CMO Update November 29, 2021
*Omicron Edition*
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The SARS COV-2 coronavirus responsible for COVID-19 infections has mutated numerous times over the course of the pandemic, as many viruses do. The longer time it takes to develop herd immunity, in this case globally, the more opportunity for the virus to mutate through natural selection into a more virulent version. |
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The original Alpha variant was essentially eliminated worldwide as the more contagious Delta variant arose this summer, resulting in the Delta surge visualized below.
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Last week in South Africa and numerous other countries, a new variant named Omicron was identified. Researchers spotted Omicron because it contains more than 30 mutations to the spike protein — the SARS-CoV-2 protein that recognizes host cells and is the main target of the body’s immune responses. Many of the changes have been found in other variants and are linked to heightened infectivity and the ability to evade infection-blocking antibodies.
Therefore, the WHO has declared Omicron a “variant of concern” and is engaged in further study. Independent scientists agreed that Omicron warranted urgent attention, but also pointed out that it would take more research to determine the extent of the threat and to answer the following key questions.
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1. Is Omicron more transmissible and contagious than Delta?
- a. The numerous mutations suggest it could quickly become a dominant strain
- b. Monitoring wastewater for viral load estimates outbreak size. In just a few weeks, in Pretoria S. Africa (north of Johannesburg) viral load detected in wastewater has reached similar levels as the peak of Delta, which indicates transmission may be remarkably swift
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2. Does Omicron cause more severe disease or a different clinical course?
- a. COVID-19 symptoms have always been puzzling and unpredictable. Some S. African doctors treating early Omicron patients report more fatigue and fever, with no loss of taste or smell, and overall milder symptoms, although this is anecdotal in small numbers
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3. Is Omicron resistant to our current vaccinations and/or natural immunity?
- a. On Face the Nation Sunday, Dr. Scott Gottlieb, former FDA commissioner says: "If you talk to people in vaccine circles, people who are working on a vaccine, they have a pretty good degree of confidence that a boosted vaccine — so, three full doses of vaccine — is going to be fairly protective against this new variant."
- b. Unfortunately, the US markedly lags many countries regarding administration of vaccine boosters, including for those with natural immunity from prior infection. Boosters are proven to induce a striking increase in level and breadth of neutralizing antibodies, likely offering strong protection against Omicron as they do for Delta.
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The effectiveness of vaccines is shown here in the example of New York City, an early epicenter of COVID-19. NYC doesn't require vaccination, but makes it very hard to participate in public life without one. Hence the adult vaccination rate is nearing 90% and COVID mortality rate is very low. NYC also suffered seriously during the earlier waves and natural immunity from prior infection likely also contributes to herd immunity and low mortality now. |
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Fortunately, the world is also in a better stage of preparedness for a potential Omicron surge due to treatments now available to reduce the severity of disease.
In addition to monoclonal antibody treatments like Regeneron, there are direct antiviral medications, like remdesivir, molnupiravir and the latest paxlovid.
Dr. Eric Topol states, “If Omicron turns out to have substantial immune evasiveness, the pills will add a significant layer of defense. We should get these small molecules into mass production, especially Paxlovid, with its takedown of upstream Mpro, and much higher efficacy than Molnupiravir (to date).
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The other great news is that all the pharmaceutical companies have been expecting new variants and are already engaged in clinical trials of modified vaccines that target them. Pfizer and Moderna mRNA vaccines are easier to adapt than those such as Johnson & Johnson because they simply deliver genetic codes in tiny bubbles of fat, then use the body as a factory to make the protein the immune system needs to recognize (the virus’ mutated spike protein). These codes can be quickly swapped out and there is no need for the enormously time-consuming process of growing cells in tanks that is required for other types of vaccine. Moderna announced today that they anticipate availability of an Omicron specific vaccine booster in 3 months.
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NIAID Director Dr. Anthony Fauci said the variant “‘is a clarion call’ for people to be vaccinated,” and added it will “inevitably” be in the US, “The question is, will we be prepared for it?” NIH Director Dr. Francis Collins “said ‘there’s no reason to panic, but... a great reason to go get boosted.’
QualDerm continues to closely monitor the pandemic and we will update you further as new information arises. CLICK HERE to read the updated version of our QDP Vaccine FAQ to share with patients and staff.
In the meantime, please cooperate with our efforts to confidentially and voluntarily collect vaccination status in case we must comply with the proposed federal OSHA mandate as described previously.
Finally, I was notified today that a patient I cared for last Wednesday developed symptoms on Thanksgiving day and tested positive for COVID-19. This is my first known direct patient care exposure and it involved an aerosolizing dermabrasion procedure. Knowing that our staff all used strict PPE and I am fully vaccinated, including my booster shot, provides me great reassurance that even as a high risk person I am well protected.
Stay safe and have a great week.
~ Dr. A
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