Forget the debate over how scared we should be of omicron. What matters is putting our energy into solutions that work — taking action that matters on a personal level and demanding effective actions from world leaders.
Scientists are already scrambling to learn how well our existing vaccines will work against this new coronavirus variant. That can help predict how much benefit might come from speeding up worldwide vaccination and booster campaigns, and whether vaccine passports will protect people or give a false sense of reassurance.
Reports that most omicron cases are mild are understandably reassuring for many individuals — especially those of us who aren’t elderly or immunocompromised and have access to booster shots. But some scientists have frowned on such optimism because of the larger picture. If this thing keeps growing exponentially and infects millions of people in a short time, health systems will collapse, even if a tinier fraction of cases are serious.
Cases are rising rapidly in the UK and South Africa, suggesting that omicron has some advantage over delta, the currently dominant coronavirus variant. It might be that it’s inherently more transmissible, or that it’s better able to get past immunity in those who’ve been infected or vaccinated, or some combination of those factors.
Omicron’s genes are weirdly different from previous variants, appearing to be only distantly related to delta. No one is sure where it came from — possibly from growing for months in immune-compromised patients, or from leaping into an animal host and back into humans.
It has 21 mutations in the top part of the spike protein, molecular epidemiologist Emma Hodcroft of the University of Bern said in an interview. Some of these mutations are alarming because they’d been observed in earlier variants that were good at evading immunity from vaccines or past infections.
In just a couple of weeks, scientists have accumulated an impressive amount of preliminary data. Some labs assembled mock versions of omicron by genetically manipulating other variants to carry some of the variant’s key mutations, Hodcroft said. Researchers can grow these “pseudo viruses” in petri dishes and test how well they stand up to antibodies extracted from the blood of vaccinated or previously infected people.
Then last week, a lab in South Africa made headlines with results on the behavior of actual samples of omicron. It found the virus did somewhat evade immunity generated by two shots of the Pfizer vaccine, but was neutralized well by antibodies taken from patients who had been both vaccinated and previously infected with earlier variants. At around the same time, Pfizer announced that antibodies from a booster shot helped stop omicron in laboratory experiments, though the findings aren’t peer reviewed, and outside researchers didn’t get to see the data.
At a press briefing Wednesday, Harvard infectious disease specialist Yonatan Grad said they still don’t know details of any of these experiments. Did the blood come from people who were vaccinated last month or 10 months ago? This matters because other studies demonstrated that antibodies from the Pfizer and Moderna vaccines wane significantly over six to nine months.
“In real humans, it might be more complex, but I think we can probably say that we expect more reinfection or breakthrough infections with omicron than we’ve seen with other variants,” Hodcroft said.
How severe those infections will be isn’t clear. Vaccines (or past infection) leave people with immune cells that hide in the bone marrow and lymph nodes, and these become activated if there’s a new infection and create a bunch of new antibodies. Lab experiments wouldn’t necessarily capture this phenomenon.
With only partial knowledge about the dangers of omicron, wealthy countries such as the US are starting to push harder to get third doses into everyone, though we’d save more lives by getting initial doses to countries with low supplies. Scientists will know a lot more in three or four weeks, when cases of severe disease would be expected to crop up, after omicron has spread and cases have had time to progress, and epidemiologists can measure how fast the variant is expanding outside South Africa.
How and where the disease spreads will depend on past cases in the population, vaccine uptake, seasonal cycles and other factors nobody yet understands. The past behavior has been surprising.
Earlier variants, including alpha, rose fast in the eastern US in the fall of 2020 and then plummeted in the middle of the winter 2021. Those early variants barely touched India, but delta suddenly exploded there in the spring of 2021. That wave, too, crested and fell suddenly.
With omicron, the severity of disease is going to be particularly hard to ascertain without waiting until it infects a sizable number of people of different ages. The original version of SARS-CoV-2 was mild in most people — and it was enormously destructive.
“Even if Omicron has a milder severity — and we don’t know this at the moment — if it spreads really quickly, even a smaller percent of a big number is a big number,” Hodcroft said. “We’re also, in most of the West, fairly ill-prepared for this, since our delta cases are riding so high — we have very little wiggle room left.”
So the best-case scenario would be either that omicron isn’t as transmissible as it first appeared and it fizzles out, or that it’s only little more transmissible than delta and a lot milder — so mild that almost nobody has to be admitted to an ICU.
“It would be the best thing we can hope for,” Hodcroft said, but it’s not something she or other experts are betting on.
Hope is fine as long as it doesn’t lull people into inaction or lessen the sense of urgency. A lot can be done now, including producing omicron-specific vaccines and doing a better job of distributing existing vaccines to the countries that need them most. People need to be ready for more restrictions if the worst-case scenarios play out.
There’s some evidence that vaccinations cut back on transmission. That means the more shots we can get into arms around the world, the fewer chances the virus has to stumble on some new variant — perhaps something that’s not mild at all.
The Canadian government says it will donate up to 200,000 vaccine doses to fight the mpox outbreak in Congo and other African countries.
It says the donated doses of Imvamune will come from Canada’s existing supply and will not affect the country’s preparedness for mpox cases in this country.
Minister of Health Mark Holland says the donation “will help to protect those in the most affected regions of Africa and will help prevent further spread of the virus.”
Dr. Madhukar Pai, Canada research chair in epidemiology and global health, says although the donation is welcome, it is a very small portion of the estimated 10 million vaccine doses needed to control the outbreak.
Vaccine donations from wealthier countries have only recently started arriving in Africa, almost a month after the World Health Organization declared the mpox outbreak a public health emergency of international concern.
A few days after the declaration in August, Global Affairs Canada announced a contribution of $1 million for mpox surveillance, diagnostic tools, research and community awareness in Africa.
On Thursday, the Africa Centres for Disease Control and Prevention said mpox is still on the rise and that testing rates are “insufficient” across the continent.
Jason Kindrachuk, Canada research chair in emerging viruses at the University of Manitoba, said donating vaccines, in addition to supporting surveillance and diagnostic tests, is “massively important.”
But Kindrachuk, who has worked on the ground in Congo during the epidemic, also said that the international response to the mpox outbreak is “better late than never (but) better never late.”
“It would have been fantastic for us globally to not be in this position by having provided doses a much, much longer time prior than when we are,” he said, noting that the outbreak of clade I mpox in Congo started in early 2023.
Clade II mpox, endemic in regions of West Africa, came to the world’s attention even earlier — in 2022 — as that strain of virus spread to other countries, including Canada.
Two doses are recommended for mpox vaccination, so the donation may only benefit 100,000 people, Pai said.
Pai questioned whether Canada is contributing enough, as the federal government hasn’t said what percentage of its mpox vaccine stockpile it is donating.
“Small donations are simply not going to help end this crisis. We need to show greater solidarity and support,” he said in an email.
“That is the biggest lesson from the COVID-19 pandemic — our collective safety is tied with that of other nations.”
This report by The Canadian Press was first published Sept. 13, 2024.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
HALIFAX – The Nova Scotia government says it could be months before it reveals how many people are on the wait-list for a family doctor.
The head of the province’s health authority told reporters Wednesday that the government won’t release updated data until the 160,000 people who were on the wait-list in June are contacted to verify whether they still need primary care.
Karen Oldfield said Nova Scotia Health is working on validating the primary care wait-list data before posting new numbers, and that work may take a matter of months. The most recent public wait-list figures are from June 1, when 160,234 people, or about 16 per cent of the population, were on it.
“It’s going to take time to make 160,000 calls,” Oldfield said. “We are not talking weeks, we are talking months.”
The interim CEO and president of Nova Scotia Health said people on the list are being asked where they live, whether they still need a family doctor, and to give an update on their health.
A spokesperson with the province’s Health Department says the government and its health authority are “working hard” to turn the wait-list registry into a useful tool, adding that the data will be shared once it is validated.
Nova Scotia’s NDP are calling on Premier Tim Houston to immediately release statistics on how many people are looking for a family doctor. On Tuesday, the NDP introduced a bill that would require the health minister to make the number public every month.
“It is unacceptable for the list to be more than three months out of date,” NDP Leader Claudia Chender said Tuesday.
Chender said releasing this data regularly is vital so Nova Scotians can track the government’s progress on its main 2021 campaign promise: fixing health care.
The number of people in need of a family doctor has more than doubled between the 2021 summer election campaign and June 2024. Since September 2021 about 300 doctors have been added to the provincial health system, the Health Department said.
“We’ll know if Tim Houston is keeping his 2021 election promise to fix health care when Nova Scotians are attached to primary care,” Chender said.
This report by The Canadian Press was first published Sept. 11, 2024.
ST. JOHN’S, N.L. – Newfoundland and Labrador‘s chief medical officer is monitoring the rise of whooping cough infections across the province as cases of the highly contagious disease continue to grow across Canada.
Dr. Janice Fitzgerald says that so far this year, the province has recorded 230 confirmed cases of the vaccine-preventable respiratory tract infection, also known as pertussis.
Late last month, Quebec reported more than 11,000 cases during the same time period, while Ontario counted 470 cases, well above the five-year average of 98. In Quebec, the majority of patients are between the ages of 10 and 14.
Meanwhile, New Brunswick has declared a whooping cough outbreak across the province. A total of 141 cases were reported by last month, exceeding the five-year average of 34.
The disease can lead to severe complications among vulnerable populations including infants, who are at the highest risk of suffering from complications like pneumonia and seizures. Symptoms may start with a runny nose, mild fever and cough, then progress to severe coughing accompanied by a distinctive “whooping” sound during inhalation.
“The public, especially pregnant people and those in close contact with infants, are encouraged to be aware of symptoms related to pertussis and to ensure vaccinations are up to date,” Newfoundland and Labrador’s Health Department said in a statement.
Whooping cough can be treated with antibiotics, but vaccination is the most effective way to control the spread of the disease. As a result, the province has expanded immunization efforts this school year. While booster doses are already offered in Grade 9, the vaccine is now being offered to Grade 8 students as well.
Public health officials say whooping cough is a cyclical disease that increases every two to five or six years.
Meanwhile, New Brunswick’s acting chief medical officer of health expects the current case count to get worse before tapering off.
A rise in whooping cough cases has also been reported in the United States and elsewhere. The Pan American Health Organization issued an alert in July encouraging countries to ramp up their surveillance and vaccination coverage.
This report by The Canadian Press was first published Sept. 10, 2024.
