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Omicron is all over the news right now. Most of the headlines are pretty scary as the media tracks how crazy fast this variant is spreading. However, what does the actual data tell us? Let’s dig in.

Omicron Blogging? Are You Nuts?

Omicron is a new COVID variant that can spread more rapidly and has certain mutations. It was discovered in South Africa and is more transmissible than the original strain or Delta.

I have avoided any blogging on COVID for the past year because it’s such a sensitive, strange, and politicized subject. The few times I did blog on this topic during the depths of the pandemic, I got everything from high praise to very nasty responses. However, the disconnect between the data out of South Africa and the hysteria in the media headlines has caused me to come back for one encore COVID blog. In addition, remember, many times I’m blogging to force myself to take a deeper dive into what we know about a topic so that I can be informed when patients ask.

The Origins

The doctor who first identified Omicron had some interesting things to say. She at the time had the world’s deepest clinical experience with this disease, so we should listen carefully to what she said (1):

“Dr. Angelique Coetzee, chairwoman of the South African Medical Association, told the BBC Sunday that she started seeing patients in November with “unusual symptoms” that were slightly different than what she saw among COVID-19 patients infected with the delta variant.

“It actually started with a male patient who’s around the age of 33 … and he said to me that he’s just been‚ extremely tired for the past few days and he’s got these body aches and pains with a bit of a headache,” she told BBC.
The patient had a “scratchy throat,” she said.
The patient did not have a cough, or a loss of taste or smell, which are among the most common COVID-19 symptoms.

“What we are seeing clinically in South Africa — and remember I’m at the epicenter of this where I’m practicing — is extremely mild, for us (these are‚ mild cases. We haven’t admitted anyone, I’ve spoken to other colleagues of mine and they give the same picture.”

So at that point, Omicron was not a big deal, basically a COVID variant like the cold or the flu.

How Are Things in South Africa Where Omicron Has Spread Like Wildfire?

If Omicron were as severe as the media headlines suggest, South Africa would be a war zone right now, right? After all, Omicron has been there long enough that people should be overrunning hospitals and many should be dying. Basically equivalent to Italy in the early pandemic but far worse because this thing spreads so quickly.

However, that’s not what was just reported in the British Medical Journal (3). Despite Omicron representing 90% of the new sequenced COVID cases and despite a dismal 33% vaccination rate in South Africa, here’s what the BMJ tells us:

“The data suggest that infections in the current wave are less likely to lead to hospital admission than in South Africa’s previous surges. After adjusting for vaccination status, the risk of hospital admission for newly diagnosed adults is 29% lower than in the first wave, said Shirley Collie, a statistician at Discovery Health, presenting the findings. “Furthermore,” she said, “adults admitted to hospital currently have a lower propensity to be admitted to high care and intensive care units, relative to prior waves.”

Again, great news! That last part is critical data, as the big issue with the original and Delta variants is that they caused an overload of ventilator and ICU capacity. Also, note the phrase, “after adjusting for vaccination status“. While South Africa has a poor vaccination rate overall, that vaccination rate jumps significantly in the elderly. Hence, given that the elderly are the ones most likely to be hospitalized, that means the raw hospitalization numbers are far lower.

Is there any data on excess deaths (that may or may not be due to Omicron)? That’s the number of people who died above the baseline expected for this time of year. This is from the Daily Telegraph (4):

“Between November 29 to December 4 – just as South Africa’s omicron wave is thought to have started – national excess deaths across the country were already 21 per cent that expected based on data from 2014 to 2019.

From the 5th to the 11th December – after the country’s omicron wave was declared – excess deaths rose only slightly, to 23 per cent above the average.”

So excess deaths have been low in South Africa and they haven’t moved much. Now, of course, one media outlet, Bloomberg, was quick to take the same data and interpret it in a way that maximized eyeballs:

“Excess Deaths Rise in South Africa as Omicron Spreads”

So, according to some in the media, our slight increase in already low excess deaths becomes a scene out of the movie “Outbreak”.

When viewed as a scientist or physician, this data is very positive. Meaning it takes 3 weeks for a COVID patient to perish from the time the disease is detected. That means that if Omicron was first reported to WHO on November 24th and first detected in specimens collected from November 11-14th, and given that in one month Omicron now represents almost all new cases, we should be seeing significant excess deaths right now (5). That’s not happening.

The New Tissue Replication Study

One thing that could explain why Omicron is so mild is that it has a much harder time replicating in the lower airways (lungs) than the upper airways (trachea and nasal cavity). Meaning, for a virus to fill up lungs with fluid, as the original and Delta COVID strains did, it needs to be able to invade the cells in the lungs by replicating itself. A recent study sought to see how Omicron compared to its two viral siblings in that regard:

Notice that this is LOG SCALE. Each gradation is 10X the last. This shows that Omicron replicates 10 times slower in the lungs. Because of the log scale that’s 90% less. That’s fantastic news, as that means that Omicron is likely more akin to the common flu which also likes to replicate itself in the nasal passages and the upper airways and is less capable of invading the lungs of healthy people.

Isn’t the SARS-Cov2 Virus Supposed to Mutate to Become MORE Deadly?

Only in the movies. In the real world, all a virus cares about is replicating itself as many times as it can. If you kill the host, that means spreading yourself to fewer hosts and fewer overall copies are made. Hence, as a virus evolves, it tends to be selected to be less virulent and not more. In that way, viral evolution maximizes replication.

Will We Hear About Omicron Deaths?

Yes, the usual flu bug kills tens of thousands of people a year. Most of those people are elderly or severely immunocompromised. So despite being mild, there is little doubt that Omicron will kill some people, likely the same ones who would normally be taken from us by the influenza virus. However, you can bet that some in the media will hype those deaths.

A World Without Risk?

As a society, we have done a very poor job of managing this pandemic. From a public health standpoint, I give us very low marks. The biggest problem is that we have not conveyed the risk in a way that allows people to understand how to change their behaviors. Meaning that public health officials needed to let the public know in easy-to-understand terms what their actual risk of death or hospitalization was with each wave. For example, was I more or less likely to die of COVID than this year in a car crash? In the early pandemic, depending on viral spread, your risk of death from COVID exceeded that of dying this year in a car crash. Once vaccinations came on board, that risk, for the vaccinated went way down. In fact, for anyone who wasn’t elderly or immunocompromised, it went below the risk of dying in a car crash. Based on the data we have, for Omicron, that risk of death or ending up in the ICU is even lower and that’s despite decreased efficacy of the existing vaccines against this variant.

Should You Get a Booster?

I am fully vaccinated and everyone in my family is as well. Why? Because the original strains were bad enough that left unchecked they could overwhelm hospital systems. In addition, I’m in a people contact role as a doctor where I’m performing exams or procedures on many, many people each week. In addition, I’ve looked at the data on the safety and efficacy of the Pfizer and Moderna vaccines extensively and in my medical opinion, they are both convincingly safe and effective.

Right now, the two mRNA vaccines are less effective against Omicron. However, some in the media have often misreported the purpose of vaccination, which is to prevent ICU stays and death. In that regard, the existing vaccines still work (6).

I and my wife will source a booster shot this holiday season. Why? Not really because of Omicron, but to allow extra protection from the original strains. I have the ability to measure my own antibodies in the office and I can tell that while I still have good antibodies from my original shot, the titer has gone down a bit. Hence, if you’re older or have medical risk factors, I would recommend a booster. If you’re young and healthy, I’ll leave that choice to you.

Is Omicron What We Need Right Now to End the Pandemic?

Maybe. What I mean is that a low virulence/highly transmissible COVID strain may be a blessing in disguise. This will rapidly infect the vast majority of people on earth in short order. Many fewer will perish or end up in the ICU and all will be left with natural immunity. Given that NOTHING we do, including strict lockdowns, will stop this from happening and we have gotten many orders of magnitude better at treating severe COVID, this may turn out to be a good thing. Meaning that by the end of January or February, pretty much everyone you could come in contact with will have the antibodies and T-cells to kill COVID. That’s how pandemics end. Now in practical reality, COVID will likely be endemic and here to stay. However, it will increasingly be very manageable.

The upshot? Omicron is closer to a nothing burger than a scene out of a Zombie Apocolypse movie. Given that some of our public health officials and media continue to screw up the response to this one, if we all just go about our lives, Mother Nature may take care of this one for us.

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References:

(1) BBC Sunday. Omicron symptoms mild so far, says South African doctor who spotted it. https://www.bbc.com/news/av/uk-59450988

(2) HKU Med. https://www.med.hku.hk/en/news/press/20211215-omicron-sars-cov-2-infection

(3) Dyer O. Covid-19: Omicron is causing more infections but fewer hospital admissions than delta, South African data show BMJ 2021; 375 :n3104 doi:10.1136/bmj.n3104

(4) Daily Telegraph. Excess deaths remain flat in South Africa, sparking hope omicron fuels only mild disease. https://www.telegraph.co.uk/global-health/science-and-disease/excess-deaths-remain-flat-south-africa-sparking-hope-omicron/

(5) CDC. Omicron Variant: What You Need to Know. https://www.cdc.gov/coronavirus/2019-ncov/variants/omicron-variant.html

(6) WHO. WHO Global Consultation – What evidence do we have that omicron is evading immunity and what are the implications? https://www.who.int/news-room/events/detail/2021/12/15/default-calendar/who-global-consultation—what-evidence-do-we-have-that-omicron-is-evading-immunity-and-what-are-the-implications

Chris Centeno, MD is a specialist in regenerative medicine and the new field of Interventional Orthopedics. Centeno pioneered orthopedic stem cell procedures in 2005 and is responsible for a large amount of the published research on stem cell use for orthopedic applications. View Profile