What to know about the omicron variant

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With the appearance of the omicron variant of the SARS-CoV-2 virus, there are a number of questions regarding what the disease is, how it is transmitted, who is vulnerable and how it is treated. Marilyn Bulloch, associate clinical professor in the Harrison School of Pharmacy’s Department of Pharmacy Practice, provides comments on what is known about the newest variant.

Bulloch received her Doctor of Pharmacy from Rutgers in 2007 and completed residencies at the University of Alabama at Birmingham and the Charleston (S.C.) Area Medical Center. Her research interests include acute care pharmacotherapy, infectious diseases, internal medicine and medication use in older adults. She has spoken at the national, regional and local level on a variety of medicine related topics, including influenza and other concerning viral infections. She has been published in numerous medical and pharmacy journals, including Pharmacotherapy, Annals of Pharmacotherapy, the Journal of Pharmacy Practice and the Journal of the American Pharmacists Association.

What is the omicron variant?
Like most things with COVID-19, our knowledge of the omicron variant is still evolving. It appears to have substantially more mutations than other variants of concern, some of which could have some profound impacts on things such as how easily it can be transmitted or the severity of illness it may trigger.

I say ‘could’ because we do not know entirely yet. About half of the mutations seem to involve changes in the part of the virus that helps SARS-CoV-2 enter host cells and cause infection. It is possible these changes may circumvent recognition by antibodies gained from vaccination or natural immunity. The concerns arise based on a sharp increase in cases, including severe cases and hospitalizations in South Africa after it emerged.

In one area, about 90% of new cases were caused by the omicron variant – less than a month after being first recognized. Officials are still trying to determine if the severity is specifically linked to the omicron variant mutations or is just a statistical observance since more people are becoming infected.

How do these new variants continue to come out?
It would be more surprising if we did not see any more variants emerge. Viruses, and really all microorganisms, adapt to survive. This is particularly true when anti-infectives and vaccines are introduced into the situation and the pathogen learns how to evolve in response.

I think it important to keep in mind that all variants are not going to cause a new wave of pandemic cases or will be able to resist our ability to prevent or treat them. Currently, the World Health Organization is tracking several variants of concern, of interest or under monitoring. Not all of these have had a widespread impact on public health and about 13 are no longer being monitored because they do not appear to have a significant epidemiological impact.

If I am vaccinated, am I still protected against the omicron variant?

At this time, we do not know how well the vaccines protect against the omicron variant. The head of one of the vaccine manufacturers has publicly stated that he felt the vaccines would be less effective against omicron. Health officials around the world are working to determine the impact, and the vaccine manufacturers are working to address the issue as well with their products.

We know with other variants that the vaccine may not always protect against infection, but that vaccinated patients are less likely to develop severe infections or to die. Even if the vaccines are not highly effective against preventing infection with the omicron variant, there is hope that their role in preventing severe COVID-19 will continue to be seen.

Even though there is concern surrounding this new variant, it is important to remember that other variants of SARS-CoV-2 are still circulating. We know that the vaccine is protective against those strains. We also know that people can be infected with COVID-19 multiple times – what strain caused the initial infection will influence the natural immunity that you develop, and that natural immunity does not appear to be extrapolated to all the known variants.

Even if we do not know much about omicron, should people get vaccinated and receive the booster?

Yes. We know COVID-19 is still circulating in other forms, and that remains true in Alabama. The delta variant is the most popular, and current vaccines and the boosters are effective against it. With viruses, the emergence of variants will be constant. It is important not to get so focused on one variant that you allow yourself to be vulnerable to the others.

Are the symptoms, transmission or general severity of illness different with the omicron variant?
Knowledge on transmission or virulence of this variant is still being evaluated. In South Africa, there has been a sharp increase in hospitalizations, but it remains to be determined if this is because the omicron variant is more severe or is just a statistical observation since more people are becoming infected in general.

It is likely too early to know how or if the symptoms with the omicron variant will differ from other variants of SARS-CoV-2. At this time, it does not appear to cause any new symptoms that have not been reported in COVID-19 previously, but the grouping of symptoms may be different.

In South Africa, physicians and scientists are reporting that patients with the omicron variant are experiencing “mild” cases. The symptoms they are reporting, including cough, sore throat, fatigue, headache and muscle aches, are similar to what is seen with influenza, and they are reporting fewer patients complaining of loss of taste or smell. However, if we have learned anything from COVID-19, it is that we need to wait on more data before we can say for certain how virulent it will be.

Why is there so much concern with omicron?
It is so new and has become so dominant so quickly in some areas. We do not know how much protection we will have from vaccines or natural immunity. There are also concerns that the monoclonal antibodies, the medications used in high-risk outpatients to prevent progression to severe illness, may be less effective against the omicron variant. That, in itself, is as concerning as the lack of vaccine protection – it would indicate that the virus has managed to evolve enough to circumvent what has been successful treatments for COVID-19.

Our ability to detect changes in, monitor and understand SARS-CoV-2 has increased significantly since the virus emerged approximately two years ago. There are a lot of unknowns with omicron right now, but it is unlikely that that knowledge will remain unknown for long.

One comforting thing in all of this is that we do have current and emerging treatment options that do not target the spike protein, where these mutations seem most prone to. Instead, many of these treatments target viral replications at other stages in the process or mitigate the inflammatory response seen with severe illness. Omicron may be a new variant, but it is not a novel virus, and we are not completely defenseless against it.

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