COVID-19 Omicron Variant

We thought we could breathe a sigh of relief as 2022 approached. Here we are, two years into the COVID-19 pandemic, with a new variant taking hold.

We know you have plenty of questions about the Omicron variant, and one of our family medicine providers, Dr. Michael Samel, is here to answer some of the most common.

How is the Omicron variant different than previous COVID-19 variants?

People infected with the Omicron variant appear to more rapidly display symptoms and the virus appears to be more quickly spread, which are likely results from a more rapid rate of the virus doubling inside the body. In other words, Omicron grows more quickly than Delta, and that plays a big role in why we are seeing it rise across the nation.

Do you think we’re seeing an increase in cases because of a combination of Delta and Omicron?

This is a difficult question to answer definitively because it depends on the region one looks at. Nationwide, the answer is simple in that the vast majority of cases are Omicron, especially in regions where there was already a large proportion of people who had completed their vaccination series. What is encouraging about this is that we know Delta caused pretty significant illness in a relatively large proportion of those affected, and we remain hopeful at this time that some of the early information that seems to support Omicron causing less severe illness will prove valid. For regions like our own, since we have a population that is less than 50% vaccinated, we have continued to see cases of Delta but we are also starting to see cases of Omicron as well. So the answer for us is yes, we are seeing cases of both, but we will continue to look to our data from our state department of health as well as other states and the nation as a whole to determine whether Omicron will outcompete Delta in the long run.

Is the Omicron variant more contagious than Delta?

It appears to be more rapidly spread and grows rapidly in the body, so one would hope that despite it appearing to be generally more contagious, we can encourage people to isolate until their symptoms resolve. If someone has a more severe case, they should to come to the hospital and get the treatment they need. It truly takes every person working together in being aware of what symptoms of infection are, getting tested when appropriate, and continuing preventative measures like appropriately wearing masks over the nose and mouth, socially distancing, and washing hands frequently when interacting with people outside their home.

Is the Omicron variant more harmful than Delta?

This remains an open question, but for right now early data seems to show that the symptoms of Omicron infection are relatively more mild. An important thing to remember, however, is that the symptoms of infection cannot be used to imply long-term risk associated with COVID infection at this time. One way to frame this is with a thought experiment. Let’s pretend that it turns out that the Omicron variant is 5x less likely to cause severe illness or death as compared to previous variants. On its face, this is clearly a positive result, but if it spreads to 10x more people compared to a previous variant, this still leads to double the risk of overall severe illness or death. We also continue to research the incidence and consequences of long COVID, otherwise known as PASC (post-acute sequelae of SARS-CoV2 infection). All this is to illustrate we must continue looking at both the rate of infection and rate of severe outcomes, and an increase in the volume of infections remains a major concern due to the limitations of our hospital systems and medical resources.

What are symptoms of the Omicron variant?

The Omicron variant is still primarily a respiratory virus, so the symptoms are as expected to be respiratory in nature like sore throat, cough, congestion, and runny nose. There are also some aspects that one might find to be more general, like a feeling of fatigue or a headache. At this time there do seem to be early reports of less loss of taste/smell with Omicron, but we continue to gather more information about this new variant and do our best to keep people informed.

We’re hearing that Omicron seems to affect the upper respiratory tract more than the lower respiratory tract, could you explain exactly what that means?

The dividing line in the anatomy of the respiratory tract is the vocal folds. An external way of feeling or mentally visualizing this line is that it is near where one would find an Adam’s apple on the front of the neck. Above the vocal folds is the upper respiratory tract including the mouth, nose, pharynx, and throat. Below the vocal folds lie the trachea (AKA the windpipe), bronchi, and the lungs. Most of us are familiar with having an upper respiratory viral infection, most often called a “cold.” Many of us are also familiar with a lower respiratory infection, which sometimes is a pneumonia or bronchitis, with the main difference being that pneumonia is associated with inflammation and often fluid inside the lungs, whereas bronchitis is inflammation of the lower airways without significant issues with the deeper parts of the lungs where oxygen exchange with our blood occurs.

All of this comes back to what we are seeing regarding common symptoms of Omicron, which most frequently seems to present with sore throat, congestion, runny nose, and possibly a headache or fatigue. Thinking about where those are happening, they are all upper respiratory. A cough can either be upper or lower respiratory since our bodies have lots of ways to sense whether it feels we need to cough, some in the upper respiratory tract, like when you feel a tickle in your throat, and some in the lower respiratory tract that are more associated with receptors that monitor stretch/pressure of our tissues.

Does the Omicron variant concern you in regard to pediatric cases?

Every pediatric case of COVID-19 concerns us, since we remain concerned about MIS-C, an extremely dangerous autoimmune syndrome that has a high rate of death. There is also uncertainty as to the long-term effects in children infected with COVID-19, since there are some indications we are seeing elevated rates of Type 1 Diabetes in children who have been infected. We also have a pediatric population that remains mostly unvaccinated, so there is little additional protection that we can offer them in the short-term beyond the preventative measures of mask wearing, social distancing, and good hand hygiene. While COVID-19 continues, we also cannot lose sight of influenza, as we are seeing cases this year as opposed to last year where many schools were doing distance learning or had greater levels of precautions in place. It is our role as adults to act as the main barrier to children getting ill by refraining from contact with children while we are ill, being thoughtful of how we model following preventative precautions, and encouraging good hand hygiene.

Long-term, we need to work on improving vaccination rates in our pediatric population. The Pfizer vaccine is now available starting at age 5, and there are continuing trials for vaccines for children age 6 months to 5 years, so talking with your pediatrician about getting vaccinated is also something highly recommended. Notably, Pfizer was just approved for a booster at 5 months from second dose of vaccine rather than the 6 months previously approved, and booster doses have been approved for the teen populations age 12 to 15.

Are COVID-19 vaccines effective against Omicron?

At this time, it appears the mRNA-based vaccines such as the Pfizer and Moderna vaccines do show about a 30% effectiveness in preventing severe illness with the standard 2-shot series, but we see an increase up to at least 75% effectiveness with completion of a third booster shot. The reason I say “at least” is that as with much of the information around Omicron, we continue to gather data, and in some of that data the level of protection is as high as 90% with a booster. One of the more encouraging pieces of data that I have seen is that with a previous case of COVID-19 illness and just a single mRNA dose, there was about an equivalent protection offered against Omicron as compared to a person who had never been ill with COVID-19 but completed full vaccine series including booster. This should be encouraging news to us all, as it means that even those who have been hesitant to receive vaccination, otherwise delayed vaccination, or those depending on immune response following COVID-19 illness would gain significant protection with even a single mRNA vaccine if they’ve had a case of COVID-19 previously.

What are your thoughts on the Pfizer COVID-19 pill?

I am hopeful, especially since the potential of an oral medication allowing outpatient treatment of COVID-19 would certainly help to relieve the pressure on our hospital systems to have sufficient beds for those ill with severe COVID-19 as we face this new, massive wave of infections. The hope is that we would be able to prevent progression for a significant portion of people getting sick, as hospitalizations are rising rapidly right now. Sadly, I worry this treatment will not be as available as we would like it to be as Pfizer has stated their production is not to the quantities they had projected.

How should people continue to protect themselves from COVID-19?

The standard precautions remain to get vaccinated, wear a mask over the nose and mouth, socially distance, and maintain good hand hygiene. Some important additional things to note on these precautions is that production has increased on N95, KN95, and other high-grade masks, and these should be the level of mask that people should attempt to use whenever possible. If you’re not able to use one of these types of masks, double-masking is the best alternative, and of course any mask is better than no masking. We are also continuing to get more data surrounding boosters. Notably, Pfizer was just approved for a booster at 5 months from second dose of vaccine rather than the 6 months previously approved, and booster doses have been approved for the teen populations age 12 to 15.

Any final thoughts?

This is both a complex and simple problem for us all to work on. It’s complex because we have seen how social, medical, political, financial, and other powers that be have had to try and coordinate a response in an atmosphere of general mistrust and uncertainty, but for us in health care specifically we are trying to ask for simple interventions to be followed by the community members we wish to support. We cannot prevent all illness, but we can certainly work together to decrease the harm to our people and the community in general.

Health care workers and institutions are being stretched once again for another wave of COVID-19. A lot of people have retired or otherwise left working in health care due to the strain and often the feeling of helplessness that we face, especially due to issues related to the spread of misinformation and vaccine hesitancy. I encourage all people to remember that health care workers will always be here for them, and we are dedicated to giving the best advice we can to keep our community safe and healthy. Please give us some grace if wait times lengthen, or if delays in care occur, because none of us wish anyone ill. We are doing our best, so please try and help us take care of everyone by following the standard precautions. Take care.

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