Omicron in the U.S.: What to Know; About Vaccines, Virulence, PCR Tests, Monoclonals, and Natural Immunity to this Variant

Dec. 20 , 2021 -- The Omicron coronavirus variant has been found in dozens of states across the country since it was first identified in South Africa in November, and many may be wondering: Will it upstage Delta and cause a winter surge? Is it still safe to gather with others for the holidays? How is this variant affecting children?

Experts addressed those and other questions in a webinar hosted by New York University last week, acknowledging that it will take some time to find out all the crucial facts about Omicron.

But in the meantime, here's what's known -- and not -- about Omicron in the fast-changing COVID landscape.

As of Dec. 15, Omicron transmission had been reported in 80 nations, according to Michael H. Merson, MD, a visiting professor of global health at the New York University School of Global Public Health. In the 35 states with Omicron cases, the numbers vary. Right now, New York and New Jersey are detecting the Omicron variant at about four times the overall rate in the country, he said. But whether or not the variant will remain in ''pockets" is currently unknown, he said.

When it comes to deciding about gatherings and travel, "trust your instincts," Elodie Ghedin, PhD, chief of the systems genomics section at the National Institute of Allergy and Infectious Diseases and affiliate faculty member at NYU, said.

"In the past 2 years, you have developed a feel for what feels too close. This is not April 2020. You have learned a lot in the last 2 years."

As an example of safe holiday gatherings, the experts cited President Joe Biden's appearance last Tuesday at a party of 400, which was held on a hotel rooftop due to COVID concerns.

"It's very important to spend the holidays with family and friends," Merson said. "But do so wisely. That's my advice about travel."

That means getting vaccinated and boosted when eligible, making use of rapid testing when called for, masking, handwashing, avoiding crowded indoor spaces, and keeping your distance from others.

Knowing your risk level and that of family and friends when making plans for the holidays is also important, Merson said.

Is Omicron greatly affecting children?

Experts are waiting on data to find out.

"The jury is still out on how virulent Omicron will be for kids," said Celine R. Gounder, MD, a member of President Biden's COVID-19 task force and a clinical assistant professor of medicine and infectious diseases at NYU Grossman School of Medicine. "We don't know."

The best thing parents can do right now is to vaccinate their children ages 5 years and up who are eligible, she said.

Do monoclonal antibody drugs work well against Omicron?

No, Ghedin said.

"Most of the monoclonal antibodies do not seem to work very well against Omicron," she said.

What's known about how infectious Omicron is?

"It appears to be the most infectious variant to date," said Gounder.

"Relative to Delta, Omicron appears to be 2-3 times more infectious."

Put another way, she said, you are likely to infect 2 to 3 times more people than if infected with other variants.

People should not count on their natural immunity from a prior COVID infection to protect them from the Omicron variant, Gounder said.

It also does seem that the Omicron variant might be less virulent than other variants, she said. (Virulence refers to how severe a disease an infected person can get.)

If Omicron is less virulent, isn't that good news?

Yes and no, Gounder said.

"Even if it's a mild disease, you can still have lots of deaths. Let's say COVID has a case fatality rate of 1% and you have 100 people who get infected -- and one death,” she said.

Then say Omicron's rate is .25%, but if you have 400 cases, since it is more infectious, that's still one death.

"We really have to be very careful when we say less deadly and less severe [when talking about Omicron]. On a population level, Omicron could be just as deadly as Delta even if it causes mild disease, if more are infected,” she said.

If a COVID test is positive, will the results specify whether it’s the Delta or the Omicron variant?

"Unfortunately, you will not be able to get that information from a PCR test done in the community," Ghedin said. "If you are doing it through a research entity, they might provide that information, but I highly doubt it."

With more people vaccinated now than in the past, can we consider COVID endemic, not a pandemic, now?

No, Gounder said.

"We are nowhere near endemic [status]," she said. "We are still very much pandemic. Saying it is endemic now is like saying, 'Let's do nothing.'"

Currently the U.S. is at a level of about 60% of the population vaccinated, she said.

"We really need to be getting to 85, 90 percent" before transitioning into endemic status.

In tropical countries, the flu is endemic, Ghedin said, ''and it's there year-round. We are not there with SARS-CoV-2.”

Do monoclonal antibody drugs work well against Omicron?

No, Ghedin said.

"Most of the monoclonal antibodies do not seem to work very well against Omicron," she said.

So, Ghedin, which one(s) work? For the answer, see this posted earlier today...

How Omicron Evades Natural Immunity, Vaccination, And Monoclonal Antibody Treatments

Of the eight approved or authorized antibodies, all but sotrovimab completely or almost completely lost their neutralizing activity against the Omicron pseudovirus. A cocktail of cilgavimab and tixagevimab had a reduced potency of 200-fold. Sotrovimab, conversely, shows a drop of 3-fold drop in neutralization potency.

Which raises a big question. If the powers that be won't tell which variant you have, then how do the doctors know which monoclonal antibody to administer? Hmmm?

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