We can win over Omicron. We just need to use the tools we have available | Eric Topol

THELast week, we learned from virus sequencing and early reports from South African scientists that there is a new variant with 50 mutations compared to the original Wuhan strain. It was quickly named Omicron and classified as a variant of concern by the World Health Organization, a designation that has only been used for four previous variants (Alpha, Beta, Gamma, Delta) among thousands of variants noted in the evolution of Sars-CoV. -2 viruses.

We know a few things about Omicron, namely its sequence and the site of its many mutations, much more than the previous worrying variants, and some of places in the RNA of the virus that can drastically affect transmission or impair our immune system ( or vaccine-induced immunity) to respond. This is all theoretical, as there have been other mutational variants in the past that have been detected but have been shown to be devoid of any clinical consequence.

We can also infer that Omicron must be from an immunocompromised host to have such a large number of mutations (from an initial Alpha variant line) to evolve rapidly in a person’s body. This phenomenon has been shown in several previous cases in which there are unrestricted viral mutations inside a person’s body due to inadequate defense of the immune system. And the chronic infection of the individual then spreads to other people.

The other thing we do know is that there was an outbreak in Gauteng Province in South Africa, and after Omicron was reported to the rest of the world, more than 15 countries have confirmed to new cases, mainly of travelers, but now multiple community transmissions have been documented.

To date, the pattern of hospitalizations in Guateng is the same as in previous waves, neither worse nor better. It’s likely Omicron has been around for months, but it wasn’t until recently that there was the first sign of a sudden surge in one place. Fortunately, it was diagnosed quickly, and the rest of the world was notified, much better than the previous worrying variants.

It is still unclear whether the overgrowth of cases is linked to high transmission, like Delta, or immune breakout, like Beta. Most likely due to the widespread mutations or what is known as ‘antigen drift’ it will behave more like beta, with some immune evasion properties. The extent of this will be determined over the next two weeks by laboratory studies that examine the virus in culture and the sera of vaccinated people to see how their neutralizing antibodies behave against Omicron.

But whatever the results of these lab studies and the follow-up of new cases around the world, we have all the tools to prevail over Omicron. This includes mitigation measures like masks, especially medical grade ones, physical distancing, ventilation, and air filtration.

We have remarkably potent vaccines with 95% efficacy against symptomatic infections, hospitalizations and death. And although these mRNA vaccines have some loss of efficacy over five to six months, their efficacy is fully restored to 95% with a third injection (booster).

In addition, this third stroke induces remarkably high neutralizing antibodies, much higher than the second dose of vaccine, and much greater activity against the variants. Additionally, the T cell response to vaccines is much less susceptible to variants than neutralizing antibodies, which puts us in a good position for fully vaccinated people to reduce the risk of serious disease.

Beyond mitigation and vaccination, we will soon have potent pills, when taken early in the first few days of a Covid infection, one with around 90% effectiveness, to prevent hospitalizations and deaths. The protective benefit of pills such as Paxlovid is not expected to be substantially affected by Omicron.

There are many fully validated rapid antigenic tests that should be made available free of charge as in many other countries to help diagnose infectivity in people with or without symptoms, which may promote the early use of treatments, such as anti-Covid pills. As a result, we are in a better position to defend against Omicron than we would have been earlier in the pandemic. We are also probably on the verge of developing pan-sarbecovirus vaccines, which could protect against all future variants, and which just need a prioritized, coordinated and funded global effort to speed up the process. Yet the most important thing that holds us back is human behavior: reluctance and resistance to use all of these tools.

While Omicron is a cause for concern, our problem now is Delta’s lack of containment in the United States, with over 90,000 new cases per day and over 50,000 hospitalizations. We’re the number one source of new infections in the world, and they’re all Delta now. If we had successfully vaccinated over 80% of our total population, as several countries have done, and used third injections to avoid any significant decline, we would have confined Delta. Our problem now is not Omicron, but rather not using the tools at our disposal, which get better and better over time.

  • Eric Topol is the Founder and Director of the Scripps Research Translational Institute, Professor of Molecular Medicine and Executive Vice President of Scripps Research


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