COVID #10: Omicron Edition
Overnight we have a new COVID variant, one that seems to be spreading fast. As of this writing, it has been detected in the United States, and given that only a fraction of COVID cases are ever detected, this means there are probably dozens, if not many hundreds, of cases of this new variant on our shores.
Why we should care? Omicron has about 50 genetic mutations that appear to be new when compared to known variants. This means it may behave differently than the variant we all know and love, Delta. Most importantly, Omicron has several mutations that affect its spike protein, which might render it resistant to the vaccines we have already, as well as the monoclonal IV treatments we use to keep people out of the hospital, and even the new oral medications that are about to become available.
To clarify what I just said. Viruses have genetic material just like humans do. This genetic material can undergo alterations when the virus replicates, leading to new viruses with characteristics that are different from earlier viruses. In the case of Omicron, it appears the old coronavirus somehow mutated in 50 different places in its genonme, creating a new, distinct, breed of coronavirus. And we aren’t sure what its new characteristics are.
So why is it still called a coronavirus? It still has most of the characteristics of the old COVID. It still infects the respiratory tract the way the old one does, spreads by the same airborne methods, and still invades certain cells in the lung to cause disease. Most importantly, Omicron still has a version of the “spike protein,” a pointy extension on its surface that allows it to attach to respiratory cells and invade them. So it is still the same virus, just a little different.
Different how? That is the great question. It appears that Omicron has a spike protein that looks somewhat different from Delta’s. It still does the same thing, just looks a little different, like the way a Chevy looks different from a Nissan, even though both do the same things.
The problem is that the variations in the spike protein may look different to the human immune system. There is the possibility that Omicron might be able to infect someone who is already immune, because the new altered spike protein is not recognized by the antibodies already present in that person’s immune system. The new changes just might make the new Chevy look different enough from the old Nissan that the virus description the immune systems uses could lead to mistakes in identifying the virus. And since the COVID vaccine stimulates the body to make antibodies specifically targeted at the spike protein and nothing else, there is the possibility that vaccinated patients could catch Omicron.
The important thing to understand is that this is theory based on genetic changes that have been detected in Omicron. These changes could enable Omicron to evade the vaccine, but it is also possible that they don’t. All scientists know right now is that the changes alter the spike protein enough that a problem is possible. But it could be that the vaccine still works against Omicron. There was concern when Delta first emerged that it might evade the vaccine, but this has turned out not to be so. Vaccinated patients have done well with Delta, and this could be the case with Omicron.
What scientists are looking for. There are four questions scientists need to answer about Omicron.
1. Do the mutations mean Omicron is deadlier than the previous variants?
2. Is Omicron more contagious than Delta?
3. Does the vaccine protect against Omicron?
4. Is the Omicron variant stable?
We don’t have answers to these questions yet, but the few cases that have been detected provide us clues. First of all, almost all the known cases of Omicron have been mild. This can happen. Not all mutations of viruses have to be bad — some of them can cause a less deadly virus. If this turns out to be the case, Omicron will not be a major health concern going forward.
It is not clear at all how contagious Omicron is, and this is very important. Delta is very contagious, and if Delta is more contagious than Omicron it may completely outpace Omicron and make it irrelevant. The weed that grows fastest in your yard is most likely to choke all the other weeds out, and Omicron may not go anywhere if it can’t move as fast as Delta.
It is also not known if the COVID vaccine protects against Omicron. So far, the few vaccinated people who caught Omicron seem to be only mildly sick, so the answer may be that the vaccine won’t prevent you from catching Omicron all the time, but it could prevent serious disease. This would be a positive development.
The fourth question, about Omicron’s stability, is important as well. If a mutation produced Omicron, more mutations could continue to change it. Thus Omicron could simply disappear from view, if all its mutations added together make it a weaker virus.
The big mistake many people make. People who have watched too many superhero movies have a mistaken idea about mutations. When Thanos or some other supervillain undergoes change in the movies, he always gets more powerful. Each mutation (acquisition of a new Infinity Stone) made Thanos stronger.
This is definitely not true of mutations. Some mutations are good, some are bad. Mutations are random. In fact, most viral mutations are fatal to the virus, which is why there are so few important COVID variants. If every COVID mutation made the virus more viable there would be billions of COVID variants circulating, each one killing people on its own, but that is not happening. That’s because the vast majority of variants are not strong viruses, and end up petering out. As a virus of interest, Omicron is a variant that is stable enough to be passed from person to person for an extend period, but the mutations it has taken on may not be giving it any superpowers. In fact, if anything, it is just as likely that the combination of 50 new mutations in Omicron have made it less dangerous to the general public.
What misinformation is out there? I have already heard one that says if Omicron evades the vaccine, that is reason not to get vaccinated. Wrong. First of all, Delta is still thousands of times more common, and we know the vaccine works against Delta. If you are walking around in the rain and see a lightning bolt, you don’t take off your raincoat because the raincoat won’t protect you from lightning. In the same way, you don’t take away your protection from Delta just because Omicron is out there. That’s lazy thinking.
Secondly, just because the first case of Omicron in the United States was found in a vaccinated person, that doesn’t mean the vaccine doesn’t work. Vaccinated people sometimes get Covid. The point of the vaccine is threefold — (1) you are less likely to get infected in the first place; (2) if you get infected you are less likely to get extremely sick; and (3) vaccinated people who catch Covid tend not to be be contagious for as long.
There are reasons to think all of these benefits will hold with Omicron. Omicron has not yet caused an increase in deaths or hospitalizations. As long as this holds true, we have reason to believe the Omicron variant is not a turn for the worse, and that we shouldn’t abandon our current approach to pandemic control (vaccination, masking, and social distancing). Unless Omicron proves to be more dangerous than Delta, we should stay the course.
Finally: It is remarkable that medicine has progressed to the point that researchers were able to spot Omicron, genetically sequence it, and begin collecting data on it within weeks of its appearance. Twenty years ago none of this would be possible. Thirty years ago, we might not have had the genetic sequence for the original COVID even now, after 2 years. What looks like an alarming turn of events is really science being so good at tracking COVID that we can see wrinkles and new developments in the course of the pandemic that we wouldn’t have noticed in a previous age. Instead of fighting blindly, as medical people have had to do in pandemics in the past, we can see COVID’s every move and react to it.
With COVID, science is moving faster than it ever could before, and we will have our answers about Omicron within days or weeks. Only a decade or two ago, that would be impossible.
COVID is a dangerous and tricky disease, but we have more information and weapons to combat it than ever in human history. The odds are we will figure this out, just as we figured Delta out.
Get your shot. Mask when you are in crowded places. Social distance. We know these things work, and if you want things to get back to normal, following the science is the way to get there.
