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December 1st 2021 Covid updates

Hello Medlogic patients,

I hope everyone had a nice thanksgiving break. I just wanted to drop a note about the Omicron variant since there are understandably a lot of questions and concerns. This update goes over local cases as well as information (the little concrete information we have) on this newest variant and finally some thoughts on getting ready for holiday travel, new year's and family gatherings.

Local cases:

Lake county, IL: test positivity 6%, fully vaccinated 70%, hospital bed use for covid 11%, ICU bed use for covid 14%

Racine, WI: test positivity 13%, vaccinated 55%, hospital bed use for covid 10%, ICU bed use for covid 24%

Kenosha, WI: test positivity 14%, vaccinated 54%, hospital bed use for covid 14%, ICU bed use for covid 30%

Omicron variant:

I have to say I was surprised we are already on "O" in the Greek alphabet and wonder if we will have to switch over to another language once we get to omega. The WHO actually skipped two letters though (Nu and Xi), so maybe it's not that bad. The WHO named this a variant of concern which ranks as "more serious" than the variant of interest. This has generated instant news, panic and speculation.

Why is Omicron "more serious"? >>> It has more mutations in the spike protein (43) than the other known variants (Delta had 18). More doesn't equal "worse variant" though. Mu was a more severe variant that never spread widely because it couldn't outcompete Delta for transmissibility.

What does this mean IRL (In Real Life)? >>> That it has more mutations than the other known variants in the spike protein. And right now that's it. That's what we know concretely. Factually. We don't know if it is more infectious and if it is more infectious, we don't know if it is because it escapes immune system detection due to its mutations or if it spreads more easily because of its mutations. We don't know if the vaccine is less effective for this variant.

So what do we know factually and concretely? We know that Omicron was first identified in South Africa and the vast majority of cases are located there, for the time being. So far there are less than 400 confirmed cases worldwide, with over 200 of those in Africa. UK and Europe have confirmed cases, as do Hong Kong, South America and yes, even the US (one case). There are several more cases suspected (thousands suspected but not yet confirmed worldwide). Here is the data tracker for that: So factually, we know it's reached a vast distance quickly but is still in the early stages of spread.

These numbers are expected to increase to > 10,000 cases per day by next week. Omicron quite literally will "go viral" and not in a good way. This has prompted some countries to close their borders to South Africa and other African countries and other countries to implement stricter mitigation efforts on travel, masking and testing. We know that reports from the field at hospitals in South Africa caring for omicron covid patients are rapidly increasing cases but not severe disease. The majority of infected patients are either unvaccinated or under vaccinated (1 shot of a 2 shot series).

We know that thus far Omicron is similar to Delta in that there are higher rates of "immunity breakthrough" if your immunity is from infection (what some call "natural immunity") vs from vaccinated immunity. The risk is 5 x higher for re-infection with delta if you have protection from having covid vs protection from vaccination. Omicron is following that same pattern from the cases evaluated so far, but data is limited.

We know that Moderna has said they can manufacture an updated vaccine to address the mutations if needed within 60-90 days. It made beta and delta vaccine boosters but they were never needed because the original flavor still worked well.

We know omicron can be detected by PCR testing without sending to genomic sequencing due to the special signal it contains.

What can we guess? Omicron variant might spread quickly worldwide and might become the dominant variant over Delta. It might be more infectious (passed on more easily which is measured by R0) due to its mutations and the vaccines we have might be less effective but early data does not suggest they are ineffective. It also might be less transmissible (lower R0). We don't know but data suggests it may have a lower R0 than Delta. We need more data to say. We should have it as cases increase exponentially in the next 1-2 weeks. Science doesn't like to guess for very long.

Vaccine updates:

CDC updated guidelines to say all adults 18 and up should get a booster. That recommendation is directly related to concerns on the new variant. The previous language was that they "may choose" to get a booster. Boosters will help here. This is basic immunology and I won't bore you with the details of why and how they work. If you are unvaccinated, consider getting vaccinated and if you are vaccinated, consider getting boosted. If none of that is appealing, continue to fight the good fight with everyone else and continue reasonable mitigation efforts like masking, handwashing, not sitting on Santa's lap (ie distancing). That brings me to my last part.... holiday travel and gatherings.

Holiday travel and gatherings:

First, dial down the panic. I know many of us have really missed things like traveling, family visits, vacation, holiday parties. This is our second pandemic holiday season and we've got this. It's not ideal or fun, but it's doable. I think we need 1-2 more weeks of omicron data to understand what the actual impact will be in terms of R0 and vaccine penetration. In the meantime, those with international travel plans should at least check their trip cancellation or interruption policies. Those with domestic travel plans should continue to follow the precautions already in place (masks and hand sanitizing required). Those with family gathering plans should evaluate based on their own situations of health risks based on history, vaccination status and ability to take time off of work/school if someone in your holiday group tests positive. Everyone is going to be in their own situation and have their own risk tolerance. It will help to be flexible and also be respectful if people want to wear masks at holiday parties or family gatherings or ask you to wear a mask at their party/gathering. It will also help to skip doing body shots at the bar with your friends.

I'll write another update when we have more reliable, concrete information.

Dr. Green


Jill Green MD MedLogic Primary Care

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