Omicron: Your Action Plan

On Friday, November 26, the World Health Organization’s (WHO) Technical Advisory Group on SARS-CoV-2 Evolution met to discuss a new variant of COVID-19: B.1.1.529, now known as Omicron. This is not the first variant, and it won’t be the last. The development of variants is expected and predictable. Scientists have told us over and over that variants develop when we allow viruses to circulate. Viruses circulate mostly among unvaccinated people; so until we vaccinate the whole world and everyone has immunity, variants will continue.

As they do, the WHO evaluated the variant based on several factors: potential increased transmissibility, potential increased disease severity or harmfulness, potential changes in clinical disease presentation, and factors that would require a change in clinical or public health guidance. They also evaluated the variant’s potential ability to sidestep natural or vaccine-acquired immunity, avoid detection through current methods, or evade treatments. They labeled it a “variant of concern,” meaning that it is probable that it could meet the criteria above in a way that could have a widespread impact.

It is still rather early in Omicron’s spread, so there are only a few things we know for sure.

• We have discovered that Omicron has 30 – 50 mutations, some of which appear to be able to evade the immune system and increase transmissibility.
• We also know that Omicron was first identified in South Africa, but it’s not helpful to label it as having come from there. It is circulating worldwide. We are indebted to South Africa, which has one of the world’s most sophisticated genomic testing infrastructures, for having identified it.

Early reports are yielding more information that scientists are working to confirm.

• They suspect that Omicron is even more infectious than Delta, which seems to infect unvaccinated people regardless of how careful they are to mask and distance when gathered. Regrettably, I continue to hear from mostly unvaccinated patients who are surprised when they get COVID. Many end up in the hospital. Make no mistake. Delta seems to be almost systematically finding everyone in our community who has not been vaccinated. It’s just that infectious.
• Omicron seems more transmissible than both the original strain and Delta. According to recent reports, it is spreading more than twice as quickly as the Delta variant in South Africa.
• The first studies suggest that our current vaccines almost certainly provide some or a lot of protection against Omicron infection and serious illness.
• Early data could indicate that this variant may cause milder disease; however, this is not at all proven, because the majority of cases in Africa are among healthy young persons who often get COVID in a milder way. We don’t yet know if those who are more vulnerable (older adults, children, infants, pregnant women, and immuno-suppressed people) will have a different clinical course.
• There’s a suggestion that this new variant more readily infects people who have had COVID in the past (and who are still unvaccinated) than those who have gotten the vaccine. This is scary, because we don’t know how severe reinfection will be.

While there is still a small chance that Omicron will simply disappear, that likelihood is narrowing by the day. It is far more likely that we will need to work together in new ways to limit its spread. Here are some of the efforts in that direction.

• Scientists are working hard to evaluate Omicron based on several factors: transmissibility, disease severity or harmfulness, changes in clinical disease presentation, and factors that would require a change in clinical or public health guidance. They are also evaluating the variant’s ability to sidestep natural or vaccine-acquired immunity, avoid detection through current methods, or evade treatments. More information on each of these topics will be discovered and shared in the coming weeks.
• Governments are enhancing surveillance, increasing genome sequencing, collecting and reporting data, and launching more vaccine clinics for people ages 5 and up.
• Vaccine manufacturers have already begun working to design a booster to fight Omicron specifically.

The most important part of this plan is that you complete the very important responsibilities assigned to you.

• If you have not been vaccinated, do it. For the safety of yourself, your family, your community, your world, please get vaccinated. You can’t avoid COVID without getting vaccinated. The other mitigation methods are not enough.  
• If you are eligible for a booster, get boosted. You are eligible if you are 18 or older and received either Pfizer or Moderna more than 6 months ago or Johnson & Johnson more than 2 months ago, you can schedule a booster appointment or walk in. Complete information is at https://svhealthcare.org/COVID-Resource-Center.
• Continue to encourage those unvaccinated people you know to get vaccinated, and help those who need to get a booster get one.
• Continue all other mitigation strategies vigilantly. Wear a well-fitting mask when indoors with people you do not live with, even if you are fully vaccinated. (So many positive cases are being generated by people having dropped their masks!) Avoid crowded places, stay physically separate from those you don’t live with, ventilate indoor spaces, and wash and sanitize hands frequently and thoroughly.
• If you choose to gather, keep it small, among vaccinated and boostered people, outdoors if possible, and masked. You may consider getting tested in advance of gatherings where masks will be removed for eating and drinking.

This is not the first challenge COVID has thrown our way, and it won’t likely be the last. By working together, we will save lives and decrease the impact for everyone.

Marie George, MD, FIDSA, is the infectious disease specialist at Southwestern Vermont Medical Center in Bennington.