The holidays are fast approaching and we have a new mutation of the Covid-19 virus called Omicron. The Omicron variant of covid-19 has the highest transmissibility to date and is also evading some of our natural immunity (past infections of covid-19 resulting in antibodies) and vaccine mediated immunity. When I first learned of this new variant, I legitimately had a bit of a meltdown that Saturday because I did what I encourage my patients not to- I read the news media accounts of what was happening before I evaluated the actual research or waited to see what trusted sources from experts in the fields of Epidemiology and Infectious Disease were saying. So, I’m writing another post in the simplest way I know how to get you information in a FAQs format. In short, don’t panic, but be cautious.

Why is the Omicron variant more concerning than the Delta variant?

Studies in vitro (petri dish) and ex vivo (human tissue from lungs outside of the human body) are showing the Omicron variant to have 70 X’s higher replication rate than Delta variant. It spreads really fast. So, our case rates are about to skyrocket again. We will likely start seeing a significant rise in the Omicron variant the week between Christmas and New Year’s with a peak in cases around the 2nd week of January. The omicron variant is also showing some ability to evade our immune responses from either prior infection or vaccines. It is still unclear if the Omicron variant is causing a more severe disease.

If the cases are milder with Omicron, then do we still need to be worried?

Yes, we should still be concerned because even mild cases will put stress on our healthcare system and economy as a whole. It creates a cycle of more hospitalizations meaning less beds and staff available for healthcare emergencies that happen such as heart attacks, strokes, car accidents, etc. Medical staff that have been exposed have to isolate/quarantine which means less workers to care for the sick.  Other industries will also be stressed from an increase in cases, illnesses, and exposures.

At this point, isn’t it inevitable that everyone will get Covid-19?

No, we have tools of mitigation and using a layered approach can be very effective in reducing the spread of the virus and preventing further mutations. Our first tool is vaccination including boosters. We can avoid indoor gatherings of large crowds, we can continue masking and social distancing, and doing rapid testing before an event can also help.

I got the first 2 doses of Pfizer or Moderna vaccine, or the recommended one dose of the Johnson and Johnson vaccine, do I really need a booster?

Yes, you really do need a booster because the antibody response after boosting is different. It’s not only raising the levels of antibodies a person has, it is generating a broader level of immunity by producing antibodies against more parts of the virus than the initial series. Those that only got the first series of shots will have less of neutralizing antibodies preventing infection from Omicron. The T-cell response should help keep the severity of infections down however (less hospitalizations).

Why are boosters more protective again?

Boosters restimulate the immune system and increase the number of antibodies a person has. Remember that the mRNA vaccines are letting our immune system recognize the Spike protein on the surface of the covid -19 virus. This allows our immune system to make antibodies against the Spike protein and fight the virus/infection. The mutations of this protein as a result of the Omicron variant make it less recognizable to our system. The more antibodies we have, the more they can find the limited landing spots on Omicron. This will decrease breakthrough cases and decrease transmission.

Are there populations of people we should be most concerned about with Omicron?

Yes, reports are showing that the older population of people age 65 and older are having more breakthrough cases. Our younger kids that can’t be vaccinated yet, ages 5 and younger are at more risk of getting sick and subsequently hospitalized. For children, this could be from other respiratory diseases being more prevalent in the winter months however.

Who is eligible for a booster vaccination and should get one?

Everyone that is age 16 and older can get a booster 6 months after completing the primary series of vaccinations.

If I got the Pfizer vaccine injections first, should I then get the Moderna booster and vice versa?

There is not enough compelling evidence that mixing vaccinations will yield better protection. It is recommended to get whichever is easiest for you of either Moderna or Pfizer. A booster of one of the mRNA vaccinations available (Pfizer or Moderna) is preferred over the Johnson and Johnson vaccination, even if your first vaccine was the JJ&J one.

I’m fully vaccinated and boosted, as are my family members, can we still travel and visit over the holidays?

Everyone should take into account their level of risk and the benefits of seeing family and friends into account. If you do decide to travel and visit, then using the layered approach to protection would be advised. This includes masking in indoor spaces, preferably an N95 on planes, socially distancing when possible, opening windows for ventilation when possible, washing hands, and staying home if you are sick. Doing a rapid test right before an event to detect infections is also beneficial. The rapid tests are good for a few hours (not days), so one before travel and then one before the event is recommended as the results can change that quickly.

What kind of rapid tests should I get and do I need to also get a PCR test?

Most pharmacies have a rapid test available. One that I have used is Binax Now. They take 15 minutes to run and are fairly easy to use. There are also testing sites still available in most states for free. If the test is positive, then a confirmatory test with PCR would be recommended.

I tested positive, now what??

If you test positive and are at higher risk for severe infection due to a health condition such as diabetes, obesity, or immunocompromised disease, then you may qualify for monoclonal antibody treatment. Monoclonal antibodies are made in a lab to target a specific infection. They are administered via infusion or as a shot. There may be an administration fee, but otherwise should be free. They work best when given within 10 days of symptoms and different sites may have different parameters on who qualifies. The government decides how much each site receives based on perceived risks, so there is some variability on what will be available. If you want to check on sites near you, you can call 1-877-332-6585 or reach out to me or your physician.

Who is eligible for monoclonal antibodies?

Monoclonal antibodies may help for post exposure prophylaxis in individuals who are at higher risk of getting severe disease or hospitalized from covid-19 whether vaccinated or not. Anyone that is high risk and has an exposure or a positive test, is 12 years of age or older, and weighs at least 88.2 lbs. should be eligible.

When will we have vaccines for children younger than 5?

Hopefully early next year. Unfortunately, the clinical trials showed that a 2-vaccination series didn’t produce enough of an immune response in children ages 2-5, so they are adding a 3rd shot to the series. Clinical trials are still ongoing for ages 6 months to age 5 as well.

Will this pandemic ever end?

Yes, it will. We still need to work on vaccine equity and having easy access of vaccines for low- and middle-income countries. Otherwise, we will continue to have a global problem if the virus is allowed to continue to infect and mutate. The good news is that we are learning more every day about how to prevent and treat covid-19 infections. The ending of the pandemic will probably look like a slow dying out of the virus. There will still be small pockets of the population where it will resurface which will cause news media to react and some to panic, but eventually we should be able to eradicate it enough to return to a semblance of normal.

Long covid syndrome is also something that everybody regardless of age or health should be wary of as well. We know that covid-19 can cause damage to lung and heart tissue, take away the sense of smell and taste, and have longer lasting effects of fatigue, worsening asthma, headaches, memory loss or brain fog, and more. We will continue to study this virus and hopefully find answers for help and treatment. If you are a long covid sufferer, please know that you are not alone, your symptoms are real, and there is hope for support and treatment.

In conclusion, don’t panic with each news story about covid-19 and the pandemic. Continue to do what we know works (as you are able) which is vaccination, boosters, social distancing, masking, and staying home when you are sick. Realize everyone’s situation is different and help your family, friends and neighbors when you can, give grace to those not coping well, and know that this won’t last forever. Happy Holidays and here’s hoping for a safe and healthy New Year!