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Where London goes with Omicron Seattle will follow, with the rest of the US close behind

[KIRKLAND, Wash.] – (MTN) A record 93,000 new COVID cases were reported in the United Kingdom by the National Health Service just hours after Trevor Bedford, Ph.D., an Associate Professor, Biostatistics, Bioinformatics and Epidemiology Program Vaccine and Infectious Disease Division, at Fred Hutchinson Cancer Research indicated that where London goes, Seattle will follow five days later.

France closed its borders to the UK on Friday evening and on Saturday, London Mayor Sadiq Khan declared a “major incident” as Covid-19 hospital admissions rose 30% in a week. The National Health Service reported seven people have died from the Omicron variant and believe that “hundreds of thousands” of cases are going unreported. Cases are expected to grow at a dizzying rate well into January.

On Friday, Bedford told reporters that 50 percent of new Covid-19 cases in King County, were likely Omicron and doubling every 2.4 days. The next day, Pavitra Roychoudhury, MSc, Ph.D., of the University of Washington Virology Division tweeted that Omicron was 50 percent of all cases in Washington.

In an interview published on Saturday in the New York Intelligencer, Bedford shared his prediction on what is to come. “I can expect caseloads that are huge. I can easily expect a 50 percent attack rate from Omicron. I can easily expect that.”

“Attack rate,” is how much of the population will be infected – and Bedford predicts that half of the United States population will catch the Omicron variant. Because the United States does not take a national approach to genomic sequencing, and not all hospitals test patients for COVID at admission, the number of people already hospitalized is murky. From the earliest reports, the hospitalization rate was between 2% to 5%.

There was little good news to be found over the weekend on the impact the new wave is going to have on the United States. In the Northeast, Mid-Atlantic, and Great Lakes Region hospitals are already at or over capacity and receiving additional aid from FEMA. Many states are struggling with dwindling testing funds and a lack of data because tracking systems were dismantled over the summer.

A cascade of drug makers indicated late in the week that the current version of monoclonal antibodies in distribution aren’t effective against the Omicron variant. Unlike vaccines, which target all antibodies, monoclonal antibodies only target one. The antibody that was “cloned” in the process was effective against previous variants but doesn’t produce a significant immune response with Omicron.

In a series of studies, only Sotrovimab, produced by GlaxoSmithKline, showed promise against the fast-spreading variant. The monoclonal antibody received Emergency Use Authorization ( EUA) from the U.S. Food and Drug Administration (FDA) on May 26. Health and Human Services (HHS) reported they would be distributing 55,000 doses across the United States this week, with Washington receiving 552.

Back in the UK, the National Health Service reported that on any given day, about one percent of the national health force would be absent from work due to illness. In London, the number of workers calling out sick surged 40 percent. In the United States, healthcare workers have been fleeing the profession for years, while nurses have complained about short staffing for over a decade. Area hospitals will be impacted dramatically if Omicron starts to infect their workforces.

HHS reported over 68,000 people were hospitalized with COVID across the United States. Statewide on Friday, only eight percent of acute care and 12 percent of ICU beds were available. In King County many hospitals are already at or above capacity, but not due to COVID patients. A shortage of staffed skilled nursing and rehabilitation beds has left patients ready for discharge nowhere to go.

Over the summer when patient loads were lower, the Delta wave brought Oregon and Washington hospitals to the brink of crisis standards of care while collapsing the healthcare systems in Idaho and Alaska. Hospitalization rates for COVID and non-COVID patients are already much higher as the region prepares to face the biggest challenge yet.

According to HHS, EvergreenHealth Kirkland had 19 acute care beds available while Overlake had 17. Both hospitals were reporting ICUs near capacity with 3 beds at Evergreen and 4 at Overlake.

During the Delta surge, states learned that activating the National Guard for nurses and doctors was a poor option. Trained hospital staff who are “weekend warriors” were frequently already supporting surging hospital admissions. The activation in some cases made staffing situations worse.

King County residents vented their frustration on social media about the inability to get a booster shot, find home COVID antigen tests, and PCR test results being delayed. In other circles, Seahawks fans raged against the scheduling change against the Rams due to coronavirus.

Officials in the UK pleaded with government officials to implement further public health restrictions to stem the tide of new cases, as models indicate that by January, the island nation could see 3,000 to 4,000 new hospitalizations a day. Londoners were already starting to deal with closed shops and restaurants, and delays in services because so many people have been sickened.

It is unlikely any additional restrictions will be implemented across the United States, where COVID has been turned into a political weapon. The U.S. Department of Homeland Security (DHS) indicated in a Nov. 10 memo, “If a new COVID-19 variant emerges and new public health restrictions are imposed as a result, anti-government violent extremists could potentially use the new restrictions as a rationale to target government or public health officials or facilities.“

Numerous studies and growing real-world data from Africa and Europe indicate that immunity from prior COVID infections or vaccination without a booster provides enough protection to prevent severe COVID symptoms that result in hospitalization and death. Booster shots ideally received within the previous 12 weeks, boost immunity for more.

For people relying on viral vector vaccines such as Johnson & Johnson, AstraZeneca, or Russia’s GNCEM, there appears to be even less protection without a booster. On Thursday, The Centers for Disease Control (CDC) endorsed the recommendation from the Advisory Committee on Immunization Practices (ACIP) to recommend the mRNA Pfizer and Moderna vaccines over Johnson and Johnson. The decision was made due to the waning effectiveness of the J&J vax and nine confirmed fatalities, seven women including one from Seattle, and two men, from vaccine-induced immune thrombotic thrombocytopenia (VITT).

A study published on Dec. 14 found that Moderna with a booster provided the best protection from Omicron, followed by Pfizer with a booster, and then Johnson & Johnson with a Moderna booster. The study also evaluated individuals who had a previous COVID infection and then got vaccinated. They found that immunity was better than vaccination without a booster, but not as robust.

Real-world data from Europe and Africa indicate that relying on immunity from a previous COVID infection is offering little protection from becoming symptomatic. Epidemiologists have stated it is possible to be infected with the Delta and Omicron variants at the same time. It also appears that natural immunity from Omicron won’t protect a person from a later Delta infection.

There is mounting evidence that Omicron is no more severe than Delta, but little evidence it is less so. On Friday the Imperial College of London released a report that found no evidence that Omicron is “mild.”

“The study finds no evidence of Omicron having lower severity than Delta, judged by either the proportion of people testing positive who report symptoms or by the proportion of cases seeking hospital care after infection. However, hospitalisation data remains very limited at this time.”

The challenge for the public and health experts is comparing the current global wave to previous spikes in COVID cases. During the original wave in the spring of 2020, no one had any type of immunity. When the Alpha and Beta waves came in the winter of 2020, vaccines were just rolling out. When Delta arrived the variant was more transmissible and more severe than prior strains. It also was capable of nibbling around the edges of vaccine protection due to its mutations.

Omicron has arrived in a population that has received a variety of mRNA and viral-vector vaccines with different doses as well as disease acquired immunity from different strains. The timing of receiving a vaccine, prior infection, or a combination also impacts how much immunity a person has.

Many people are more mobile and have returned to work and school while simultaneously taking fewer precautions. An additional challenge is the rate of vaccination is not homogenous, with highly vaccinated communities adjacent to vaccine-resistant populations.

All of these factors are obscuring the true nature of Omicron and because the United States does a poor job of genomic sequencing in some states, little is known about the current hospitalized population and which variant patients have.

Although data out of South Africa has been more encouraging, experts had warned that the recent end of the Delta wave, a higher than understood vaccination rate, and the youthful nature of the South Africa population would favor better outcomes. Although only 26% of South Africa’s total population is vaccinated, over 34% of the county was ineligible due to age. On Oct. 20, the nation expanded vaccination to 12 to 17-year-olds and introduced booster shots to adults on Dec. 9. In reality, 44% of South African adults are fully vaccinated, including 61 percent of people over 50. Additionally, only 5.7% of South African residents are 60 or older.

Researchers are watching King County closely for several reasons. The region is a leader in genomic sequencing and research. As Omicron moves through the region it will provide critical data to build a better understanding of transmissibility, the impact on public health measures, prevention and treatment, and how severe Omicron is. King County is highly vaccinated, but has pockets of low vaccine acceptance, providing a more realistic cross-section. Finally, New York City is almost unique compared to other US cities due to its size, reliance on public transit, and the number of people who live in buildings with communal areas.

Dr. Cameron Webb, the senior policy advisor for equity for the White House COVID Response Team shared early symptoms to look for if you start feeling ill.

  • Sore throat, espeically if it is more than mild
  • Headache
  • Fatigue – severe fatigue appears more common in children
  • Runny nose
  • Sneezing
  • Dry cough

County health officials continue to appeal for people to get vaccinated and get a booster shot if they are eligible. They recommend frequent hand washing and wearing an N-95, KN-94, or KN95 mask whenever you’re out of your home, and to stop using cloth masks. When it comes to Christmas and New Year’s celebrations and travel plans, it is recommended to test the day off and celebrate outside or in well-ventilated indoor areas.

Because of the systems put in place by King County Public Health and supported by County Executive Dow Constantine, the region is better prepared to provide vital data to the rest of the nation. It is very likely that by Christmas, Seattle will feel a lot more like March 2020 than December 2021.

Health and Lifestyle, Local, National

Washington watches and waits for the Omicron COVID variant to arrive

Knowledge is the best tool to fight against fear. A wise person chooses to be informed so they can make sound decisions. To join the fight against COVID misinformation, you can share this update through your social media platform of choice.

[KIRKLAND, Wash.] – (MTN) Health officials and researchers are in a race against time to unlock the secrets of the Omicron COVID variant and its potential impact on public health as more nations report discovered cases.

Washington state is one of the leaders in genomic sequencing of COVID tests samples in the United States, led by the University of Washington Medicine. Standard PCR tests can detect a marker for a potential Omicron variant. Omicron shares a mutation with the Alpha variant that the current PCR tests look for, enabling researchers to see if a specific spike protein has a deletion. That would become a probable case that would be tagged for confirmational sequencing.

President Joe Biden addressed the nation on Monday saying, “there are three messages about the new variant that I want the American people to hear. First, this variant is a cause for concern, not a cause for panic.”

The President went on to praise South African officials and their scientific community for, “the kind of transparency that should be encouraged and applauded.”

Currently, in Washington, 99.6% of new COVID cases are the Delta variant, and 0.4% are Mu. The last cases of the Beta, Epsilon, Eta, and Kappa variants were detected in June and the last cases of Gamma and Iota were in August.

“Omicron has an unprecedented number of spike mutations, some of which are concerning for their potential impact on the trajectory of the pandemic,” the WHO said in a statement today.

“The overall global risk related to the new variant …is assessed as very high.”

On Sunday, Dr. Angelique Coetzee told South Africa Today, “Most of these cases are mild whether they are vaccinated or not. There is no increase in our hospital admissions currently.”

Hospital admission for COVID-19 by week, South Africa Gauteng Province, Public and Private Hopsital, through November 28, 2021

Less than 12 hours later, the hospital admission data from the South Africa Department of Health painted a very different picture. In the previous week, COVID hospitalizations had increased 66% nationwide and 210% in Gauteng Province, the epicenter for Omicron cases. Two weeks ago 135 Covid-19 patients were hospitalized in and around Johannesburg jumping to 580 on Monday morning. Hospitalizations at public and private hospitals increased almost equally and officials at Baragwanath Hospital reported moderate to severe symptoms with almost all patients unvaccinated or partially vaccinated with the Pfizer vaccine.

Dr. Coetzee in her interview on Sunday went on to take a more cautionary position, “Two weeks from now we might say something different, but we urge…people out there please get vaccinated, listen, do the right thing, and stop going to big gatherings.”

She also added the unvaccinated should be worried, saying, “especially if you are above the age of 50, we have seen this many times.”

“There is a saying. You’re not safe until everyone is vaccinated.”

The 7 day rolling average for new COVID cases in South Africa grew to 2,275 on Monday, 90% of new cases are Omicron, and 10.8% of tests are coming back positive

The WHO appeared to address the reports from Dr. Coutzee and her reports on the severity of the new variant in a statement last night. “There is currently no information to suggest that symptoms associated with Omicron are different from those from other variants.”

The statement added, “Initial reported infections were among university students—younger individuals who tend to have more mild disease—but understanding the level of severity of the Omicron variant will take days to several weeks.”

Dr. Coetzee saw her first suspected Omicron variant patient on November 18 and has based her statement of symptoms being mild on two-dozen patients who are mostly university students and younger, and about 50% vaccinated. In an interview with the BBC on Thursday, she stated all were in good health with no comorbidities.

Although she is credited and has self-proclaimed to have “discovered” Omicron, the first detection of the B.1.1.529 variant was collected on November 9 in Botswana and confirmed by South African scientists on November 11. South African officials notified WHO on November 24, a day before Dr. Coutzee stated she contacted South African authorities on her observations.

Despite a lot of unanswered questions, a clearer picture is slowly starting to emerge. The three riddles scientists need to solve are how contagious Omicron is compared to the Delta variant, can it escape public health measures, preventions, and treatments, and if the symptoms are the same, worse, or milder than previous variants.

Here is what is currently known about the Omicron COVID variant.

Symptoms

For children, adolescents, and young adults there is conflicting information. One doctor is reporting mostly mild symptoms that can be treated at home while hospital officials are reporting cases are similar to Delta.

The WHO stated on Sunday, “There is currently no information to suggest that symptoms associated with Omicron are different from those from other variants.”

Transmissiblity

Concern is growing among the CDC, WHO, and a constellation of health officials that Omicron is highly transmissible. At least equal to Delta and possibly higher.

In less than two weeks, Omicron went from almost non-existent to 90% of new cases in South Africa. It appears it can effectively outcompete the Delta variant. However, this introduces bias in the data because the Delta wave had just ended in South Africa. Did Omicron become the dominant strain by outcompeting Delta or due to the absence of Delta? More research needs to be done to answer that question.

There are other variables that could explain the sharp increase in cases that go beyond the simple reproductive number, known as R0. Omicron has so many more mutations than previous strains, it could be benefiting from immune escape. Although the R0 is lower than Delta, its uniqueness compared to previous mutations enables it to reinfect people relying on natural immunity. So overall transmissibility may be lower than Delta, but its ability to escape immunity results in more infections.

Is it in the United States

Cassie Sauer, CEO of the Washington State Hospital Association said on Monday, “I think that there is almost no chance that it’s not [here.]”

The United States does not have a national standard or requirement to genetically sequence some or all COVID tests that come back positive. Those decisions are left up to individual states. It is likely that states with aggressive public health programs such as California, Washington, Colorado, New York, or Massachusetts will identify the first cases.

How long do researchers think Omicron has been circulating

Dr. Trevor Bedford from Fred Hutchinson in Houston, Texas successfully estimated the arrival of the original COVID strain in 2020, using data from the Washington State Department of Health. Using the same methodology, Dr. Bedford’s model indicates that Omicron likely started circulating between September 19 and October 21. There is no evidence to support that the variant originated in South Africa.

Credit – Dr. Trevor Bedford, Fred Hutchinson, Houston, Texas – probability of origin date for Omicron variant

Why are so many travelers testing positive

In total numbers, there aren’t many travelers testing positive. When you consider that in all but two cases the testing of 200 to 250 people on an aircraft has yielded one or two positives, the percentage of breakthrough cases is small. Headlines are blaring two positive cases detected, which is critical to know – they aren’t blaring 248 negative tests on 777 that landed tonight.

Because the people tested are 95% to 100% vaccinated, this creates a false data fallacy. You have an almost exclusive sample of vaccinated people.

In South Africa, the Department of Health has reported almost everyone hospitalized in the last two weeks is unvaccinated or only partially vaccinated. Dr. Coetzee reported 12 of 24 patients she cared for were unvaccinated.

Based on this early data, it appears the current vaccines remain at least moderately effective at preventing infection and remain very effective at stopping moderate to severe COVID.

Are the current vaccines ineffective

There isn’t enough data, and almost every public company making a vaccine announced over the weekend they were testing their current versions against Omicron. Pfizer, Moderna, and Johnson & Johnson announced over the holiday weekend they were testing to see if the current vaccines remained effective.

There is some data out of South Africa that is indicating that vaccines are helping prevent moderate to severe illness and the cases being detected among vaccinated travelers appear to be asymptomatic to mild. However, many of those cases were detected in the last 72 hours and more time is needed to see how these new cases will progress.

In Israel, the first three travel-related cases were fully vaccinated with boosters. One was Pfizer, one was J&J, and one was AstraZeneca. We know that the viral-vector vaccines haven’t performed as well against the Delta variant as the mRNA vaccines.

The evidence suggests that there is more vaccine escape with Omicron, but not outright vaccine ineffectiveness. It still appears to be preventing hospitalizations, which would indicate it would prevent deaths.

Pfizer said they could make a new version if required in 100 days and Moderna said it would take 60 to 90 days. Johnson & Johnson did not provide a timeline but made a statement today they could create an updated version if it was required.

There are some new COVID vaccines in development called subunit vaccinations. There has been no information about the impact Omicron will have on the research.

Is disease acquired immunity still effective

There is growing evidence that immunity gained from a previous COVID infection that isn’t supported by vaccination, is experiencing significant breakthrough numbers.

Researchers are working to determine if the sharp increase in the number of cases and the high positivity rate of tests is due to Omicron being equally or more transmissible than Delta, or if part of the increase is being driven by other factors.

The pattern of mutations found in Omicron is very distant from all previous strains.

Are monoclonal antibodies still effective

There is evidence that Omicron has a significant ability to resist monoclonal antibodies. Specific mutations may have the capability to not only bypass B cells but resist T cells (which isn’t the same as HIV which destroys your T cells).

UW Medicine is evaluating the performance of currently available antiviral treatments and we will know more information in the coming weeks.

Will the new antivirals that are pending approval still be effective

There was a report from Pfizer on Monday morning that Paxlovid is effective against the Omicron variant, which is very good news. This is easy to administer than monoclonal antibodies, easier to distribute, and cheaper.

Nothing has been stated about Monulpiravir from Merck. The FDA will be considering the EUA request this week but there are hints they will label Monulpiravir a Class C drug if the EUA is granted. A Class C drug can’t be used by pregnant women, women actively trying to get pregnant, and nursing mothers because the drug has not been tested to determine if it causes birth defects or pregnancy complications. The FDA has already requested data for Merck to understand the impact better.

What should I do

Health officials recommend you continue to do the same things you are doing now. Get vaccinated if you’re not already. Get a booster shot if you’re eligible, and over 2.4 million Washingtonians are currently eligible. Wear a mask, wash your hands, avoid crowded indoor spaces, and reconsider your short term travel plans if you were planning to fly.