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What we know and don’t know about the Omicron variant

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A new and potentially more transmissible coronavirus variant first identified by South African scientists has prompted a fresh round of travel restrictions across the world and raised concern about what may be next in the pandemic.

The strain, named Omicron, was designated Friday as a variant of concern by the World Health Organization, which said studies of it are underway as advisers continue to monitor it.

While scientists say there is reason to be concerned over Omicron, they stress there is still a lot we don’t know — including whether the variant is indeed more contagious, whether it causes more severe disease or what its effects on vaccine efficacy may be.
“While this is concerning, as the WHO has indicated, I do think that we have to step back and wait for the science on this,” epidemiologist Dr. Abdul El-Sayed told CNN.
It will be a couple weeks until more answers are clear, said Salim Abdool Karim, co-chair of the South African Ministerial Advisory Committee on Covid-19.
“The reality is we’ve only know about this virus for just over a week, so we don’t really have the kind of data required to answer those questions definitively,” Karim said Monday when asked if Omicron is more transmissible, more virulent and evades vaccines.
People must be careful not to presume what the likely clinical picture will be based on what is being seen right now, he told John Berman on CNN’s “New Day.” There needs to be a much broader picture, as it’s too early to see severe cases, which normally come a few weeks later, he said.
It may take two weeks to have solid answers about the Omicron variant, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, is telling the White House.
“Dr. Fauci informed the President that while it will take approximately two more weeks to have more definitive information on the transmissibility, severity, and other characteristics of the variant, he continues to believe that existing vaccines are likely to provide a degree of protection against severe cases of Covid,” a White House news release said.
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Health officials do not know yet if the variant will cause more severe outcomes, former FDA Commissioner Dr. Scott Gottlieb noted Sunday to CBS News.
“Is this making people more ill? There’s no indication that it is. And in fact, there’s some anecdotal information offered from physicians in South Africa that this could be causing milder illness. Now, that could be an artifact of the fact that initial cases seem to be clustered in younger people, perhaps in outbreaks around universities,” Gottlieb said.

Early evidence suggests it transmits faster

The Omicron variant was highly contagious in South Africa — but that doesn’t mean the same thing will happen elsewhere, Dr. Francis Collins, director of the National Institutes of Health, told Jim Sciutto on Monday on CNN’s “Newsroom.”
“I think it is clear from what’s happening in South Africa that this Omicron variant does spread rapidly,” Collins said, noting that Covid-19 cases are relatively low in South Africa. “What we don’t know is whether this Omicron variant will outcompete Delta in a country like ours, or whether Delta, because it’s been so successful, will basically just push it aside. That’s another unknown.”
Omicron has similar mutations to the Delta variant, Karim said, so there’s an expectation that it will transmit faster. Based on early evidence in South Africa, “it’s certainly transmitting faster than the Delta variant.”
There are no known cases of the Omicron variant in the United States so far, Fauci said Monday on ABC’s “Good Morning America.”
“It’s inevitable that sooner or later it’s going to spread widely because it has at least the molecular characteristics of being highly transmissible, even though there are a lot of things about it that we do not know but that will be able to be ascertained in the next week or two, I believe,” Fauci said.
The Omicron variant indeed is comparable to the Delta variant, said Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota.
“We’re seeing a variant that has the capability of high transmissibility, meaning that it’s very readily transmitted, and that has been the variant that ultimately wins the kind of the king of the hill for the viruses, as Delta basically replaced Alpha, which replaced previous strains,” Osterholm told CNN’s “New Day” on Monday.
“It’s very likely that we’re going to see in the days ahead that the Omicron virus is going to ultimately be the new king of the hill, and in fact it will bring with it this ability to potentially impact on immune response,” he said.

A doctor says cases have been mild — so far

A South African doctor says the Omicron cases she has handled so far have been mild.
“So it started with a younger generation of 40 and less, and the most predominant clinical complaint is severe fatigue for one or two days, with then the headache and the body aches and pain,” Dr. Angelique Coetzee, a private practitioner and chair of South African Medical Association, told Reuters.
“Some of them will have what they call a scratch throat, and some will have a cough, a dry cough. But it’s not a constant cough. It comes and goes. And that’s more or less the big symptoms that we have seen.”
Coetzee, who was among the first in the country to suspect a new Covid-19 variant was making people sick, and her colleagues have not treated anyone requiring oxygen, she said.
Some patients have had high temperatures, including one severely ill child with a fast pulse. The child was treated at home and was feeling better after about 48 hours, Coetzee said.
“I’m not saying the virus is not going to give you severe infections, but the whole hype out there doesn’t make any sense, medical sense, at this stage,” Coetzee told Reuters. She acknowledged the clinical picture of the virus could change.
Asked about reports of milder symptoms in South Africa and Israel, Fauci said, “I think that’s premature to say that. … We just do not know.”

Vaccines are the best way to deal with it, expert says

The best advice for dealing with the new variant is to get vaccinated and then get a booster shot, Collins said.
“Your best protection against Delta is to get vaccinated, and if you’ve already been vaccinated and six months have passed since you got Pfizer or Moderna, get your booster; two months since J&J, get your booster,” he said.
“That was a reason already, but now add Omicron to the mix,” Collins said. “And we do believe that this new variant, which will probably come to our shores, will also be something vaccines and boosters can help you with.
“Get your vaccine, get your booster,” he said. “It’s the best chance we’ve got to drive this Covid-19 pandemic away.”

What vaccine makers are saying about it

Moderna should know in the next couple of weeks how effective its vaccines are against the Omicron variant, its chief medical officer said Monday.
“If we need to manufacture an Omicron-specific variant, it’s going to take some weeks, you know, two to three months is probably what we’re looking at to be able to really begin to test it and manufacture it,” Dr. Paul Burton told “Good Morning America” on Monday. “We’ll know from laboratory tests in the next couple of weeks just how effective the vaccines are against this variant.”
Moderna is also testing an Omicron-specific booster, it said.
“For several days, we have been moving as fast as possible to execute our strategy to address this variant,” Moderna CEO Stéphane Bancel said in the news release.
Omicron includes mutations “seen in the Delta variant that are believed to increase transmissibility and mutations seen in the Beta and Delta variants that are believed to promote immune escape. The combination of mutations represents a significant potential risk to accelerate the waning of natural and vaccine-induced immunity,” Moderna said Friday in a news release.
If its current vaccine and booster are insufficient against the variant, one possible solution is boosting people with a larger dose, which Moderna said it is testing. The company is also evaluating two multivalent booster candidates to see if they provide better protection against Omicron; both include some of the viral mutations present in the variant.
AstraZeneca also is looking to understand the impact Omicron has on its vaccine, which is not currently authorized for use in the US, it said.
“AstraZeneca is also already conducting research in locations where the variant has been identified, namely in Botswana and Eswatini, that will enable us to collect real world data of Vaxzevria against this new virus variant,” a spokesperson for the company said Friday.
The company also is testing its antibody treatment, AZD7442, against the variant, it said. AstraZeneca asked the US Food and Drug Administration in October to authorize emergency use of the treatment.
Scientists at BioNTech, the German company that partnered with Pfizer to make its Covid-19 vaccine, are also investigating the impact of the variant on their shot, with data expected within the next couple of weeks.
Johnson & Johnson also is testing the effectiveness of its vaccine against Omicron, its spokesperson told CNN in a statement.

Its mutations are raising concern

Omicron has an unusually high number of mutations, with more than 30 in the key spike protein — the structure the virus uses to get into the cells they attack — South African genomic scientists have said.
Scientists are concerned the mutations could make the variant more transmissible and could result in immune evasion.
Scientists are working to find out whether the variant could evade immunity, saying its mutations can help hint or predict whether it will be the case, Fauci told CNN on Friday.
“What you need to do, is you need to get that particular sequence of the virus, put it in a form in the lab where you can actually test the different antibodies, so you can have a prediction that it might evade, or you can actually prove it,” he said.
“Right now, you’re talking about sort of like a red flag that this might be an issue, but we don’t know,” Fauci added. “Once you test it, you’ll know for sure whether or not it does or does not evade the antibodies that we make, for example, against the virus through a vaccine or … after you get infected.”
The dean of the Brown University School of Public Health does not believe the variant will create a situation where “vaccines will be rendered useless,” he said.
“I think that’s exceedingly unlikely,” Dr. Ashish Jha said. “The question is, is there a tiny hit to vaccine efficacy, or is there a large hit? I think we’ll get some preliminary data probably in the next few days.”

How it compares with other variants

While mutations — and new variants — of the virus are expected as it continues to spread, experts say there’s more reason for concern with Omicron.
“We have seen a lot of variants pop up over the last five, six months, and most of them have not amounted to much. This looks different,” said Jha. “It’s acting differently, it looks like it’s much more contagious than even the Delta variant.”
The Delta variant fueled a virulent summer Covid-19 surge in the US and helped drive recent surges across Europe. The Delta variant was about as transmissible as chickenpox, one document from the US Centers for Disease Control and Prevention indicated.
When experts looked at other variants, Jha said, it usually took several months for those strains to become dominant — in other words, the most common strain of the virus spreading in one area.
“This one has become dominant very quickly in South Africa in the regions where it’s been found. Within a matter of days to weeks as opposed to months,” Jha said. “Now, the number of cases in South Africa is quite low, so it can be for other reasons as well, not just because it’s more transmissible but the speed with which it has taken off is really unlike anything we’ve seen before.”
Preliminary evidence suggests Omicron also poses a higher risk of reinfection, compared to other variants of concern, WHO officials said Friday in their statement.

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