Omicron - update and Q&A

Arblus look its Omicron!

Hope everyone is doing well.

I have been a bit absent lately as work has picked up as we prepare for the next COVID season. I wanted to provide an update as I am sure everyone has questions regarding the new VOC Omicron.

What is Omicron? - Omicron is also called B.1.1.529 - it is the newest VOC (variant of concern) and has over 60 mutations from the initial COVID strain. It is called Omicron because the last mutation was called ‘Delta’ and so this would technically be called Nu (skipped bc it sounds like new) and Xi (skipped bc its a common surname) so they went to the next Greek letter.

Why is it concerning? - It was first reported in South Africa but has since spread worldwide. The main reasons it is concerning is the speed at which it spreads and the ability to evade immunity (vaccine or prior infection)

How fast does it spread? - Its hard to say but how we measure it is a Rt value (basically how many people one person will infect if they have it). Delta was about 1.09. Omicron is at least 2.5-4 range.

Does it evade the immune system? - Yes it does. It appears as per the latest data that two shots of the vaccine (mRNA) offer about 33% reduction in symptomatic disease and 70% against serious one. Two shots of the Astrazenca did not offer much protection. It also infects those with prior COVID at a much higher rate that Delta.

Why is this? - Multifactorial. The obvious answer is that it has more mutations. Also we need to factor in that we are further and further away from the 2nd dose and it seems this vaccine is likely a 3 dose vaccine

Is this expected? Yes. As viruses evolve they do tend to infect faster and usually milder. A lot of vaccines are 3 doses (ie - DpTP).

Is it milder? - We simply don’t have enough data. Its hard to extrapolate from SA since they don’t have a high vaccination rate. Initially it doesn’t appear to be that severe but time will tell.

Why is everyone so worried? - Even if its milder, it will infect about 2-4X more than Delta. So lets do some math. Lets say 1% of those people get sick needing ICU. Thats the unvaccinated. The vaccinated have 70% protection so they get it at a rate of 0.3% that makes them sick enough to end up in ICU. At its peak the 3rd wave was about 4000 cases a day. 1% means about 40 got sick a day. With Omicron we estimate about 12,000 a day at least. Of those 80% are double vax (9,600) that will have about 29 get sick and of the 2400 left thats 24. So thats 53 in total. So, it could be MUCH worse even if the numbers are lower since the total number of cases is so high.

Do Boosters help? Yes. Boosters seem to offer over 90% benefit against serious infection and 70% against any disease. That was after either two doses of mRNA or AZ with a mRNA booster.

Kids - do they get sick? - Early to tell but it seems not to have a particular attack rate aimed at children. Most cases are in the ‘target wrestling demo’ as we like to say.

Why 18-49 range? I think its unlikely the virus only effects younger people. It has more to do with lifestyle (ie - contacts they have). Also less boosters.

What can I do to reduce the risk? Everyone should be boosted as soon as the can (6 months after dose 2). Get your kids the doses as soon as you can. Try to reduce the number of unnecessary contacts.

No Christmas gathering? Not necessarily. If you don’t have any high risk people (ie - chemo therapy, unvaccinated etc) then you can probably enjoy the holidays. Keep groups as small as possible and ideally rapid test everyone on the day of the event.

Rapid tests - how/where do I get them? They are easy to administer - ask me if any issues. In terms of getting them you can find them online for 10-20 dollar range. Some regions are giving away free ones. If you need them and cant afford them I have a few extras I can maybe send but thats limited supply.

What kind of masks do I need? Omicron seems airborne. A regular cloth mask or medical grade may not be enough. An N95 (or equivalent ie K95 etc) is recommended when indoors outside your home.

Are we going to lockdown again? Maybe. Depends on how severe the hospitalization rate is and how many people are affected. Its all TBD based on the next two weeks. I would hate to see it but I think its possible.

What is the ICU situation now? Slow trickle of unvaccinated cases mainly. I would not accept a surge for at least 2-4 weeks.

Are you guys ready? Hopefully. I am not going to lie - we are understaffed (nurses mainly) as many quit or moved on after COVID destroyed them. Its hard seeing unvaccinated peope continue to come in when you know it was preventable. However, we will do our job and nurses in my experience always step up more than anyone else when needed.

Any new treatments? Yes. Some new treatments are emerging that may help as well.

This sounds horrible. Any good news? Yes. Boosters work well. Also early reports suggest a rapid rise and fall in case numbers so it could dissipate very fast. Also it might be milder which is great.

TLDR. Sum it up man - Omicron is a beast. It will infect a lot of people. Everyone should get boosted and vaccinate their kids and reduce social circles. If you are meeting unmasked for a dinner try to rapid test everyone the day of the event. On the plus side if you have vaccines you are unlikely to get super sick especially with a booster even if you get it.

Happy Holidays to everyone and stay safe. If you have any questions at all please reach out

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Thank you for this Alex.
I really appreciate how concise this all is.

I’m really hopeful that lots of parts of Canada are highly vaccinated in the double-doses - so even if it does spread rapidly, it wouldn’t be clogging up hospitals. But as you said, it wont’ be known for a couple of weeks.

I think lockdowns at this stage will be very difficult to enforce - mainly because the vast majority of people (I’m in the Ottawa area, where it’s close to 90% eligible is double vaxxed) - feel they’ve gone along, and are being safe - and just don’t want to deal with all of this again, going on two years. I have a hard time to disagree with that thought process. And I totally understand that we are in a pandemic and people’s thoughts and emotions matter little to how a virus acts.

Hopefully though, we are able to avoid that - and people are overly-cautious in the coming weeks, and we avoid any disaster.

Also, why has there been such hesitation to admit it is airborne? I feel like this is commonly accepted, and has been for well over a year.

What’s your opinion on this story - and recent developments?
I came across it on Twitter, and am not sure if it’s trustworthy or truthful, but seemingly paints a picture that it’s a quick and large wave that will quickly dissipate.

Hesitation to admit that it’s airborne is perplexing. I would anticipate as the word on the street for meetings I had yesterday is that the government may recommend N95’s going forward. One of the issues is access to these things and cost, and conflicting messages. Again I don’t understand the reluctance but I’m hopeful that it’ll change soon.

The data out of South Africa is immensely difficult to analyze. We know there was a rapid rise in cases as well as a rapid or what seems like a rapid fall. The problem is the data is unreliable. They don’t test that many people anymore ate some areas had almost a 90% positivity rate. So they just gave up on testing and reporting this. There also is questionable vaccination data released for these people. Until the data is more robust out of South Africa or we get more data from countries that are slightly more reliable such as the UK it’s going to be difficult to extrapolate to North America.

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@Alex_Patel My aim right now is to get the booster Royal Rumble weekend, but I have to admit, after listening to the government about Mixed Vaccines being ok and getting 1 dose of Moderna & 1 dose of Pfizer, only to find out other countries had issues with this and didnt consider you double vaxxed, I’m a bit hesitant on what to do.

I know things seem to be straightened out with that now, but I have some questions…

  1. Which booster do you recommend for someone who has mixed vaccines?

  2. Are there any numbers on how mixed vaccines have been working, compared to 2 of the same dose? What have you personally seen?

  3. My biggest worry is getting this booster and then a month or 2 later they come out with a better shot and then I’m screwed again and cant get it or have to wait for it. Is there any word on updated vaccines coming out soon?

[quote=“Rated_R_Poster, post:4, topic:16229”]

  • Which booster do you recommend for someone who has mixed vaccines?

mRNA - Pfizer has more data but either probably fine. However Pfizer is better studied as a booster and we know it works well.

  • Are there any numbers on how mixed vaccines have been working, compared to 2 of the same dose? What have you personally seen?

The major data is on those who are Astra Zeneca and now switch to a Pfizer. They had the same levels of antibodies as someone who had three doses of Pfizer. So it does seem that mixing vaccines produces similar immunity.

  • My biggest worry is getting this booster and then a month or 2 later they come out with a better shot and then I’m screwed again and cant get it or have to wait for it. Is there any word on updated vaccines coming out soon?

There will almost certainly be an updated booster targeting the variants out in about 3 to 6 months. However this is likely to protect against future infections. By 3 to 6 months Omicron will probably have dissipated so I would say get the booster now and then if necessary repeat in six months is fine.

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Thank you very much, I appreciate it.

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Free rapid tests to take home!

LCBO to have free rapids as well

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Bottom line tons of updates

Everyone can booster in Ont as of Monday
Free test Inc at LCBO for everyone.

Lots we can do before the tidal wave hits to come out on our feet

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Thank you so much for this information!

I got my booster shot at the end of November just as this news was coming out. All three shots Pfizer.

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An interesting read. Some guesses as to how it spreads quicker - but also how it appears less severe.

It’s interesting – we were debating this thing yesterday. We all saw the same paper and again I’m sure it’s part of the story but it’s a little more complicated.

In South Africa their hospitalizations are up 45%. However, they have a high unvaccinated population.

When you compare what happened with Alpha and Delta, I would suspect that an unvaccinated persons risk of serious infection is going to be similar to those. However, a person who is now double vaccinated is not going to be the same as a unvaccinated person during the alpha wave. Also, viruses naturally evolve to be more infectious and less deadly over time.

The most worrisome thing about Omicron is that it’s four times more likely to replicate in the population than Delta. So even like I said if the number of people percentagewise drops, the absolute number will still be high who gets sick.

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Thank you as always @Alex_Patel. What a gift you have been for this community. I wish you a very happy and safe holiday season.

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Opinion question @Alex_Patel

Obviously too early to tell - and this might come back to look incredibly naïve. But if in a week - ten days from now, hospitalization rates remain low or flat, despite the huge rapid spread in numbers of Omicron (specifically in Canada) - does that mean the fact this has overtaken is somewhat a positive?

A weaker version of the virus in a highly populated vaccinated population that doesn’t fill up the hospital and cases are very mild, seems like a somewhat a good place to be?

Also, if it forces powers that be to recognize the fact it is, and has always been airborne - might help pump needed money into ventilation of schools and hospitals (which is good for all airborne viruses, right?)

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Correct. If this virus becomes endemic in that it spreads with mild disease (similar to any common cold or flu) then it no longer is as deadly and everyone will have some degree of immunity. It likely continues to mutate and evolve and may need boosters like the flu shot but it no longer becomes as big a threat from serious illness standpoint.

So yes it wouldn’t be a bad thing if this turns out to be the case.

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Here’s the thing - it’s coming. There isn’t anything we can do to stop it now. Everything we tried in terms of vaccinating the population and such was in preparation for this.

Right now all we can do is make sure that people get as many vaccines as fast as they can, reduce their contacts to at least limit the spread a little bit, and test them selves so that they aren’t meeting other people if they’re infectious . Apart from that it is going to hit us and how hard it hits us will be revealed in the coming weeks.

As Bane says (a line I told many colleagues today)

“Calm down doctor, now is not the time for fear. That comes later.”

As was said above by @MarkP it could end up being mild enough that it’s a blessing in disguises. Or it could be severe enough that it’s crippling. Time will tell.

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Thanks Alex.

I told a friend that I’m feeling like a conspiracy nut by searching out news stories from South Africa, and reading about their very low hospitalization rates as the wave seems to have dropped off. Searching for a glimmer of hope in all of this. For the last two years I’ve been losing my mind in anger when people would compare COVID to a cold or flu. But here we are, and there is a slight chance we could be looking at this variant as being just that.

I guess we see how Europe looks in the coming days, and we will see how it may play out here. I’m hoping for the best. I really hope Alex that you have a very quiet Christmas and New Years in the ICU, so we might just be through the worst of it.

I’ll say something my dad has said (going on two years of living with pancreatic cancer now…)… “Prepare for the worst, hope for the best. We live in hope”.

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Hearing lots of reports that half the ER staff at various hospitals are down with Covid.

One of the problem is going to be even if people don’t get sick healthcare workers are going to have to be off work once they get it. Even a mild illness if it hits its everyone at once can be crippling.

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Another question! (Sorry to be taking up so much of your time.)

At what point do you think it’s safe to conclude if Omicron is indeed a wave of disaster, or just a patch of rough water?

If hospitalizations are usually delayed a week or so - I’d imagine by right around Christmas, we’d know what we are in for.

I’d imagine early next week in the UK will also be very telling.

Again, clinging to the South Africa numbers as a glimmer of hope, and hoping the rest of the world follows the same pattern.