Covid-19: Omicron may be more transmissible than other variants and partly resistant to existing vaccines, scientists fear
BMJ 2021; 375 doi: https://doi.org/10.1136/bmj.n2943 (Published 29 November 2021) Cite this as: BMJ 2021;375:n2943Read our latest coverage of the coronavirus pandemic
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Dear Editor
I read with interest and some trepidation your news item (1) “Covid-19: Omicron may be more transmissible than other variants and partly resistant to existing vaccines, scientists fear”. This has now been designated (2) as variant of concern (VOC) by the world Health Organisation. Although not a lot is known about this variant many governments including ours have implemented various measures from travel restrictions to compulsory wearing of face coverings (3). There are reports of increased hospital admissions in parts of South Africa where this variant has taken hold (4). However, WHO has cautioned against any conclusions by stating “but this may be due to increasing overall numbers of people becoming infected, rather than a result of specific infection with Omicron” (5)
On 28th November an alert (6) was sent from the Chief Medical Officer through the Central Alerting System (CAS). According to the CMO “Healthcare workers who return from any travel overseas to countries not on the travel red list should not return to work until they have had an initial negative PCR. They should also do daily LFDs until day 10 after return”. This is a very prudent and precautionary move which needs to be welcomed and adhered to as the variant has now been detected in 44 countries according to Omicron tracker (7). One wonders why this intervention has been restricted to health care workers and not expanded to include social care workforce. Although care homes are not the same as hospitals the social care workforce do care for vulnerable and elderly population and introduction of COVID let alone a new variant with unknown potential can have disastrous consequences. Earlier on in the pandemic the government was accused of abandoning the care homes (8). According to Public Accounts Committee (9) “Ministers have been accused of a “slow, inconsistent and at times negligent” approach to social care during the coronavirus pandemic that has exposed years of delayed reforms to the sector”. The government is currently facing a legal challenge (10) on the way it treated care home residents during the initial pandemic waves and the system should ensure that care home residents are prioritised and treated at par with NHS patients.
It is now a requirement (3) that “All international arrivals to take a Day 2 PCR test and self-isolate until they receive a negative test”. Unlike healthcare workers who are employed by the NHS social care work force is diverse and has many employers and operate within the care market. Hence there may be logistical difficulties and even legal obstacles to such a mandate. However, to protect our care home residents from the potential onslaught of Omicron the same rules should be extended to social workforce returning from abroad. This can be reviewed once we learn more about the variant characteristics. If Omicron gets into care homes, it is very likely that it will through patient movement likely to get into the hospitals. The same rules of health workers should also apply to social care workforce as the two sectors so closely linked and care for our vulnerable section of the population. The care sector might need some support to implement this measure and the government should do all it can working with Directors of Adult Social care and the wider sector to ensure that this sensible is adopted and implemented by the social care sector. This measure will go a long way in preventing seeding of the variant in care homes and its associate impact which we are trying to prevent in health care settings.
Dr Padmanabhan Badrinath, Lead Consultant for Health Protection & Lead for enhanced COVID Specialist Team, Public Health Suffolk, Suffolk County Council & Associate Clinical Lecturer, University of Cambridge.
Directorate of Public Health & Communities, Endeavour House, Suffolk County Council, Ipswich, IP1 2BX p.badrinath@suffolk.gov.uk
Disclaimer: The views expressed here are the personal views of the author and in no way represent the views of his employer, Suffolk County Council, or the University of Cambridge.
Conflict of interest: The author works in a local authority Public Health Department and is the lead consultant for health protection and part of the local COVID specialist response.
References:
(1) Torjesen I. ovid-19: Omicron may be more transmissible than other variants and partly resistant to existing vaccines, scientists fear. BMJ 2021;375: n2943. Available from: https://www.bmj.com/content/375/bmj.n2943
(2) World Health Organisation. Classification of Omicron (B.1.1.529): SARS-CoV-2 Variant of Concern. Nov 26, 2021. Available from: https://www.who.int/news-room/statements/26-11-2021-classification-of-om...(b.1.1.529)-sars-cov-2-variant-of-concern
(3) Prime Minister's Office, 10 Downing Street and The Rt Hon Boris Johnson MP. Measures against Omicron variant come into effect: 30 November 2021. Available from https://www.gov.uk/government/news/measures-against-omicron-variant-come...
(4) The Wall Street Journal. Omicron Variant Drives Rise in Covid-19 Hospitalizations in South Africa Hot Spot. 29 Nov 2021. Available from https://www.wsj.com/articles/omicron-variant-drives-rise-in-covid-19-hos...
(5) World Health Organisation. Update on Omicron. 28 Nov 2021. Available from https://www.who.int/news/item/28-11-2021-update-on-omicron
(6) Central Alerting System. Update on COVID-19 Variant B.1.1.529. Available from: https://www.cas.mhra.gov.uk/ViewandAcknowledgment/ViewAlert.aspx?AlertID
(7) BNO News. Tracking COVID-19 variant Omicron. Available from https://bnonews.com/index.php/2021/11/omicron-tracker/
(8) BBC news. Coronavirus: Care homes felt 'completely abandoned'. May 2020. Available from: https://www.bbc.co.uk/news/uk-52660490
(9) Independent. Coronavirus: MPs accuse government of ‘slow, inconsistent and at times negligent’ approach to social care 29 July 2020. Available from https://www.independent.co.uk/news/uk/politics/coronavirus-social-care-h...
(10) High Court of Justice, Queen’s Bench Division. The Queen (on the application of (1) Dr Cathy Gardner (2) Fay Harris) v (1) Secretary of State for Health and Social Care (2) NHS Commissioning Board (NHS England) (3) Public Health England. Oct 2021. https://static.crowdjustice.com/crowdjustice_document/Gardner_v_SSfH_Cla...
Competing interests: The author works in a local authority Public Health Department and is the lead consultant for health protection and part of the local COVID specialist response.
Dear Editor
The continued decline in COVID-19 cases following the intense second wave in India has led to hope that a return to normalcy might be near. Across the country, emboldened by the fact that the festival season did not lead to a steep rise in cases, restrictions have eased and public behaviour is largely returning to normal.
Situation now. The low number of cases currently in India, even as cases are rising across much of Europe, appears largely attributable to two factors. First, seroprevalence studies indicate that a large proportion of the population has already been exposed to the virus providing some level of protection to subsequent infections. Second, the immunisation campaign has gained momentum. Approximately 44% of Indian adults have been fully vaccinated and 82% have received at least one dose. What is more, scientists believe that prior infection followed by one or two doses of vaccination may have a larger protective effect than two doses of the vaccination alone.
A new variant of the SARS-CoV-2 virus was recently identified in Botswana. Called the Omicron variant, early evidence suggests that it may be responsible for the steep rise of cases in the Gauteng province of South Africa. In this region, 90% of samples from the past few weeks have been of the Omicron variant. This variant has a large number of 32 mutations. Some of them are cause for serious concern because they may allow the new variant to evade immunity obtained from a past infection or via a vaccine. The World Health Organization (WHO) has recently labelled this variant as a ‘variant of concern’.
While the emergence of the new variant is concerning and requires extreme vigilance, there are several questions that remain unanswered at the moment. Is the variant more transmissible? Can it evade the immune system? And is the variant associated with more severe disease outcomes?
The possibility of a new, more transmissible variant of the SARS-CoV-2 virus has, of course, been the principal worry of epidemiologists. Some other recent variants, with a more limited repertoire of mutations, have raised concerns briefly, but have not risen to the level of being named a variant of concern so far. What is concerning here is that cases of the new variant have risen so sharply as to suggest that it may far outstrip the Delta variant in its ability to infect people. There are no reliable estimates of just how much more transmissible the Omicron variant is compared to previous strains of the virus. But even crude calculations suggest it could be much larger than for those strains.
When new variants can evade immunity obtained through immunisation and prior infections, there is a greater chance for breakthrough cases and further transmission. WHO has recommended studies to understand the degree to which the immune system is evaded by the Omicron variant. This is a key question for India given the high proportion of individuals with some level of immunity, mostly from infection. If these mutations do lead to greater immune escape, vaccines and treatments like monoclonal antibodies might need to be reformulated.
Luckily, RT-PCR tests should still detect the Omicron variant.
Where did the Omicron variant come from? Viruses mutate all the time and SARS-CoV-2 is no exception. What is unusual is the very large number of mutations that the Omicron variant has accumulated. This is likely a consequence of a chronic infection in an immunocompromised patient, such as one infected with HIV. A strong immune response can ultimately eliminate the virus. However, in a weakened immune system the virus will continue to multiply and mutate, changing its form to evade immune response. Given this, prioritising the elderly and immunocompromised for a future additional dose would make sense.
While a number of nations have already closed their doors to travellers from South Africa, epidemiologists worldwide recognise that these measures can only offer temporary relief. Given that a case was found in Hong Kong in a traveller from South Africa a full four days into a mandatory quarantine, and that this patient may have infected another individual who turned positive some days later, it seems very likely that cases may have already crossed borders without being detected. Israel has also reported cases, with one already triple vaccinated with the Pfizer vaccine before testing positive. The symptoms in this case were mild.
As long as the virus circulates, the possibility remains that new variants could emerge. The best option is to reduce case numbers. For this, vaccination is an especially powerful tool. Even a single dose of vaccine can reduce dramatically the risk of hospitalisation or a worse outcome; two doses do even better. However, the current inequity in vaccine distribution means that this means of control is out of reach of most in lower and middle-income countries. While many rich countries are now arranging for booster doses to safeguard their populations, even younger and less vulnerable individuals, this policy comes at the cost of the rest of the world, where vaccine coverage remains abysmally low. More than 60 countries have vaccinated less than 25% of their population, including South Africa. It is these regions that hold the most potential for a new, more transmissible variant. Equity in the distribution of vaccines is an urgent global public health need, quite apart from being ethically and morally the right thing to do.
Competing interests: No competing interests
Re: Covid-19: Omicron may be more transmissible than other variants and partly resistant to existing vaccines, scientists fear
Dear Editor
Much of the concern about the Omicron variant of SARS-CoV-2 seems to be because of the high number of mutations present in its genome which have rendered it more infectious then previous variants. There is anxiety that it could rapidly replace Delta and become the dominant variant.
The question I want to ask is what effect might those same genetic mutations have on virulence? As I understand it, it is the way the host cells respond to the virus that produces such severe illness in some people. Multiple changes to the spike protein will inevitably change the properties of that protein and consequently the way it interacts with the host cells. I could imagine a scenario in which the spike protein has changed so much that it now only causes mild symptoms. You would then have a virus that is so infectious that it becomes the dominant variant, replacing all previous ones and yet only produces mild illness. At that point the pandemic would be over.
Initial reports are indicating that people infected with the Omicron variant so far have only mild symptoms. Could the Omicron variant turn out to be a blessing in disguise?
Competing interests: No competing interests