What we know about Omicron so far, according to a specialist in infectious diseases

One week has passed since the new COVID-19 variant Omicron, first identified in early November by scientists in South Africa, was identified as a “concern variant” by the World Health Organization because of its numerous mutations that can affect how easily it is spread or the severity of the disease it can cause.

According to the Centers for Disease Control and Prevention, about 40 countries have now confirmed Omicron cases, including the United States. On Wednesday, the first confirmed Omicron case was discovered in California; now other states, including Minnesota, Colorado, New York and Hawaii, have also confirmed cases.

CDC Director Rochelle Walensky said during a Covid-19 press briefing at the White House on Friday that “we are prepared and ready to quickly recognize the Omicron variant.”

However, researchers around the world are racing to understand the threat posed by Omicron. Compared to previous variants, does it spread more easily, cause more serious cases and has the potential to avoid COVID-19 vaccines?

Dr. Monica Gandhi, an infectious disease specialist and professor of medicine at the University of California, San Francisco, spoke on Thursday with Yahoo News about what is known so far and what doctors have seen on the ground in South Africa. (Some answers have been edited for clarity.)

Yahoo News: What are some of the latest updates on the Omicron variant, including whether it’s been shown to make people sicker?

Dr. Monica Gandhi: We’ve known Omicron for a week, but we’re actually getting some updates. So as for the symptoms … the World Health Organization said it appears the Omicron variant is causing milder disease among those who have not been vaccinated. Ninety percent of the people in the hospital with Omicron are unvaccinated in South Africa. This is a really important point because it means that vaccines protect against this variant. And these symptoms seem milder and they are described as more muscle pain, more fatigue. In fact, not so much coughing or loss of taste and smell, which has really defined COVID-19 before. That is what has been described so far in South Africa.

What do we know about COVID-19 vaccine protection against the Omicron variant?

As for the possibility of evading the vaccines, I actually have to answer this in two parts.

What we see clinically is that when a variant is described in a country, one suddenly begins to see it everywhere. This is a highly contagious respiratory virus – travel bans can not change that. And it was described very quickly in Denmark, the Netherlands, Israel, Italy, Great Britain, Canada, Portugal and the United States. And all of these cases tend to be vaccinated individuals because these are places that have had high access to the vaccines. And either vaccinated individuals are asymptomatic or have very mild symptoms. Just that [recent Minnesota] the case in the usa had symptoms for two days and is now just fine. And there was no transferability of [first] case, described in San Francisco by a traveler. They made contact tracking and no transmission from that person. That is the clinical data. If you have mild or no symptoms, it basically means that your vaccinations are working. And then it is important that 90 percent of those in the hospital, again in South Africa, are unvaccinated or have received one dose of the vaccine.

So what are the immunology data? [Vaccines] induces antibodies, which we talk a lot about because they are super easy to measure. But in fact, they also evoke what is called cellular memory or immune cells that serve as templates to help us later.

So one is called B cells and one is called T cells. And the way to think of B cells is that they are the recipe book for making more antibodies in the future, if you ever see a variant in the future. What B cells do if they see a variant in the future, think of it as a recipe. They are not going to make antibodies against an old strain. They will actually adapt their antibodies to combat the variant they see in front of them. Say you’re in a high altitude area and you need to add more yeast to your recipe, they know that. That’s what a recipe does. That changes with the circumstances. And so B cells are actually being helped by T cells to make antibodies, they will adapt to the variant they see.

And then T cells – the way to think about it is that there are a lot of T cells lining up across the tip protein. Yes, the Omicron variant has 32 mutations across the nail protein. However, there can be up to 90 T cells that line up against the tip protein. If you change 32 of them, you have 60 left fighting the virus if they see it. So it is difficult to avoid the vaccines with a variant. And now I think we have a really good consensus that Omicron does not seem to be evading the vaccines.

What do we know about how portable Omicron is?

In terms of transferability, that’s actually the only thing that’s happened to the variants. That’s the only change. What I mean by that is that the ancestral tribe – there was actually an old variant in the past that we never talk about, the 614G, which was actually more transferable than the Wuhan ancestral tribe.

Then the Alpha tribe, first identified in Britain, was also more transmissible than the ancestral tribe. And then the Delta variant, which at least was first identified in India and seemed much more transferable than the Alpha variant. So the only thing that the variants seemed to change about something at COVID-19 is to make it more transferable. And it has consequences because it can spread faster. And we saw that with the Delta variant, but no variant that has emerged since the Delta variant: Mu variant, Lambda variant, R.1 variant, Delta-plus variant and even the Omicron variant. I do not yet think we are convinced that this is more transferable than Delta. We’ve been describing this for a week, so it’s not very long. But it is Botswana for example [identifying] all its cases right now [as] Omicron, but the cases do not go up. And it actually seems that from wastewater analysis in South Africa it has actually been in South Africa for a while. It has been in Europe for a while. And in many places that are highly vaccinated, we do not see cases increase. So there is actually no convincing evidence that Omicron is more transferable.

What should Americans be advised to do now that Omicron cases are in the United States?

Now that we have a week’s data, I actually do not think anything should change for vaccinated individuals. And two doses seem to work well in, at least, South Africa, where they have not rolled out universal boosters. And this is what I would advise Americans: If you are fully vaccinated, you are great.

I would say that the ones that I really emphasize need boosters would be the ones over 65, the ones that are immunocompromised, the ones that have multiple medical conditions that are under 65, or if you are someone who is will be around someone who is immunocompromised. These are the four groups I really want to emphasize that they need to get a booster. For it will just help you prevent even a mild case of COVID. You do not want it around an immunocompromised individual, and of those who develop serious breakthroughs, it is more likely that it is older people or immunocompromised people. So I will advise on the boosters.

In terms of unvaccinated, what we saw with the Delta variant, which was more transmissible, is that there were actually massive increases in cases and hospitalizations in more unvaccinated regions of the United States. We are a better place than we were with the Delta variant, which became very dominant in this country in July. We are now in December, we are on at least 70 percent first dose vaccination in the United States. Many places are over 80 percent vaccination where I live, in the Bay Area.

We now have a year of data on these vaccines. Remember, they were released on December 14, 2020. They are safe and effective. And I really want to encourage the people who are on the fence to be vaccinated.

I do not think we are going to see an increase in cases or hospitalizations except in places with lower vaccination rates, and so I think the cornerstone of solving this problem is vaccination.

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