Do these headlines sound familiar?
“'Mutant' Covid strain in London” (1)
"AstraZeneca vaccine doesn't stop South African strain" (2)
"New Variant in South Africa renders AstraZeneca vaccine ineffective in young people." (3)
“Brazil variant that's ripping through the young can't be stopped from reaching UK.” (4)
“Indian Variant will kill up to 1,000 people per day by Autumn.” (5)
None of these five headlines are recent nor do they refer to the current Omicron variant.
The first is from December 2020 and refers to the Alpha strain (originally called the UK strain.)
The next two headlines are from February 2021 and are about the Beta variant, also first identified in South Africa.
The fourth headline is from April 2021 and refers to the Gamma strain, previously called the Brazilian variant. And the fifth one is from May 2021 and is referring to the Delta variant.
Now we have headlines such as: “Horrific Omicron variant causes hospitalisations to TRIPLE in two weeks in South Africa as mutant Covid sparks panic” and “Supermutated Omicron variant reaches three more European counties.” (6)
Nobody needs to be told that COVID-19 is a major health threat, the fact that we are close to two years of a worldwide pandemic proves it. These headlines do however show how the media irresponsibly runs attention grabbing headlines which benefit no-one.
They either increase anxiety and stress in those already frightened by COVID-19 or can have completely the opposite effect - some people become so used to seeing the same type of repetitive headlines they no longer pay attention to any messages about the virus.
We now know, with regard to the above headlines, that the AstraZeneca vaccine turned out to be highly effective against the Beta variant and that the Gamma variant had little impact on the UK. (7) (8)
Whilst the Delta variant has thus far accounted for 99% of COVID-19 cases in the UK we have never seen a death rate in excess of 1,000 deaths a day, the highest seven day average was 170 deaths per day in mid-November. (9)
It is important to remember that thousands of variants are in circulation around the world - this is how all viruses behave. Viruses change every few weeks and, whilst these changes are expected, they are unpredictable in terms of exactly what aspect of the virus will change. Most variants have such minor changes from the original virus that they are insignificant and viruses can even mutate to become weaker but a few will have more marked changes and become "variants of concern".
Variants of concern are labelled as such because they may prove more infectious and/or more lethal. They may also go unrecognised by the body's immune system, so called “escape mutants”, which means a vaccine that worked pre-mutation is no longer as effective. However, if the vaccine continues to prevent serious disease and death, perhaps by reducing the illness to a milder form, that would still be hugely beneficial.
Variants are labelled by scientists as of Interest, Concern or High Consequence. (10)
The Omicron variant has now been categorised as a “Variant of Concern.” There are no Variants of High Consequence (the most serious level) at the time of writing. (11)
What is a variant or mutation?
The word “mutation” is often used in the media and films to signify something dangerous, alien and/or deadly. Scientifically it simply means a change in the genetic makeup of a living organism. These changes are needed for the process of evolution of a species and can be a change for the better, allowing an organism to adapt to its environment and survive. Other mutations have deleterious effects, for example cancer is caused by gene mutations. (12) (13)
Of itself, “mutation” is a neutral term and does not imply a good or bad process, only a natural one. Whilst some viruses can mutate to become more serious, it is just as possible for a virus to mutate into a less deadly form and cease to cause serious illness. (14)
All the COVID-19 variants have mutations (or changes) in the spike proteins that project from the virus surface. These spikes are the structure the vaccines target so there is concern that changes in the spikes may render the vaccines less effective. However, the human body makes many different types of antibody in response to either infection or vaccination - known as a polyclonal response – which means it is highly unlikely a new variant will not be recognised by any of the body’s antibodies. (15)
What is the Omicron variant?
New variants of concern are now labelled with letters from the Greek alphabet. The name “Omicron” was simply the next letter in line to be used.
It was first sequenced in Botswana and South Africa and has a high number of mutations – more than 50 in total, of which 26 are in the spike protein clubs on the virus surface. This compares with 10 in the spike proteins in the Delta variant and four in the Alpha variant. (16)
The high number of mutations in the spike protein is the highest seen to date and that is why scientists are concerned. This high number raises the possibility of the variant being able to evade immunity, be it either from previous COVID-19 infection or vaccination.
However what we don’t yet know is the effect of all these Omicron mutations on each other. We don’t know if some will work together and make the variant more infectious and/or deadly or if the converse could be true – that some of the mutations will cancel each other out.
Using simple numbers as an illustration, we know that there are 26 mutations but do they all carry the same value or do they vary? If some work simply side by side without influencing each other then it is the mathematical equivalent of 1+1=2, simple and easy to understand. However if some work together and become stronger as a result it could be a case 1+1=3 or 1+1=5, something that is not expected and is hard to understand. Likewise, if some cancel each other out the equation could be 1+1=0.
Exactly how the mutations interact with each other is crucial to knowing exactly what affect Omicron will have on COVID-19 infection and fatality rates and how effective the vaccines are going to be against it. At the time of writing scientists are working on exactly this with results not expected for two to three more weeks although the World Health Authority (WHO) technical lead on COVID-19, Maria van Kerkhove, has announced today (1 Dec 2021) that some early data on the transmissibility of Omicron may be available “within days.” (17)
At the same time doctors and scientists are collecting real world data to try and understand the effects Omicron is having on the people infected with it.
We are currently at the stage where we know quite a lot about the genetics of the Omicron variant but only a little about how it behaves.
Does the Omicron variant cause more severe disease?
The honest answer to this question is that we don’t yet know.
Hospitalization rates are increasing in South Africa but this may be because of an increasing number of people becoming infected, rather than a result of specific infection with Omicron. (18)
If a variant has a lower risk of causing serious disease but is more infectious it can result in more hospital admissions than a less infectious but more deadly variant.
This initially sounds counter-intuitive but to again use simple numbers let’s assume the risk of becoming seriously ill and needing an ITU bed is 1 in 100 for the Delta variant but lower at 1 in 1000 for the Omicron variant. It would be easy to become complacent and regard the new variant as less serious even if it is proven to be more infectious.
However, if the Omicron variant becomes the dominating virus in the majority of cases of COVID-19, imagine a scenario of 100,000 cases of COVID-19 where 99,000 of the cases are caused by the Omicron variant and only 1,000 by the Delta. This would mean 99 people from the group with the Omicron variant need an ITU bed – compared to only 10 of the people with Delta.
A highly infectious, rapidly spreading variant can soon cause more hospitalisations than a less infectious yet more deadly variant simply by the weight of the number of people it infects even if it is not as deadly as the less infectious one.
According to the WHO there is currently no information to suggest that symptoms associated with Omicron are different from those from other variants.
Anecdotally, some South African doctors are reporting that most cases of Omicron COVID-19 they are seeing are presenting with mild symptoms and that whilst hospitalisations are rising, the vast majority of ITU admissions are people who are either unvaccinated or only partially vaccinated. (19)
Will vaccination protect against the Omicron variant?
Again the honest answer at the time of writing is that we don’t know yet.
However the WHO is saying there is no evidence to suggest the vaccines won’t work and some very early data from Israel is suggesting that the vaccines will still work to prevent serious disease and deaths from the Omicron variant. (20)
It is too early to give definitive answers about vaccines and Omicron but it is highly unlikely the current vaccines will not have any effect at all on it and if the media begins reporting that the vaccines are "ineffective" or "failing to protect" it is important to ask, "What was the end point the failure is based on?"
There are many different layers of protection - protection from death, protection from severe disease, protection from mild disease, protection from asymptomatic infection. A vaccine that "fails" to prevent asymptomatic and mild illness but protects against serious disease and deaths is still doing a good job.
All the current vaccine producers have announced they are already working on how to adapt their vaccines against the Omicron variant if necessary.
In Conclusion
Over the course of the next few weeks we should know a lot more about the Omicron variant.
The worst case scenario is that it will prove to be more infectious, more deadly and resistant to immunity whether that immunity is acquired from previous infection or vaccination.
The best case scenario is that it causes a milder disease for the vast majority of people, is no more infectious than previous variants and that the vaccines remain fully effective against it.
I suspect the reality will lie between these two positions but even in the worst case scenario we will not be where we were at the beginning of the pandemic.
We now have vaccine technologies that are proven to work and can be modified against new variants. Within the medical profession huge strides have been made on how to treat those who are critically ill with COVID-19. We can carry out rapid testing for the virus and scientists know what they are looking for now when they study it.
Omicron may, at worst, prove to be a major setback in the pandemic but I doubt we will find ourselves back in the same position as at the very start of the pandemic.
