'More questions than answers' about latest covid variant omicron, Pittsburgh doctors say

The newly flagged covid-19 variant dubbed omicron likely already has hit the United States — though scientists aren’t yet sure how contagious or dangerous the latest mutated version of the novel coronavirus might be.

“Anytime a new variant is found, scientists start studying to see if it’s more contagious — does it cause more lethal disease, does it have the ability to evade our diagnostic tests and does it have the ability to evade … our treatment options like monoclonal antibodies,” said Dr. Matthew Moffa, infectious disease specialist at Allegheny Health Network. “Right now, it’s too early to answer all of those questions.”

Pittsburgh-based Dr. Amesh Adalja, an infectious disease expert and critical care and emergency medicine physician, agreed that “there are more questions than there are answers at this point” regarding omicron. The highly contagious delta variant poses the biggest threat locally and nationwide so far.

“Right now, omicron is not a prevalent variant in the U.S.,” Adalja said. “What’s killing people in the U.S. is the delta variant.”

Covid hospitalizations on rise in Allegheny, Westmoreland

Investigations into the latest coronavirus variant making headlines globally are happening as Western Pennsylvania hospitals admit growing numbers of covid-19 patients.

As of Monday afternoon, more than 270 covid-19 patients were being treated for severe symptoms, or cases requiring ventilators, across the 14-hospital Allegheny Health Network. In addition to its flagship Allegheny General Hospital in Pittsburgh’s North Side, AHN’s includes Allegheny Valley Hospital in Harrison; Jefferson Hospital in the South Hills; and neighborhood hospitals in Harmar, Hempfield and McCandless.

The number of people hospitalized for covid-19 at AHN facilities is up from 250 patients last week and marks a sharp climb from the start of summer. AHN was treating as few as five to 10 covid-19 patients systemwide in June.

“It’s been going up and up over the last week or two,” said Moffa, an internal medicine physician and director of infection prevention at West Penn Hospital in Pittsburgh’s Bloomfield neighborhood. “We’re not as bad as we were last winter, but the trajectory is not very encouraging.”

AHN’s covid cases hit a record high of about 370 patients hospitalized in December 2020, when vaccines were not available to most people.

“We’re creeping back up to that peak,” said Moffa, “which is a little bit hairy going into the holiday season.”

The system’s trend is in line with the looming covid surge that Westmoreland County-based Excela Health’s top doctor warned about last week.

“The delta variant is the more contagious version of this virus, and it is going to find unvaccinated people and make them sick,” Adalja said. “It’s even worse as you get into the suburban areas outside of Allegheny County, where vaccination rates drop off significantly. If you look at hospitals like in Punxsutawney or in my hometown of Butler, they’re really under stress because of the spread of this virus, the more contagious variant and the kindling that these unvaccinated individuals are.”

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Everyone urged to get boosters

Amid mounting global concerns spurred by the discovery of omicron, more than four dozen nations implemented heightened travel restrictions, and the Centers for Disease Control and Prevention urged all vaccinated American adults to get booster shots.

“Early data from South Africa suggest increased transmissibility of the omicron variant, and scientists in the United States and around the world are urgently examining vaccine effectiveness related to this variant,” CDC Director Dr. Rochelle Walensky said in a statement about the expanded booster recommendations issued Monday. “I strongly encourage the 47 million adults who are not yet vaccinated to get vaccinated as soon as possible and to vaccinate the children and teens in their families as well because strong immunity will likely prevent serious illness. I also want to encourage people to get a covid-19 test if they are sick. Increased testing will help us identify omicron quickly.”

Scientists and public health experts still are studying the omicron variant and tracking its spread around the globe, with multiple Canadian cases confirmed Sunday.

Here’s a look at what we do (and don’t) know about the omicron variant so far:

What is the omicron variant, and why is it raising concerns?

First identified in early November as covid surged in South Africa, more omicron — note, it’s not spelled “omnicron” — clusters were confirmed over the weekend in Ontario and Quebec, Canada, following reports of additional cases spreading abroad, from the Netherlands to Hong Kong to Australia.

“Preliminary evidence suggests an increased risk of reinfection with this variant,” the World Health Organization reported Friday. “The number of cases of this variant appears to be increasing in almost all provinces in South Africa.”

Nations have reinstituted mask-wearing and other pandemic-related requirements and curbed travel to hinder the potential spread of the variant while researchers dig into how it differs from prior versions of the novel coronavirus.

Reports of cases around the world aren’t surprising, Adalja said, because “this virus knows how to travel, and when you discover a new variant, it’s usually in multiple different countries by that time.”

“It’s still too early to tell if omicron is more contagious than delta or not,” Moffa said. “That won’t be discovered for weeks to come — the same with the seriousness of it and (whether it is) more lethal.”

What is a variant, and how do we thwart them?

Hundreds of thousands of variants of the novel coronavirus — which causes the covid-19 disease — are out there, and most aren’t cause for worry. The virus replicates and mutates repeatedly even while infecting someone — just like other RNA viruses such as the flu and common cold.

A relatively small number of variants get flagged for research interest, and even fewer are deemed variants of concern, such as the highly contagious delta variant.

“Before delta was alpha — the variant that started in the U.K. — and that was more contagious than the original strain,” Moffa said. “And then delta just blew alpha off the map because it was so contagious. … That’s why almost every single case in the United States for the last few months has been delta.”

Variants pose concern only if the mutation has the effect of making the virus become more easily transmittable, more aggressive at replicating or more likely to cause severe symptoms and death.

“Viruses always mutate, that’s normal,” Moffa said. “The more hosts they infect, the more mutation that occurs. Some of these mutations make the virus wimpier and then it goes away. And then some give it a competitive advantage, whether it’s more transmissible or whether it impedes prior immunity.”

As Adalja explains, the delta variant “is more contagious because it has certain mutations that enable it to bind more efficiently to our cells.” That binding “results in shedding of higher virus amounts and also likely a shorter incubation period, which translates into more transmissibility,” Adalja said.

Will my vaccination still protect me? What about booster shots?

The general consensus based on data available so far is that existing covid-19 vaccinations do provide significant protection, even from more aggressive or contagious variants.

“It’s important to know that this is not the first variant and this is not the last variant,” Adalja said. “It’s extremely unlikely that any variant is going to be able to erase everything that a vaccine does for us — meaning that even if you get a breakthrough with the omicron variant, it is likely to be mild; it is likely not to land you in the hospital. And the early data from South Africa, which is limited, is suggestive of the fact that people who are getting hospitalized with omicron are people who are not vaccinated.”

Moffa said that existing vaccines have proved to equip recipients with “such a high level of neutralizing antibodies against all circulating variants that have been discovered to date” and predicts the same to will hold true for omicron.

In AHN’s recent internal analysis of 473 covid-19 patients, “for pretty much every age group,” more than 90% of those hospitalized were unvaccinated, Moffa said.

“The take-home message for people really is, No. 1, don’t panic,” Moffa said. “Two: The best thing you can do to protect yourself is to get vaccinated if you’re not, and anyone and everyone should get a booster shot. It really leads to extra protection against all circulated variants and probably this (omicron) variant as well.”

Then there’s the other daily precautions that people should continue to keep in mind, including avoiding poorly ventilated or crowded indoor spaces, wearing masks in public and frequently washing hands.

“Eventually, covid is going to find everybody,” Moffa said. “You’re playing with fire if you’re deciding to be exposed to it without getting vaccinated, because that’s what’s putting people in the hospital.”

As the pandemic goes on, vaccine scientists and pharmaceutical companies are hustling to keep up and adapt to changing threats and emerging variants, akin to how the flu shot changes annually.

“The vaccines that were developed in 2020 were generated and made against a different virus than the viruses that are circulating at the moment,” Paul Duprex, director of the University of Pittsburgh’s Center for Vaccine Development, told the Trib earlier this year. “We just have to lie focused on what we have, how to tweak it and how to make second- and third-generation vaccines from what we have.”

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