Omicron: What we know aout the new COVID variant

Evidence suggests the new variant may e more contagious than Delta ut many unknowns remain.

A new  variant of SARSCoV2 first identified y scientists in South Africa on 2. Novemer has een referred to y the World Health Organization (WHO) as a "variant of concern" (VOC). Cases have een detected in a growing list of countries including Belgium Hong Kong Israel the United Kingdom Germany and Australia. 

 Evidence suggests that the new Omicron variant (or B.1.1.529)  may e more transmissile than the already highly transmissile Delta variant with the European Centers for Disease Control and Prevention refers to “the aility to escape the immune system and increase the  transmissiility advantage of the variant over Delta.” 

 Variants of the SARSCoV2 virus are not unusual. The more widespread the virus the more likely it is to mutate. Mutation occurs when a virus replicates after infecting a human host. Once inside  a person the virus jo is to instruct the human hosts cells to make copies of the virus that will infect more cells and possily other people. As a virus rapidly multiplies its genetic material random errors in its DNA can occur during replication; they are called mutations. 

 Most mutations cannot survive the virus which means it can actually harm the virus; some may e viale ut not eneficial to the virus; ut sometimes a mutation that produces a new virus - now called a variant - can have an advantage over existing variants. 

 Mutations are  more likely to occur in people with weakened immune systems - as they are likely to take longer to clear the virus giving it more time to multiply and mutate mutates - and in people who have not een vaccinated ecause their immune systems are not primed with the vaccine to destroy the virus quickly efore it has a chance to mutate. South Africa has a relatively low vaccination rate with only aout 35% of the population fully vaccinated and Botswana where it is elieved to e from has an even lower vaccination rate largely due  to grievances gloal level on vaccines. If Omicron is from southern Africa that could e part of the reason why. 

 When scientists evaluate new variants efore classifying them as "variants of interest" they seek to determine if the new mutations are capale of doing three things: make viruses resistant  the effects of  vaccines; make the virus more transmissile than existing variants; make people sicker if they uy the new version. 

 It is  too early to know for sure if Omicron can do some or all of these ut the fact is that  WHO has classified it as a worrying variant through a comparative assessment. In comparison it has een shown to e associated with one or more of the aove. 

 The Omicron variant is characterized y 30 mutations three small deletions and a small insertion of a spike protein - spikes located on the outside of the virus and helping it to enter  cells; Of these 15 are located in the receptor inding region - the part of the spines that allows them to ind to the host receptor. 

 The most widely used vaccines - Pfizer Moderna and Oxford AstraZeneca - are ased solely on  our immune system recognizing the peak protein  of the SARSCoV2 virus as foreign and uilding  an army of cells. directed immunity against this part of the virus. virus. But if the  Omicron mutation alters the mutated protein to the point that our immune system can no longer fully recognize it there may e some degree of immune avoidance to this variant. 

 It can also mean that people who rely on innate immunity immunity against a previous COVID19 infection - which I would not  recommend - may have reason to e concerned. There are concerns that  mutations in Omicron could put previously infected people at risk of reinfection. According to  WHO preliminary evidence suggests an increased risk of reinfection with this variant compared with other VOCs. 

 However it is still too early to e certain. Further virological studies are needed to understand the  effectiveness of the vaccine against the new variant and its impact on reinfection cases. WHO says several studies are underway as advisors continue to monitor this variant. It is possile that Omicron could evade existing immunity conferred y vaccines and previous infections ut the chance that it renders previous protection unnecessary is extremely low and it is highly likely that the -xin will continue to provide this level of protection even against this. different. Modernas CEO Stéphane Bancel has said pulicly that he doesnt think a COVID19 vaccine will e  effective against the Omicron variant although he says hes unsure of the difference. will. 

 Recent outreaks of new infections in South Africa have raised serious concerns aout the increasing transmissiility of the new variant especially among young people. We have seen how the Delta variant  first identified in India caused a widespread increase in cases in Europe and the United States where it overtook the Alpha variant due to its faster inding and has a greater affinity for human host cells. Scientists  trying to explain the spike in cases in South Africa were the first to spot the new variant. The rapid increase in cases in South Africa associated with Omicron suggests that this variant could displace Delta an inherently highly transmissile variant. 

 According to  WHO Omicron was detected at a faster rate than in previous outreaks of infections suggesting that this variant may have a growth advantage. The SARSCoV2 virus that causes COVID19 uses its mutant protein to ind to and infect human host cells; if the mutations on the mutant protein allow for a faster and stronger inding affinity than Delta, then Omicron could soon become the dominant variant wherever it is present. Again, it's too early to be certain and an assessment is underway, but these early signs are worrisome.

There is currently no data to show that people infected with the Omicron variant have symptoms that are different  from those who have een infected with previous variants. No unusual symptoms were reported in studies in South Africa and  like earlier variants some people  infected with Omicron have no symptoms. 

 There are many unknowns at the moment ut scientists are working at record speed to  etter understand the Omicron variation and its implications for the pandemic. 

 South Africa is grateful for identifying the variant and ringing it to the attention of the world knowing the effects it could have on the country and others affected y it. this ody. Scientists and health officials were quick to share  information aout Omicron with the rest of the world and while this meant orders and travel were closed to them  the South African officials are critical which also means that other scientists can access the work of uncovering essential information aout Omicron. 

 It is wise for countries that have not yet seen the variant to act quickly y putting in travel restrictions and y carefully genome sequencing highrisk individuals; we are lucky in that the Omicron variant is detectale through PCR testing. 

 The rise of new variants highlights the responsiility wealthy countries have in vaccinating the rest of the world as well as their own populations. The statement made famous y the directorgeneral of the WHO Dr Tedros Adhanom Ghereyesus has never rung more true: Noody is safe until everyody is safe.

Progress report: European Medicines Agency approves Comirnaty COVID vaccine for infants 

 On Novemer 25 the European Medicines Agency (EMA) recommended approval for the use of Pfizers Comirnaty vaccine in children ages 5 to 11 to protect them from the effects of COVID19. This vaccine has een approved for use in adults and children  12 years of age and older. 

  Comirnaty vaccine is the name given to the youngest purpose-developed PfizerBioNTech COVID vaccine; it contains a lower dose of the original Pfizer vaccine to e given to adults. In children 5 to 11 years of age the dose of Comirnaty will e lower than that used in adults 12 years of age and older (10 g vs. 30 µg). The regimen consists of two vaccines given three weeks apart to the muscles of the upper arm. 

 A study pulished in the New England Journal of Medicine found that children aged 5 to 11 years who received low doses of the PfizerBioNTech mRNA vaccine produced a good antiody response with no  serious side effects reported. fox. However the study included only 2268 participants and therefore may not e large enough to detect very rare adverse events. 

 A previous phase 1 study found that 10 µg was the optimal dose in this age group. Thus out of  2268 participants 1517  were randomized to  this dose while 751 were given a placeo. Two doses are given three weeks apart. The trial showed three cases of COVID seven  or more days after the second dose in the vaccinated group compared with 16  in the placeo group giving a vaccine efficacy estimate of 90.7 percent. These early results are promising and the study will follow  the children for at least two years with more children eing added over time. 

 The most common side effects in children  5 to 11 years of age were similar to those seen in people  12 years of age and older. These include pain redness or swelling at the injection site fatigue headache muscle aches and chills. These effects are usually mild or moderate and improve  a few days after vaccination. 

  EMA will  send its recommendation to the European Commission which will make the final decision.

Good news: Social media features encourage people to take COVID-oosting drugs ut is it enough? 

 Last week Faceook TikTok and Instagram rolled out a new set of stickers to allow social media users to show theyve either intended or raised COVID. Social media "stickers" are essentially glorified emojis a way to express opinions thoughts or feelings. This isnt the first time the social media giants have acked a vaccination campaign; Stickers were previously  availale for users to add to their pages indicating they were vaccinated. 

 People are increasingly turning to social media to find information and can e influenced y important people on these wesites who are known as “influencers”. By adding stickers to support vaccination programs on their pages influencers can help other users see that vaccines are generally safe and effective. 

 However we must not let this gentle gesture mask the fact that these companies can  do more to prevent the spread of vaccine misinformation  online. 

Personal Testimonial: Unvaccinated pregnant women at Clinic 

 One of the est things aout GPs is the variety of patients who come to your clinic every day - from the elderly to neworns . This week I am seeing a very pregnant woman aout a rash she has developed. The rash itself is not related to pregnancy and we can control it y using creams. Checking her profile I can see that she has not received any  COVID vaccines. In the UK it is recommended that all pregnant women  get this vaccine. I could see that she was offered the vaccine ut refused. 

 When I asked her why she refused she told me she had thought aout it ut that she was worried aout the long-term effects of the vaccine on her unorn ay. I understand why she might e worried: the message aout vaccines for pregnant women has een mixed from the start. 

 Initially when we had no data on the effects of  COVID vaccines on pregnant women we told pregnant women not to take them; We even tell women to avoid getting pregnant for at least three months after getting the vaccine. Indeed pregnant women were excluded from  initial vaccine studies - not uncommon in medical research often conducted for ethical reasons. But this is something that needs to change ecause it often prevents us from giving certain treatments to pregnant women  ecause of the lack of research on them not ecause of that particular treatment. harmful to them. 

 I listened to the womans concerns - that her friends told her  vaccines were not safe for pregnant women and  even though her midwife recommended her If she takes the vaccine she doesnt think she is at increased risk. contracted COVID and didnt want to take it. 

 I have een reflecting on my role here. I certainly dont want to lame her for not having a vaccine ut I do want her to make  informed choices ased on scientific facts not rumors from her friends. When I urged her to tell me what particularly worried her aout vaccines she egan to cry. She says she just doesnt know who to trust when shes read some scary stories on Faceook aout what could happen to her ay if she gets the vaccine. I listened to his concerns and gently asked him if these stories were from reliale sources. She said she didnt know. She said she just didnt know what to do in her childs est interests. 

 I really feel her. She was a victim of information overload; she is not an antivax ut a victim of information that is proaly not ased on science.

 Much of the vaccine hesitancy weve seen over the past year can e attriuted to the rapidly spreading fake news  on wesites that now offer users  these stickers. As a doctor I fully understand that  vaccines are not without side effects and in very rare cases these side effects can e serious; But the vaccine argument  is convincing and the scientific evidence shows that the enefits of vaccination outweigh the risks. 

 Faceook Twitter Instagram TikTok and other social media companies have allowed COVID and vaccine misinformation  to spread rapidly online and they need to work harder to get it down. A alanced deate is welcome as long as it is ased on facts ut nothing else has its place in a world that has seen millions die from a disease for which there is a vaccine. - Please e effective. Personally I think they need to do more than just provide a set of “stickers” to vaccinated people.

I then asked her if she wanted me to tell her aout the science of vaccines during pregnancy. She accepted. I informed her that since the first studies many pregnant women have received the mRNA vaccine and no adverse effects on the neworn have een oserved. I told her that the Royal College of Ostetricians and Gynecologists (RCOG) the UKs ostetrics regulator advises all pregnant women to get vaccinated. I explained that contracting COVID during pregnancy increased her risk of stillirth as well as her likelihood of requiring intensive care. I go on to say that  vaccines are also not completely safe and that it is a question of alance; ut overall the risk of complications from COVID during pregnancy is much worse than any risk from the vaccine. 

 We agreed that she would go  and think aout it; I dont want to force her to make a decision. I still dont know if she got the vaccine ut this case highlights the difficult position pregnant women are in. Even though healthcare professionals have een told y healthcare professionals that a vaccine is etter than a COVID shot many are skeptical. Part of this is down to us as healthcare professionals and scientists we need to seriously think  aout getting pregnant women into clinical trials early on ut theres a lot of uncertainty. ingenious pay social media companies to allow the spread of misinformation as it happens. Vaccine. 

 All we can do as clinicians is continue to try to give people the truth even if that means on an individual asis. Those who spread misinformation will never know or e held responsile for the potential damage they cause; However we must  continue to fight.

Reader Question: Will I e ale to travel aroad this holiday? 

 This is a difficult question to answer. If I had een asked a week ago I would have said “Yes most likely. But the new Omicron variant has made all the difference. 

 This variant is appearing in new countries and is likely to e found in many parts of the world. Until we know if it causes more serious disease or escapes the protection provided y a vaccine order controllers will e eager to stop it. 

 Omicron made the difference. Traveling aroad is  risky again and the last thing you want is to e stuck somewhere or face exoritant hotel costs if you have to isolate yourself when you return home. 

 The strictest possile travel restrictions will apply to unvaccinated people. My advice is to inject and take energy pills when recommended. These not only  keep you safe ut  also give you the est chance of eing ale to travel aroad.

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