Why is omicron so worrisome? Idaho experts explain what you should know about variant
For more than nine weeks starting in September, many hospitals in Idaho had more patients than resources to care for them, largely the result of an influx of unvaccinated COVID-19 patients. It was Idaho’s deadliest period of the pandemic, with more COVID-19 patients in intensive care than ever before — and those patients were getting younger.
Now, with the winter holidays here, Idaho is facing a new potential threat: omicron, a variant that might spread more easily than the dangerous delta variant. And though only one case of omicron has been confirmed in Idaho, health officials believe there are many more coming.
After falling quickly throughout November, case rates and the test positivity rate in the Gem State have essentially plateaued. Last week, the Idaho Statesman hosted a panel of three experts to discuss the state of the pandemic in Idaho.
Dr. Christine Hahn is Idaho’s state epidemiologist. She is board certified in infectious disease, while also serving as a nonvoting member on the Center for Disease Control and Prevention’s Advisory Committee on Immunization Practices.
Dr. David Pate is the former president of St. Luke’s Health System and a member of the Governor’s Coronavirus Working Group in Idaho. He co-authored a forthcoming book, “Preparing for the Next Pandemic: Lessons, Stories and Recommendations.”
Dr. Christopher Ball is the laboratory director at the Bureau of Laboratories. He is certified in molecular diagnostics by the American Board of Bioanalysis and also serves as co-chair of the Governor’s Coronavirus Testing Task Force.
Here are a few highlights from the conversation:
Q: The holidays are fast approaching. Should families be changing any of their plans because of this new variant?
Pate: I don’t know that it necessarily requires a change of plans, but it does require people to be very careful and consider how they plan for a get-together. It involves assessing, what are the risks of yourself and your own family members? What are the risks of those that you’re going to be with? What is the level of disease activity wherever you would be traveling to, and how are you going to protect yourself during those travels if that involves public transportation at all?
Another thing we have to add to the equation is if you’re traveling somewhere where there’s currently a high level of disease transmission, you need to also go further to check: Are those hospitals there overwhelmed? Because you need to have a plan if you’re traveling and, especially taking a child, sometimes children just get hurt. It doesn’t have to be COVID. But where would you go? Would hospitals even be available for you?
There’s just a lot of things to consider and a lot of uncertainty, and the rise in omicron that we’re invariably seeing. It does mean think extra hard about those who may be at special risk. Older individuals, people that aren’t vaccinated, people who have not yet gotten their boosters, people that have underlying immunocompromising conditions. There’s just a lot of factors to take into consideration. We want people to enjoy their families, but we also don’t want any bad outcomes of that as well.
Q: Since omicron was quickly designated a variant of concern last month, scientists around the world have rushed to study this new strain and nail down its properties. As of now, what do we know about omicron? And what are we still unsure of?
Hahn: That’s a really important question, and I think if you asked me that question three days in a row, I’ll have to give you different answers. It’s really changing that quickly. This variant is spreading. There is a growing consensus that it appears to be more transmissible than delta or the previous variants. The numbers vary depending on where or what country you’re talking about, or what report, but it seems to be two times or four times more transmissible in some reports.
So definitely, it’s very catchy, and it is moving quickly. The United Kingdom (has) really good data shared (last week) by (the) CDC showing that when they compare it to how quickly delta rose in the United Kingdom, it is rising faster than delta, and remember the time we thought delta came very quickly. So I think that’s pretty concrete.
How severe it is, is one of the things that we really don’t know yet. I think people are fairly confident it doesn’t appear to be any worse than delta as far as we aren’t seeing hospitals immediately getting overwhelmed. We’re not seeing reports of a lot of fatalities. … So we’re not seeing a lot of evidence that this will be a very severe disease, but there are several caveats to that. One is that it is early on in this wave and we really are gathering data and seeing as we go. Secondly, folks in South Africa are different. The virus and the dynamics are different in other countries than they will be the United States. One reason is that in South Africa, they’ve had their own unique strains and variants circulating there that are all different and so they may have a different level of baseline immunity than we do here. Their vaccination rate is actually lower. But the initial outbreaks in that population were young, healthy people.
We don’t know how it’s going to impact the elderly in the United States, for example. So a lot of things we don’t quite know yet about severity, but at least some reassuring initial data. I would just want to be cautious not to be too over the top (about saying) that this is going to be a mild infection for almost everyone. We aren’t sure about that yet. But that’s the good news.
The other areas I want to touch on briefly: One is that we know that people who’ve had the vaccine — in the laboratory at least, when they look at those antibodies for those folks, that they have some protection, but not nearly as good protection as they do against delta. Now, on the other hand, for folks that have been boosted, that protection — again, lab data only — but that looks really good. So that’s one reason why you’ve heard us talk about boosters even more in the last few weeks. Omicron is suggesting how important it is for folks to get the booster and not rely on just the primary series.
For people that had natural immunity, if you will, that have been infected before and are saying, ‘Well, I understand that I’m pretty well protected.’ The question is, is that true? Because we’ve had delta circulating for long enough now that if you had delta, or even some of the earlier variants … in the lab it doesn’t look like it’s so good against omicron. So people that have been relying on that should think about getting vaccinated if they have not to date because omicron is going to be quite different.
And lastly, treatment. I’ll just mention the monoclonal antibodies and the antivirals. There are three products out there that we’ve been using in Idaho and around the country to help people who already have COVID, have high risk of getting very sick and getting in the hospital, and we have treatment centers set up from the state, your clinicians and some health systems treating their own patients as well. It looks like those might not work as well. The manufacturers have reported that two of the three don’t appear like they’re going to work very well. The third one, which is by GSK, and it’s called sotrovimab, that one looks like the companies reported they think it’s going to do OK.
So we are glad that we’ve got these three options, and that one of them might actually be effective. Antiviral medications are not yet out there; they’re pending. We think any day we’ll have those hopefully to start distributing, one by Merck and one by Pfizer. The companies believe that they should work against omicron. So we do have some tools, but we’ve kind of lost some other tools.
Q: Idaho hospitals spent many weeks in crisis standards of care this fall with not enough resources to deal with the influx of patients that they were seeing. How did crisis standards of care affect future hospital preparedness? Will anything be different if the state needs to activate crisis standards again?
Hahn: What we’re hearing from the hospitals right now is that, first of all, they’re exhausted. So it’s kind of like they’re coming to the end of the marathon as far as crisis standards of care — but they’ve got to keep going. So there’s sort of a sense of a loss of reserves. … More staff are asking for time off, staff have left and quit because it’s been too much, and so they’re already at the end of their reserves. And then in addition they’re looking at the omicron wave possibly coming, which is discouraging.
They also have a huge backlog now of surgeries and other, less urgent medical care that’s been put off that they know they’re facing, and a lot of patients that have been waiting patiently to get that care that maybe wasn’t an emergency, but that really impacts their quality of life. And really, that type of care needs to be done as quickly as possible. So I feel like they’re in a really tight spot.
… We think that people are going to think, ‘Oh, good, everything’s back to normal,’ and it’s almost harder for (hospitals) because that’s the expectation now that things are back to normal. But there’s a huge backlog and this fatigue that they’re going to have to deal with going forward.
Pate: I’ll just add two things — one good thing and one bad thing. The good thing is, because we’ve never done this before, we’ve learned a lot and we’ve tried a lot of innovations. The audience may not think it’s a big deal if you have to create a new space in a classroom or in the waiting room or something — how big a deal is that? It’s a big deal. Because a lot of these patients are requiring high-flow oxygen and typically you can’t keep that up easily with just an oxygen tank. So you need medical plumbing, gas plumbing. You need ways to monitor and see people, and so our ICUs are structured in a way so that nurses can have visibility to monitors … . It’s not that easy, but we’ve learned a lot how to stretch when we need to, how to get innovative about it.
I’ll just add on the bad note, what Dr. Hahn was talking about with the risk of omicron creating an infection — not severe disease, but an infection — in somebody who’s either previously been infected or who’s been fully vaccinated. We do have to worry about our health care workers, and because they typically were kind of front in line for vaccinations, they’ve had it the longest, so it’s really important that they get boosted. If a lot of these health care workers do get these infections, even if they’re mild, we still have to take them out of the service of patients, and if omicron really does spike — and we don’t know whether it will or not here — but if it does, that could be a major impact on our nursing staff, doctors and others. So that’s another concern.
Q: Like other viruses, we’ve seen the coronavirus mutating and changing over the past 20 months. Now we have this omicron variant. Why in general do viruses evolve? And what are the trade-offs that occur when viruses do change?
Ball: This is a really good question. There’s really four things which to me are really important to consider. One is if you look at what the life cycle of the virus is, it needs to be able to do three primary things. First, it needs to be able to enter and evade the primary defense mechanisms: the skin, the mucous membranes of the host and attach to a receptor so that it can get into the cell, replicate itself and then when it leaves the cell, it needs to be able to both evade our immune system and effectively get out into the environment. And then it also needs to be able to persist in the environment long enough to find a new host. Those are the three big challenges that viruses need to try to solve in order to continue on and be successful.
So as any virus is replicating, copying its genome, it’s going to make mistakes. And I think what a lot of people don’t realize is that the only viruses that we actually see and detect are the ones (where) those mistakes weren’t too detrimental. So we never see any of the failures. We only see the successes. The success stories from the virus standpoint are those that are are able to sufficiently answer those questions: Can I infect the cell? Can I replicate? Can I survive in the environment long enough to get to a new host?
What we see over time is that each cell that gets infected creates tens to hundreds of thousands of copies of itself. And in every one of those replication events, there can be errors that are made. Some of them are detrimental and the virus doesn’t survive. Some of them may confer an advantage and it helps them replicate faster and helps them survive in the environment faster, or it helps elevate the immune system faster. And that’s really the play that we have between the virus and the person that’s infected, is constant interchange of the virus trying to shift and solve those problems that are being presented to it, and the body trying to adapt to be able to respond to those changes that the virus is making.
I think with regard to omicron, what we’re seeing and what got scientists so worried was that the sheer number of changes that they observed in omicron was unlike what we’ve seen with variants prior to that. And so the vast number of changes — predominantly in the area where the virus attaches to the host cell — is what’s giving us problems both with the lessening of immune response or immune evasion of the omicron variant, and also it seems to be making it more transmissible, so it’s able to attach to cells faster, it’s able to replicate faster, and it’s able to disperse faster.
And there’s also some literature out there that would suggest that it may persist in the environment a little bit better, too. So it appears that this virus, although lots and lots of information is still to come on it as scientists study it, it may have found good ways to address all three of those big aspects that the virus needs to address in order to be more successful than, say, the delta variant or previous variants.
Other Highlights
- Hahn on hospital impact: “We saw a big wave last winter. Even if we don’t see as big of a wave, we know that we will likely see influenza in addition to it plus other seasonal viruses, and so we’re concerned about the overall burden on hospitals even if omicron turns out to not cause its own severe hospitalization wave. It’s too early to say for sure, but in my mind, most people that are studying this virus say it is still acting like a pandemic virus. It is not predictable at this point.”
- Pate on vaccines: “We have had more issues from the virus causing problems than we have from the vaccines. … Are there some things that can happen with the vaccine? Yes, you could get myocarditis. The point is not, ‘Do I get vaccinated and take a chance on getting myocarditis or do I not?’ The question is, ‘If I’m going to encounter COVID, do I want the myocarditis that comes from the infection, or do I want this really, really small chance of myocarditis from the vaccine?’ The clear answer, if you’re objective, is you would prefer it be from the vaccine. … In most cases, (vaccine side effects) are very mild, whereas COVID itself causes much more problems with (the) heart than that.”
- Ball on variants: “These viruses are changing all the time. The vast, vast majority of the changes don’t really make any significant difference in the course of the disease. It’s only those where we have either increased transmissibility, increased ability to evade the immune response in the body, or increased severity of illness. Those are the ones that we’re very concerned about. And it gets very difficult to predict when those mutations may arise because they’re happening randomly.
… As long as we have sustained and active transmission of the virus, then we’re going to have pressures put on that virus in rapid succession to be able to try to identify new and better ways to infect people and to replicate in the environment. So really, the key to trying to limit how much this virus changes is really trying to get the pandemic under control and minimize the amount of transmission and minimize the amount of interaction that’s happening between the virus and people. The longer we (continue) to allow it to spread and transmit in an uncontrolled fashion, the more likely we are to see new variants with concerning features arising.”
This story was originally published December 22, 2021 at 4:00 AM.
