Everything We (Don’t) Know About Omicron

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S1: When I asked Caitlin Jetelina how her Thanksgiving had gone, she didn’t talk about the turkey or the football or even her in-laws, though that’s who she ate dinner with. She talked about this photo.

S2: My husband took this funny picture of me up in the guestroom. I’m in a toddler chair on a toddler desk with my computer just trying to figure out what was going on.

S1: Caitlin is an epidemiologist. She spent the holiday typing away in a guest room because she was trying to figure out everything she needed to know about Omicron, this new coronavirus variant that most of us found out about just around dinnertime. Caitlin had gotten word of it a couple days before that.

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S2: Um, I guess like the Tuesday before Thanksgiving, it really came on my radar.

S1: How did it come on your radar?

S2: Honestly, Twitter, it’s I follow a few amazing scientists and there is a scientist in South Africa who was really on top of this and was being very transparent about what was going on, what they were seeing, and other scientists started to chime in and I was kind of watching from afar.

S1: I mean, you’ve said you haven’t seen this much anxiety ridden chatter among scientists about a COVID variant before, even among the calm, cool and collected people. Why the change?

S2: You know, I think that there is a lot of change with this variant. I mean, we’re talking about 30 to changes on this spike protein and Delta was nine changes and so it was a massive jump and number of mutations. Now this doesn’t mean it’s necessarily more severe. It certainly gets it on our radar.

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S1: All those mutations put this variant on the World Health Organization’s radar to by Black Friday. Omicron was a quote unquote variant of concern. Yeah, I’m trying to hold these two things in my head at the same time, which is I think you and others have been pretty clear, like no one should panic over this new variant. But at the same time? It seems to have really gotten your attention quickly.

S2: It’s a hard balance to strike, right? This isn’t like a delta plus we always expected Delta to mutate to be our next threat, but this was something that was mutated over time, really under our radar and then all of a sudden popped up

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S1: today on the show. Omicron maybe a variant of concern for epidemiologists, but should it be a variant of concern for you? I’m Mary Harris. You’re listening to what next? Stick around. Did you feel like the US was turning a corner with Delta, like we’ve, you know, boosters are out there, kids are getting vaccinated, seemed like infection rates were stabilizing in some places. Like how did you feel going into November?

S2: Yeah, I was optimistic, honestly. I always knew that winter may not look good. Coronaviruses thrive in winter, and there’s no it’s not a consequence. Our biggest wave was during December January in the United States. So I knew we were going to have another wave. I think the question was how big? And then once we got through the winter with no variants, which is not the case now, I was pretty confident we would enter an endemic state next spring. And then Omicron came.

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S1: Part of why the spread of Omicron I feel like it seems so troubling is that the variant became a variant of concern. Quickly, can you explain how that happened? Like, tell me the story of how we first learned about the variant.

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S2: The variant was actually first discovered in Botswana, and it was discovered on November 11th from a few scientists. And then after November 11th, it was quickly identified in South Africa. Three days later, and then it was identified in two cases in Hong Kong from travelers from South Africa. And you know, we have to give a lot of credit to South Africa. They have been on top of this. What do you mean when you say that? Yeah. You know, I think that one been on top of it of communicating what’s happening. They had a very swift response. So scientists around the world knew what the mutations were, so they could start decoding the threat, making this really a team effort. And then they have constantly been communicating to the global arena about what’s happening on the ground. And I think that together, those two things, because the virus was caught incredibly early. Other countries could really prepare and figure out what to do right now, as well as other could start figuring out solutions. And if this is a variant that is a legitimate threat. Hmm.

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S1: So let’s get into what makes this variant different. I know it’s got more mutations. What does that actually mean?

S2: So, yeah, so it has more plantations. We’ve seen some of these mutations before. For example, there’s you know, if you from Delta, a few from Beta, if you from Alpha, all previous variants of concern. There’s also new mutations are novel mutations that we’ve not seen on other variants of concern, but we have lab data to suggest they’re a threat. Or maybe we know because of their location on the spike protein that it makes us a little more worried.

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S1: And the importance of the variations being on the spike protein you’ve written is basically because that protein is the key into our cells, right?

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S2: That’s right. So we pay attention specifically to this spike protein because, yeah, it’s the virus’s key into our cells. And if the virus changes to become a smarter key, we need to know about it. Or not only that, either a smarter key or finds another door. We need to know about that. And so there’s kind of three things we look at to see how this key has changed. Does this key change to increase transmissibility or increase how contagious the virus is? Does it change in a way that it starts outsmarting our vaccines or infection induced immunity? And then third, what we look for, does it increase severity or hospitalization or death?

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S1: How many countries are reporting they’ve seen cases of Omicron so far? Like, I just saw a report that Dutch health authorities are saying, Oh, actually, we probably had this variant around the same time as they did in Botswana. It was already here.

S2: Yeah, and that’s not a surprise at all. So as of November 29th, it was on five different continents 21 countries, and we had about 200 confirmed cases with many, many more probable cases. So yeah, it’s it’s already spreading and we’re not surprised about that. This is a very globalized world, and usually when we detect a variant, it means it’s already been spreading so.

S1: Here’s a question I have given all of the. All of the information that’s sort of conflicting about when this variant was, where do we know where it came from? And does that matter?

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S2: No, we don’t know where it came from and I don’t know if it matters. Well, yeah, maybe it matters a little. I think that many epidemiologists, virologists have a hypothesis that this started really and an immunocompromised individual. And we think that because this is in a Delta Plus variant, it really kind of sprung out of nowhere and it may be in important. Maybe not, I guess, depending on who you’re talking to for the idea of global equity with vaccines, we’ve had more than seven billion vaccines administered. But that’s, you know, certainly not every single person in the world have had has had a vaccine yet. And until we can get everyone on the same playing field, this virus is still a threat.

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S1: Can you explain the importance of this variant potentially evolving in someone who is immunocompromised? What difference would that make?

S2: We’ve seen actually before with a beta variant, for example, that the virus can stay in someone specifically immunocompromised at low levels for a long time. So it’s not. The virus isn’t clear too quickly like it is with a healthy individual and say 14 days, it can stay in that individual for months and months. The body is a great incubator, and so when the virus is in that immunocompromised person, it can change and change and change and change. And until it changes a lot and then jumps from that immunocompromised person to another healthy person that then can transmit it. And so, you know, I think this variant has major implications of virus evolution in immunocompromised hosts. And I think what it really underscores is the need to ensure that immunocompromised people are protected by communities right through immunity rolls through masks, not just for their own sake, but for all of ours. And I think that’s something this variant has really highlighted as well.

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S1: I mean, last time we did a show about a new COVID variant, we’re talking about Delta back in June, and at the time the physician we spoke with was really calm. She was saying, If you’re vaccinated, you’re probably going to be fine. Turned out she was pretty much right. But one of the reasons she said that she felt so strongly about this was that as an HIV researcher, she knew that as a virus evolves, it can actually get less fit. So. Actually, the virus you get when it’s very evolved may impact you less. I wonder if you share that perspective and if that’s part of what’s in your head as you think about Omicron,

S2: it certainly is a possibility. You know, a virus’s main goal is not to go out and kill. It’s actually opposite of its goal. It wants to survive. And so sometimes that means the virus survives by becoming less severe so it doesn’t kill off its hosts, for example. I will say, you know, viruses aren’t intelligent beings. It’s it’s random. These mutations are completely random, whether they get more severe or less severe. So we have to take that in mind. I think the other thing we have to keep in mind is that, you know, mortality is not the only outcome with SARS-CoV-2. We also have morbidity like long COVID, which seems to affect about 30 percent of adults, 10 percent of kids. And whereas we have only touched on the surface of what long COVID can do, and so I guess my question then is, you know, if this is becoming less severe and disease, does that mean it’s also becoming less severe and long COVID? And that’s not necessarily the case. And so we have a lot of unanswered questions more questions than answers right now.

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S1: After the break, why it may only take a few weeks to get some of these answers. Caitlin Jetelina says scientists are already working on how they’ll tackle the Omicron variant. One way is by building out a virus in a lab with the variant on top of it. Scientists will then test to see if our current vaccines can fight the variant off. Scientists also want to know how transmissible the viruses and if it’s deadlier than previous variants. The good news, Caitlin says, is that it might only take a week or so to get some initial findings on these kinds of questions.

S2: We’re kind of in this lull, and it’s hard to tell people, just hold on. We don’t know yet because we we truly don’t know anything yet.

S1: That’s amazing. You think it’s just going to be a week like I think about how long we’ve been in this pandemic and to think we’ll know something in a week. That sounds like that sounds like a real upgrade.

S2: Yeah, you know, it is an upgrade, and I would hope to see an upgrade after 20 months of what we’ve been through. You know, we have teams in place, we have surveillance systems in place now. Finally, in the United States, we have people, you know, T teams and communicating across the globe working together. And so there’s a level of comfort there, I think, too.

S1: Another bit of good news is that PCR tests, those tests that go really far up your nose, they can actually detect Omicron. Caitlin says it’s a huge win because it means health workers are going to be able to track the variant as it moves from person to person.

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S2: So Omicron has a special signal on the PCR directly so we can quickly if labs are set up and know about this trick. Know whether a PCR is Omicron or something else like Delta. It is good news. It’s amazing news because this means that if and when Omicron is in the United States and starts transmitting, we can track this virus much easier and much quicker and really be on top of where this is going and how quickly.

S1: You also note that in an Omicron specific vaccine or booster could be developed really quickly. Why is that?

S2: That’s right. It’s because we have this new biotechnology, the RNA vaccines, and they’re actually very easy to alter for, you know, the Pfizer major, and I can alter it pretty quickly. It’s also a very minor change. And so with that, you know, the FDA does not require a massive phase three trial or doesn’t require to go through regulatory approval. All they require is really for a few dozen people to get the Omicron specific vaccine. Make sure it works against Omicron and then it can be manufactured, distributed and go into arms. I think Pfizer came out a day or two ago saying that this process would take about 100 days to do, and that’s compared to the nine months that it took for the first vaccine, which is a welcomed improvement.

S1: Before we go, I’m hoping you and I can go through just a few questions that I think are on people’s minds about their lives given this variant and like how it should impact their decision making. I think the biggest one is that the Christmas holidays are around the corner, and I’m wondering how Omicron should change, how people think about the way they’re going to be spending that time. Have you started thinking about that yet?

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S2: Yeah, I actually I was in a ton of media interviews yesterday and people started asking that question. I’m like, You guys, let’s just get to this week before we think about the holidays, but that’s me with my epi hat on. And I think, like a lot of people want to know what this means on the ground. I think it’s important to recognize that when our house is already on fire with Delta, we need to get transmission down right now. And what that means is we have to approach the holidays smartly. And so that means go get a booster today. Go get it. Right now, we have reason to believe that boosters will help protect against Omicron. We’re not convinced we need an Omicron specific vaccine yet. I think that if a family is fully vaccinated, everyone’s boosted. You know, that’s a very safe gathering. I think we can also, for the holidays, really leverage antigen testing. You know, those tests you can go get at your corner pharmacy and tells you in 15 minutes whether you’re positive and contagious or not.

S1: If you don’t have a bunch of these rapid tests at home, should you?

S2: Yeah, you should. You know, the problem is they are wine hard to find. They’re sometimes out of stock. And then too, they are expensive. For the average American, it’s about twenty five dollars for two two tests. And other countries have these tests readily available for free for their citizens. And we need that desperately in the United States so we can make testing as easy as possible for people so we can get control of transmission.

S1: What about masking? Does Omicron change anything when it comes to when you mask up?

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S2: No, it doesn’t. You know, vaccinated, it needs to wear a mask inside and, you know, maybe I don’t. I still am not convinced that you need to wear a mask outside in well-ventilated places. That’s not packed, but I know I mean, masks work great. There’s a study that came out a week or two ago showing that masks reduce and 58 percent of transmission, which isn’t perfect, but that will certainly help with the winter.

S1: Social distancing still important even now.

S2: You know, I have never really been convinced of social distancing because we know that this virus is airborne. It can survive in the air for up to 16 hours. So even if someone’s in a space and leaves, it can still be there. And in fact, and so yeah, I mean, you know, I don’t know, don’t talk to strangers, you know, a few inches away from them where they can spit in your face. But I don’t think six feet will necessarily help too much, either.

S1: It’s funny. I was looking at the reaction to this new variant, and in some ways I’m amazed at how fast the reactions been like it feels like. Last week, a scientist said, Huh, something new is happening and then boom, boom, boom variant of concern. And you know, people are saying, we’re making we’re planning to make a vaccine off of this new variant. It all is happening so quickly. But then I also see that a lot of other decisions that I thought we all agreed weren’t so useful are being made really quickly, too, like the decision to limit travel from South Africa. I wonder what you make of all that.

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S2: There have been policy level decisions that I certainly don’t agree with. You know, if we’re using purely science to drive policy, those are not great policy decisions. But we all know that policy isn’t just driven by science, either.

S1: It does feel a little bit to me, like South Africa raised its hand and said, Hey, we found something new, and then the response was, OK, let’s shut down all travel from South Africa. And I just don’t know if that’s the right response when someone’s out there trying to give information to the world.

S2: Yeah, I mean, I know that it’s not the right response. It’s not even effective. You know, it’s one thing if you want to close all borders to day right now. I mean, that may be effective, but if you select a few handful of countries and say, Yeah, we’re going to stop travel there, but the virus is everywhere else and we’re going to stop travel in a few days, not today. I mean, this doesn’t work that way. It’s not a public health effective solution. The other problem than actually the scientists who discovered the Omicron in South Africa came on Twitter yesterday, saying, because of all of these travel bans, they’re running out of supplies in the lab to test the threat of this virus. And so they won’t be able to start answering questions because they can’t get supplies to South Africa because of these travel bans. And so it not only perpetuates this stigma of disease, but we’re really cutting off their arms in terms of trying to answer all of these questions we desperately need as well.

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S1: Dr Jetelina, thank you so much for joining me.

S2: Yeah, no, thank you.

S1: Dr Caitlin Jetelina is an assistant professor with the School of Public Health at UTHealth. She’s also the founder of a newsletter on Substack. It is called Your Local Epidemiologist. Look it up. All right. That is our show. What next is produced by Carmel Delshad Mary Wilson, Danielle Hewitt and Elaina Schwartz. We’re led by Alison Benedict and Alicia Montgomery. And I’m Mary Harris. You can track me down on Twitter. I’m at Mary’s desk. Thanks for listening. I will talk to you tomorrow.