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Omicron and why we shouldn’t underestimate it

By DR. BENJAMIN CO, The Philippine STAR Published Jan 25, 2022 5:00 am

Omicron is the fifth variant to be recognized by the World Health Organization as a variant of concern in the ongoing COVID-19 pandemic.

In less than a month from the WHO’s declaration, it has blazed into several countries (including the Philippines), sending many into record-high numbers.

What do we know about Omicron?

Shorter incubation periods lead to more people being contagious sooner and infections occurring faster and making transmission more difficult to prevent.

Based on published literature, while Omicron has twice the speed of Delta and four times its infectiousness, it generally causes milder illness compared to previous variants. Omicron presents with predominantly upper respiratory symptoms in most patients. These include: fever, nasal congestion, cough, and sore throat.

Presenting with milder symptoms and running a shorter course of illness may be good news. This augurs well for shorter isolation and quarantine protocols and possibly a lower hospitalization rate in places where healthcare is sufficient.

Complacency will always lead us back to another COVID-19 variant or another wave.

The downside to the “swiftness” of Omicron is in the testing capacity. In a publication regarding the outbreak of the Omicron variant after an event in Norway, researchers noted that the symptoms came so quickly that catching the virus became a problem.

Those who attended the event had received a negative antigen test result two days before the party. Yet 80 people were symptomatic three days after attending the event — a clue, perhaps, to define that the virus multiplied in the people so quickly that rapid-test results were obsolete for screening guests.

Shorter incubation periods lead to more people being contagious sooner and infections occurring faster and making transmission more difficult to prevent.

In communities where more people are fully vaccinated, there is also a greater likelihood that you’ll have more people that are asymptomatic, while those who have symptoms present as a mild flu. And because symptoms are subjective, waiting for people to report when they start to feel unwell becomes an added layer of challenge in isolating those who are sick.

In communities where more people are fully vaccinated, there is also a greater likelihood of asymptomatic carriers,

Like previous variants, Omicron’s symptoms lag behind the period of contagiousness. Meaning, by the time one is ill, one has already infected other people. And symptoms and transmission do not follow to the same degree.

Based on the most recent genome sequencing data in the Philippines, Omicron currently makes up at least 97% of the sequenced specimens, with the remaining 3% still attributable to Delta. However, not all the specimens for PCR undergo genome sequencing. Hence, policymaking based on the data we currently have becomes challenging, and because the evidence is scant, the policy is hybrid as well.

Those who choose to remain unvaccinated or who have no access to vaccines end up with the short end of the straw. Getting infected puts them at greater risk for developing more severe infections and mortality. With Omicron, even those who have been previously infected with a variant of concern but are not vaccinated have a higher chance of getting re-infected.

Omicron has redefined the way the pandemic is managed. Its needle-rise in growth tells us how ugly the spread of the virus can get. A shorter incubation period puts more people at risk because there’s less time to identify an infection before it becomes infectious.

Testing

Testing should also be done as quickly as possible, and because tests offer a picture of “what went on” rather than “what’s going to happen,” a virus that replicates quickly from negative to positive over a short period of time will be difficult to validate.

Those who do not know how to use rapid antigen test kits may end up being complacent with a negative test result.

Which goes to the gold standard for identifying SARS-CoV-2: the RT-PCR test.

While PCR remains an excellent test, the processing time is dependent on the capacity of the laboratory. Because of the intricate nature of a PCR test, it takes a few hours before results come back. But not all laboratories have the same number of equipment and manpower. As resources are stretched thin with more people wanting to get swabbed, backlogs ensue.

Considering the speed of Omicron, people who are asymptomatic or waiting for their results may end up recovering already by the time the results are back.

The availability of rapid antigen testing (RAT) isn’t a perfect solution either, for two reasons. The first is that RATs being sold commercially are for healthcare worker use only. Those that do not know how to use it may end up being complacent with a negative test result. RATs for lay people (self-administered) are different from those currently approved by the Philippine Food and Drug Administration. And, like all tests, the results are only as good as the user.

Inevitably, many more will get infected in this fourth wave that the Philippines is currently experiencing. Reinfections and breakthrough infections among the vaccinated are examples of additional statistics to the daily cases.

Underestimating Omicron as “mild” places people at risk for post-COVID symptoms, which remain unknown.

Others claim that since getting infected with Omicron would simply be “mild,” then we might as well treat it as the common flu. This kind of reasoning is like taking your boat to uncharted waters and risking it all.

Let’s face it: Omicron’s long-term effects are unknown. And whether you are dealing with Omicron or some other variant, underestimating Omicron as “mild” places people at risk for post-COVID symptoms, which may be debilitating and linger for months or years.

The science of mutation of microorganisms lies in the fact that increased transmission provides the impetus for mutations to occur. With a variant that has given the world close to three million daily new cases, it will not be surprising that new variants emerge months after the cases begin to subside.

As microorganisms mutate, they learn to coexist with hosts. They can create ways on how to survive. Vaccines that were discovered against the ancestral (Wuhan) SARS-CoV-2 are less effective in both preventing infections and lowering the severity of disease for Omicron. Science will need to catch up on the virus as it evolves.

In the meantime, experimental antiviral agents (molnupiravir and nirmatrelvir/ ritonavir) are now approved as Emergency Use Authorization for patients with mild to moderate COVID-19 infections, while studies are underway to determine if they work as post-exposure prophylaxis (prevention when exposed to positive individuals).

As microorganisms mutate, they learn to coexist with hosts.

Monoclonal antibodies specific for SARS-CoV-2 are also approved as EUA. These are more expensive and must be administered as an IV infusion or subcutaneously. Because of the multiple mutations at the spike protein for Omicron, many of the approved monoclonal antibodies for the previous variants may not work as well for treating Omicron. And the cost of monoclonal antibody cocktails is prohibitive for the average Filipino worker.

For now, getting vaccinated (and boosters if it’s already your turn), masking up properly, and following the minimum health protocols, as dictated day in and day out by the Department of Health, remain our best bet at not getting infected.

At the end of the day, complacency will always lead us back to another variant or another wave.

All pandemics come to an end. How this one will, only time will tell.