concierge doctor in Richmond, VA, Dr. Steven Bishop is passionate about helping his patients improve their lives through better health. He helps healthy adults adjust their lifestyles as they age and helps patients with complex medical diseases manage and improve their health.