Omicron

And now Omicron. Skipping over nu and chi for reasons of clarity, we now have Omicron (Ο) as the latest variant of concern in the covid pandemic. Scientists, public health officials, and epidemiologists are working overtime to understand this new variant. The best to say at the moment is that we are gathering the data and have precious few real answers to the myriad of questions.

Multiple nations, including the United States, closed travel from the southern countries of Africa where O likely emerged. This is of doubtful real efficacy as cases have been reported from multiple nations in Europe, as well as Asia and Australia. Locking the barn door after the horse has fled seems to be a common occurrence with this pandemic but simply shows that in an interconnected world, walls and barriers are meaningless political statements rather than real public health policy. South Africa needs support and praise, not shunning. 

The origin of O is also of interest. The current thought is that an incompletely cleared SARS-CoV-2 infection in an immunocompromised host allowed it to replicate over weeks to months, facing an ineffective immune assault that would be the perfect driver to evolve the large number of mutations that are seen in O. South Africa continues to battle the HIV pandemic; a host with untreated or partially treated HIV would offer a perfect vessel for such long-lived SARS-CoV-2 reproduction. This is meant in no way to defame either people with HIV or South Africa. Rather, it is a consequence of two poorly controlled pandemics with an interesting overlap in the Venn diagram.

There will inevitably be the political outfall of this new variant O. Already the likes of Ted Cruz (Liar-TX) and Rand Paul (Liar-KY) are blaming Tony Fauci. I expect the headlines to be tilted towards language that will make people click on them, for which social media companies will reap money. But let’s think about what is different today from March 2020.

Our ability to test and quickly define cases of covid, including O, is way better than 21 months ago. We can and must do better with rapid tests that have high sensitivity and specificity in detecting this virus -- and their cost must come down.

We know what works and what does not work for preventing the spread of covid. Yes, wash your hands frequently but no, don’t engage in the hygiene theater that sadly still continues to this day. Droplets are not how this virus spreads from one person to the next, aerosols are. That means that ventilation is key in every setting. Indoors, the use of simple measures such as opening windows helps. HEPA filters work great but can be expensive. The Corsi-Rosenthal box is an inexpensive substitute that can be made at home from common materials; it should be considered for use in homes, schools, and other places where the risk of covid transmission is high.

Masks remain a mainstay of nonpharmaceutical interventions (NPI) to diminish covid spread. It is best to use a mask that fits well and has good filtration capability. I wear a KN-95 mask and urge others to substitute the KN-95 for cloth or surgical masks which are less effective. As with ventilation, we have learned much about masks over the past 21 months. If one is outdoors and not in a crowd, feel free to unmask and enjoy the delight of maximal ventilation courtesy of Mother Nature.

The many mutations of O may be problematic for our current vaccines but most experts feel they will not be of any use at all. The current vaccines are safe and effective. If it has been a while since receipt of your vaccine, get boosted now. Remember that when waning immunity for vaccines is discussed, the focus has been almost exclusively on neutralizing antibodies produced by the immune system by vaccination. What is not measured is the response elicited by vaccines in the cell-mediated immune system.  Don’t wait for the tweaks that will come out in vaccines to account for the O mutated variant. Yours truly will be at the front of the line for that vaccine. Meanwhile, I have had three doses of the Pfizer-BionTech vaccine because that is the tool available now.

The pandemic is a balance between the pathogen, the host, and the environment. Hosts (that’s us) can avoid infection by intelligent use of the available tools (masks, ventilation, vaccines) as well as avoiding situations that increase the risk of exposure and spread of covid (e.g., crowded indoor venues). Vaccines will improve and include the new variants. The environment includes the political environment. Where the tools to prevent covid spread are not used (anti-masking, anti-vaccination) and where all susceptible hosts are unvaccinated (vaccine equity in less wealthy nations), the pandemic will have fertile ground to continue. 

A wag on Twitter noted that Omicron is an anagram of moronic. Let’s not be moronic again as a species with the emergence of O. Stay tuned for developments but don’t panic.