December 11, 2021
A remarkable feature of this pandemic in the internet age is the speed with which knowledge about the virus can be communicated throughout the world. It was just two weeks ago that South Africa first reported the discovery of a new variant, later named Omicron. Let’s examine what we know about it now.
According to the World Health Organization, Omicron is currently present in at least 57 countries. The new variant is spreading rapidly in Europe, where it is expected to overtake Delta as the dominant strain within just a few days. In the U.K, Omicron is projected to be responsible for more than a million infections by the end of the month, while Germany’s intensive care association estimates it will become dominant in that country by mid-January.
In the United States, the Omicron variant has been detected in 27 states by genome sequencing. Alabama is one of the states where it has not yet been sequenced, but it is present in neighboring Mississippi, Georgia, Florida & Louisiana. There is a growing consensus, according to Andy Slavitt (CMS Administrator), that Omicron may NOT be innately more contagious, although it is obviously spreading faster than any prior variant.
This paradox makes sense once you know that the Omicron variant does not share the same lineage as the Delta variant. Prior infection from Delta does a poor job of protecting against Omicron’s spread. In South Africa and other places with high levels of prior Delta infections (and low vaccination rates), Omicron is spreading like wildfire in large part because of the incidence of reinfection.
But what about Europe, where vaccination rates are highest in the world? We now know, courtesy of South Africa lab tests, that two shots of the Pfizer vaccine may have just 22.5% efficacy against symptomatic infection with the Omicron variant, although the vaccine operates better to thwart severe disease. However, three doses of the vaccine offer 75% efficacy against Omicron, according to Pfizer. That’s lower than the 90%+ protection produced by 2 doses against Delta, but 75% is better than most flu vaccines. Unfortunately, booster shots are still fairly uncommon, even in countries with high vaccination rates - like the U.K. (32%); Germany (20%); France (17%); Spain (13%).
So, what does this portend for the United States and especially Alabama? The Delta variant continues to represent over 99% of all infections in this country. Therefore, those states that managed to avoid the Delta wave last summer are getting hammered today, while those states (especially in the South) that were devastated last summer are doing better today. Even so, Alabama’s daily case counts are starting to climb - over the last 7 days, Alabama had 3,813 new cases, a 20% rise from the prior week. And we now average 3.46 patients per reporting hospital, compared to 2.97 patients per hospital last week at this time, a 16% increase.
So, what is likely to happen when Omicron overtakes Delta in Alabama, as it almost surely will do this winter? First I must acknowledge that the SARS-CoV-2 coronavirus makes fools of people who make predictions about it. Subject to that qualifier, I believe we are likely to see rapid community spread in our state later this winter. The high levels of infection we experienced this summer will do little to protect us against Omicron. Meanwhile, less than half our population has received 2 shots and only 22.2% of those with 2 shots have received the booster. When you do the math, that means only about 10% of our population may expect up to 75% protection against the Omicron variant. That leaves a lot of tinder for the fire to spread.
Assuming we see rapid community spread of the Omicron variant in Alabama, our best hope lies in the distinct possibility that infections will not be as severe as Delta - hopefully, not severe enough to overwhelm our hospitals. The jury is still out on that question, though preliminary data offer reason for optimism. Most of the first reported cases of Omicron in South Africa and Europe appear to be mild, although as with all variants, there is a lag between infection and hospitalization.
In its most recent Morbidity and Mortality Weekly Report, the CDC published a preliminary symptom profile for the Omicron variant, which differs slightly from Delta. The report states that a cough is the most common symptom, afflicting 89% of cases. Anecdotal accounts by South African researchers describe the cough as dry, often accompanied by a “scratchy throat.” Losing the sense of taste and smell, common among those infected by Delta, is rare with Omicron.
If we are lucky, and Omicron turns out to be a milder strain, then my crystal ball tells me that its emergence just might wind up becoming an unexpected silver lining in this pandemic. The totals:
11/27 - 357
11/28 - 157
11/29 - 176
11/30 - 477
12/1 - 536
12/2 - 767
12/3 - 595
12/4 - 478
12/5 - 361
12/6 - 281
12/7 - 630
12/8 - 687
12/9 - 549
12/10 - 592
12/11 - 713