I have tried to collect my understanding of where we stand with Omicron at our doorstep.

This analysis is primarily relying on the excellent summaries presented by Dr John Campbell and Dr Been in their recent youtube coverage of the data out of South Africa on Omicron.

 

Update on Omicron - Dec 9, 2021

 

Vaccine protection from Omicron

Pfizer/moderna (mRNA) and AZ/Sputnik/CanSinoBio/JJ (adenovirus) - both types of vaccines narrowly target spike protein - which has escaped coverage with Omicron

Studies report a 40x reduction in neutralization of Omicron.

Inactivated whole virus vaccines like Sinopharm/Sinovac might provide some protection.

And previous natural infection also may provide protection.

 

Upcoming wave

But will be a huge wave of Omicron in 2 weeks

Already dominant in South Africa and spread to many countries.

Will become main strain in each country within 2-3 weeks possibly.

Because Omicron is multiple times more infectious (spreading) than Delta

 

Omicron "mildness" as pandemic-ender

Early signs are that Omicron is milder ie less likelihood of severe disease - from South African first 2 weeks data

If this remains true - then Omicron may signal the end of the pandemic - as it will cause massive/widespread natural infection

Which will inoculate large number of public

And pandemic will go down

 

Negatives

However, even if Omicron is "mild" it still will cause massive number of infections very fast ie initial wave will be big

so even if "mild", hospitals may still be overwhelmed just because overall infections are growing so much

Eventually the wave will cool off and hospitalizations drop as the virus runs out of fresh people to infect

 

Long haulers

There is also the matter of whether "mild" cases will still have long haulers syndrome (lingering issues).

Since with prior variants, nearly 25-30 percent of coyid19 patients have long haulers syndrome.

And even asymptomatic patients have had long haulers syndrome.

One other note is that in South Africa, they report nearly 10pct of the Omicron-positive cases are children - which is more than previous waves.

But the children so far doing well.

So we may see more children in this wave.

 

Omicron impact on vaccination policy

Omicron arrival has made talk of vaccination irrelevant

Firstly the Pfizer etc (mRNA) and AZ (adenovirus) classes of vaccines will not protect

(studies show a 40x reduction in neutralization by these vaccines)

Sinopharm/Sinovac may protect some

And natural prior infection will protect some

 

Pfizer/Moderna press release on utility of 3rd booster is not scientific

Even though Pfizer/Moderna still want people to take 3rd booster, and bureaucrats are in continuation of momentum arguing for 3rd booster, at this time most pro-vaccine doctors are questioning the value of the current vaccines - since they are not neutralizing Omicron.

Thus there is no scientific evidence to suggest benefit from 3rd booster and more likelihood of adverse events from it.

Even the pro-vaccine doctors are currently against 3rd booster:

• because of the increasing risk of spike protein toxicity with the mRNA/adenovirus vaccines

• but also because arrival of Omicron makes 3rd booster ineffective

 

Why vaccinating during wave may be inadvisable

Since Omicron wave is about to arrive, anyone thinking of getting vaccinated now, or 3rd booster now, is exposing himself to more risk.

Why? Because it has been demonstrated that post-vaccination - for example on 3rd booster, the antibodies go to near zero for 4-5 days (as previous antibodies get consumed fighting the newly created spike protein targets that were created by the vaccination). Thus a person is vulnerable to infection in 4-5 days post-vaccination. This has also been observed in practice as more than expected number of patients have previously reported "they got covid19 right after vaccination" (observed by me also)

• after 4-5 days however the antibodies do jump up again to high values

So with Omicron wave at our doorstep, a person contemplating getting 3rd booster now needs to balance risk of vulnerability for 4-5 days

 

Vaccinating 5-11year olds

This policy which made little sense earlier (because children have strong innate immunity and giving old Wuhan variant vaccine threatens to weaken the innate immune response in favor of a non-optimal Wuhan variant vaccine).

Many doctors and epidemiologists are arguing that vaccinating kids exposes to adverse events of vaccine, while providing sub-optimal vaccine protection (while weakening innate immune response).

This is a well known concept of "original antigenic sin" in epidemiology/immunology.

Where exposing a child to old Wuhan variant (that is now suboptimal against Omicron) threatens to reduce the child's survival chances - because vaccination induced antibody response inhibits their natural innate immune response (which is much better in children at fighting new virus).

 

Summary

So to prepare for Omicron:

• stop 3rd booster as not as useful

• stop booster vaccination during the wave - as will expose more desperate people at vaccination center - right when the vaccination depresses prior antibodies for 4-5 days

• stop vaccinating 5-11year olds - esp stop Pfizer with it's risk of spike protein toxicity

• and prepare with early treatment measures - esp steroids-at-day7-8 to couter the post-day7-8 hyperinflammatory stage

• steroids should not be capped at 6mg dexamethasone - but should be increased according to patient to achieve daily improvement - at day8 Cyproheptadine and Inhaled Budesonide should be used for those with incessant cough

• Remdesivir should not be used because is not beneficial in later stage, and has risk of organ damage (kidneys etc.)

• overall follow MATH+ protocol or one of the other early treatment protocols - treat early

• day7-8 or a pattern of oximeter fall 97, 96, 95 or heart rate in 90s or 100+ are signs patient is at "day8" (also persistent fever of 101 beyond day7 is also signs of hyperinflammatory fever) - and steroids ie prednisolone 40mg per day needs to be started - escalate to 60mg or more next day if don't see oximeter reversal next day

• treated early and with sufficient doses, zero percent patients graduate to needing oxygen or hospitalization

 

Final note on Omicron "mildness"

South Africa province Omicron patients for whom we have 2 weeks of data on - are being treated with steroids.

If they are treating with correct early treatment protocols - that might be why so few are needing oxygen, or having serious issues.

The same patients in the US may not fare so well, esp if the US hospitals are not following early treatment protocols.

Most large US hospitals are capping steroids at 6mg dexamethasone and also giving Remdesivir needlessly ($3000 per patient) - as a result those needing more steroids will stagnate for a few days and then wind up on ventilator

Thus Omicron in the US may have higher mortality than we are seeing in South Africa.

 

On the conventional wisdom that new variants will be easier to spread, but less dangerous

There is a thinking that disease usually evolve to become milder - since killing the host is not beneficial for the disease to spread.

That is a milder disease is easier to spread as the host lives longer.

However, this may not be true for covid19 - which is a biphasic disease. That is, the infectious phase is usually day1-5 - but patient dies usually much after day8 ie day10 or day14. And patient is usually not infectious after day8.

For this reason there is no evolutionary impact of how severely a variant kills it's patients because it has no impact on the infectious day1-5 period of the disease (patient is usually fine for day1-8 anyway and only die later).

For this reason, for covid19, it would not be surprising to have a new variant appear that is both more spreading, and also more deadly.