Omicron may help us end the pandemic and the coming weeks are crucial

As the world tried to start ‘living with Covid’, relax restrictions and reopen borders to international travel, the emergence of a new variant in South Africa froze everything again.

Will this never end? Are we forced to spend year after year under ever-changing pandemic restrictions, wearing masks, checking in at malls, and receiving regular vaccination reminders?

Hopefully not and, ironically, Omicron could in fact herald the start of the end of the pandemic and our return to normalcy.

Few people may remember them now, but in 2020 – long before we had vaccines and many expressed skepticism about their development – scientists have suggested that we should prepare for the ongoing mutations in the vaccine. virus, because it adapts to us and our environment.

These mutations, however, don’t need to be more lethal.

“… Mutating to become more lethal to humans would not necessarily be in the best interests of the virus. If a virus enters and immediately kills its host, this is usually not very good as it limits its ability to grow and infect new hosts.

Richard Kuhn, virologist and director of the Purdue Institute of Inflammation, Immunology and Infectious Disease in West Lafayette, Indiana on March 25, 2020 for Popular Science

Fight fire with fire

When a virus gets more serious, two things happen.

First, potential hosts are more eager to combat it (which is why we do quarantine and treat patients in isolation wards), so exposure to new hosts is limited. Second, when the infected host dies, its ability to transmit the virus also ends.

Thus, from the point of view of the virus (especially the airborne), it is in its interest to be able to infect as many people as possible. As a result, the strains most likely to persist are those which are the most infectious, but also the least severe.

Natural selection is at play here, and a milder virus simply has a better chance of surviving in the environment. The emergence of such a strain could help us beat the deadliest – in fact, using one viral sibling to eradicate the other.

Scientists have speculated that this could, indeed, be the case with Covid, as it gradually evolves into a form that won’t be worse than a common cold for most of us (after all, it is this is how we are already experiencing many other human coronaviruses).

Everyone has the flu - The Round of Doctors and Druggists.jpg
Asian / Russian flu epidemic in 1889. A man with the flu, taken in hand by a doctor, surrounded by dancing politicians. Woodcut by Pépin (E. Guillaumin), 1889 / Image credit: Wikipedia

In 1889, an epidemic in Central Asia went global, triggering a pandemic that spread the following year. It caused fever and fatigue and killed around a million people. The illness has generally been blamed on the flu, and nicknamed the “Russian flu”. But in the absence of tissue samples to test for the flu virus, there was no conclusive evidence.

Another possibility is that this “flu” was in fact a coronavirus pandemic. The finger was pointed at an isolated virus for the first time in the 1960s, although today it causes nothing more serious than a common cold.

In fact, there are four coronaviruses that are responsible for about 20-30% of colds. It wasn’t until recently that virologists started digging into these seemingly mundane pathogens and what they found suggests viruses have a much more deadly past.

Researchers now believe that these four viruses have started infecting humans over the past few centuries and, when they did, they probably started pandemics. The parallels with our current crisis are obvious.

Source: New Scientist, April 29, 2020

Data suggests that so far, this has not been the case as each subsequent variant of Covid-19 – A.1, Alpha, Beta to Delta being the main ones – was both a bit more contagious and deadly. This time, however, things appear to be different.

We still know very little about Omicron but, nonetheless, the first signs are positive – in fact, these are the best we have had in the past two years.

Although the virus appears to be spreading very quickly, it does not appear to have cost their lives (or a lot) and the first patients admitted to hospitals appear to have a reduced need for supplemental oxygen or treatment in intensive care compared to previous variants. .

These are the latest frontline sightings from South Africa’s Tshwane district, the epicenter of this new outbreak and possibly the birthplace of Omicron, where medics report the start of this new wave is nothing like what it was with previous viral strains.

covid-19 cases and death rate
High infection rates so far not followed by higher mortality so far / Image credit: SAMRC

In fact, many patients have been diagnosed by accident, as part of the screening process upon admission to hospital for other reasons. And those who have found themselves on treatment for Omicron suffer from milder symptoms.

In summary, the first impression on examining the 166 patients admitted since the onset of the Omicron variant, as well as the clinical profile snapshot of 42 patients currently in the COVID wards of the SBAH / TDH complex, is that majority of hospital admissions are for diagnoses unrelated to COVID-19. SARS-CoV-2 positivity is an incidental finding in these patients and is largely motivated by hospital policy requiring testing on all patients requiring hospital admission.

Using the proportion of patients under room air as a marker of accidental COVID admission as opposed to severe COVID (pneumonia), 66% of patients in the SBAH / TDH complex are accidental COVID admissions. This very unusual image also occurs in other hospitals in Gauteng. As of December 3, Helen Joseph Hospital had 37 patients in COVID wards, 31 of whom were in room air (83%); and the Dr George Mukhari University Hospital had 80 patients, 14 of whom were on supplemental oxygen and one on a ventilator (81% in ambient air).

The exponential increase in the positivity rate in these patients reflects the rapid increase in the case rate for Tshwane, but does not appear to be associated with a concomitant increase in the admission rate for severe COVID (pneumonia) due to the high proportion of patients not requiring supplemental oxygen.

The relatively low number of hospitalizations for COVID-19 pneumonia in general, intensive care and intensive care units is a very different picture compared to the beginning of the previous waves.

Dr Fareed Abdullah, Director of the Office of AIDS and TB Research at the South African Medical Research Council / Source: SAMRC

Good year?

Of course, we shouldn’t jump to conclusions too quickly – there is still not enough data on all the demographics (especially the elderly), to definitively state that Omicron is much less dangerous than Delta.

Having said that, as you can see, there is a lot of hope that this will be the case. Dr Anthony Fauci, chief medical adviser to the US president in this pandemic, has already cautiously observed that initial reports are encouraging.

The next four to eight weeks will be crucial as the variant expands its worldwide circulation, infecting thousands, if not millions, of people, which will provide us with enough information to draw conclusions about what the future holds.

But it doesn’t necessarily have to be feared, nor any other new variant that is still likely to emerge, as they may be our best way out of this pandemic.

Vaccines are a great tool, sure, but they’re not the silver bullet we hoped they could be.

Although they reduce the risk of death or serious illness and limit transmission to some extent, they do not eliminate them. They also require periodic boosters to maintain high immunity.

Given the considerable degree of vaccine reluctance in some countries, they fail to limit the impact of Covid to acceptable levels, which would allow us to start living our lives as before.

The real game changer would be a variation that is both more contagious and less serious.

Just as Delta’s high transmissibility has overtaken and, de facto, removed beta and alpha from the circulation, a milder Omicron could do this in Delta, saving millions of lives and becoming just a common cold rather than a virus harvesting millions of innocent human beings in its path.

covid variant us
How Delta took control of the United States earlier this year / Image Credit: Wall Street Journal
Covid: Why has the Delta variant spread so quickly in the UK?  - BBC News
Here’s a similar example from the UK / Image Credit: BBC

Even though Omicron is not the last word on Covid-19, it may at least be a step in the right direction and the future, milder variants that could replace it could reduce mortality even further, allowing us to live on. with as we live with other cold inducing coronaviruses.

In such a case, ironically, we would be forced to open our borders and resume regular activity more, not less quickly, as faster circulation of the new variant (s) could help us remove the troublesome Delta. And there’s no better way to do this than by encouraging human interaction.

Hopefully this scenario – as paradoxical and improbable as it may seem today – will be remembered in early 2022.

Featured Image Credit: AFP

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