By Amber Dance
Anxious world awaits answers on omicron variant
“World, meet omicron,” writes Rachel Gutman in The Atlantic. “Omicron, meet a lot of people who are very, very anxious to know more about you.”
The three big questions on epidemiologists’ minds: Is it better at spreading from person to person than previous variants? Does it make people sicker? And will it evade immunity created by vaccines or previous infection?
The World Health Organization’s speedy action in labeling omicron a “variant of concern” suggests it believes at least one of the answers will be “yes.”
There are two ways scientists can go about gleaning some early answers. One is to grow monkey kidney cells in a lab, along with the new virus, and test how they interact in a dish. For example, does adding serum from fully vaccinated individuals make it harder for the virus to enter the cells?
The other route is to watch and wait as case counts, hospitalization and death rates come in. Either way, results should start to dribble out within weeks.
There are reasons to be worried: The new variant sports a stunning number of new mutations, leading scientists to speculate it evolved in a single person with a compromised immune system, or even in an animal population, as Kai Kupferschmidt reports at Science. Such mutations could stymie antibodies trained on older variants. In South Africa, where it was first detected, omicron is spreading fast and causing many reinfections, suggesting either high levels of transmissibility or immune evasion — or both.
But there are also reasons to be optimistic: Early anecdotal reports suggest symptoms are often mild, although this could reflect the younger average ages of those infected so far. And many people already possess at least some level of immunity. Even if antibodies can’t prevent infection, experts predict T cells still stand a chance to vanquish it. Antibodies detect only the spike protein’s exterior, while T cells can bind to bits of viral proteins chopped up and displayed on the surface of infected cells. Studies suggest that T cell responses are less fazed by viral mutations, writes Cory Stieg at CNBC’s Make It.
Omicron also appears to have borrowed sequences from another coronavirus that causes the common cold, which could contribute to both higher transmissibility and milder symptoms.
Pfizer’s CEO Ugur Sahin told The Wall Street Journal that its vaccine will probably still prevent severe disease. However, Moderna CEO Stéphane Bancel told the Financial Times that vaccine efficacy will probably drop. Both companies have started developing omicron-specific vaccines, which could take just a few months to produce.
As for treatments, some antibody medications — based on just one antibody, with one binding site — may be in trouble. Antiviral medications, such as Pfizer’s pill, have a more generic approach and are more likely to work on variants.
“Omicron could, of course, turn out to be pretty much anything,” writes The Atlantic’s Gutman. She even speculates that a highly contagious but mild variant could out-compete delta to become the main circulating virus, plus possibly give people who catch it some immunity to future variants without the risk of severe symptoms. “That might even be a good thing,” writes Gutman, “a perfect variant, just in time for Christmas.”
Nursing homes open to visitors without mandates or boosters
In mid-November, the federal government lifted nearly all restrictions on visitors to nursing homes. The move, which took place before the omicron story broke, ends a 20-month policy that distressed residents and loved ones. The guidelines now only restrict visitors who have tested positive for the coronavirus or meet quarantine criteria.
The Centers for Medicare and Medicaid Services, which issued the guidelines, noted that 86% of residents and 74% of employees are fully vaccinated, nationwide.
Yet the American Association for Retired People, while praising the change, noted that the death rate among nursing home residents has recently risen to about 2,000 people per month in recent times, a much greater rate than in early summer, before delta spread widely.
“Some doctors and families now worry that the pendulum has swung too far, that fully reopening will leave an already vulnerable population prey to another surge,” writes Paula Span at The New York Times.
Meanwhile, a federal judge halted the Biden administration’s requirement that all health facility workers be fully vaccinated.
And amid a scattershot booster rollout, there’s little data yet on how much boosting nursing homes have been able to achieve, reports Reed Abelson, also at The Times.
“You need to vaccinate residents and vaccinate staff and you need to get boosters in them,” said Scott LaRue, chief executive of ArchCare nursing homes in New York. “It’s a life-or-death matter.”
Biden administration announces response to new variant
The White House, while encouraging Americans not to panic, has nevertheless promised it’s “pulling out all the stops” against the potential omicron threat.
The strategies announced last Thursday include more vaccination campaigns, testing travelers, and making at-home rapid test kits reimbursable by private insurance.
Yet Biden must also keep the economy going, and the public’s fed up with restrictions. Lockdowns are reportedly not on the table.
The new variant quickly led to a travel ban focused on several African nations, though U.S. citizens are allowed to return home. Many experts have criticized such bans, as has the World Health Organization, reports Smriti Mallapaty at Nature. They’re too late to stop the virus’s spread — it’s already here — and may hamper the shipment of key lab supplies for viral genetic surveillance in some nations.
Incoming international travelers will be required to show a negative COVID test within the previous day before boarding their flight; earlier regulations allowed three days. Biden also extended the mask mandate for all major modes of transportation until March 18, 2022.
The new plan also strongly promotes boosters; the CDC last week updated its guidance for low-risk adults from “may” get a booster to “should” get a booster.
“Many of the experts who were opposed to boosters now believe that the shots may offer the best defense against the new variant,” writes Apoorva Mandavilli in The New York Times. Boosters should amp up both antibodies and T cells. The presumption is that a more robust immune response, even if it’s not perfectly matched for omicron, is a better bet.
News outlets face familiar catch-22
As the omicron story broke over Thanksgiving break, news providers pivoted from turkey recipes to epidemiology. That quickly led to a debate over how much coverage was appropriate, as media critic Jon Allsop lays out at Columbia Journalism Review.
Editors and publishers have no good option right now: If they hype the variant and it turns out to be a dud, they look bad. If they minimize the threat and it turns out to be a major turn in the pandemic, they look bad.
“The story here is that we don’t know what’s going to happen next,” writes Allsop. While news articles with headlines like “Here’s what we know about Omicron” proliferated, some outlets focused on the uncertainty, such as MIT Technology Review’s “We still don’t know enough about the omicron variant to panic.”
Washington Post reporter Dan Diamond suggested over-reporting is the safer choice. “No one wants to sound alarm unnecessarily,” he tweeted, “but failing to warn about potential risks is a bigger sin in public health, especially if actions now could protect people.”
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