Glossary

• Virus– a type of germ that consists solely of a bit of genetic material (DNA or RNA) wrapped in a protein coat.  The coat gets the genes into the target cell where the genes force the cell to make zillions of new viruses (genes and protein coat), and on it goes.
• Variant- also known as a mutation, a variant strain of a virus is the same species of virus but with a change in the genetic code.  The change is minor if it has no impact on contagious the new variant is, or how deadly it is, or if it allows the virus to neutralize our vaccines. Variants that substantially increase harm are now listed by Greek letters, the most troublesome one now is Omicron.
• Coronavirus– a species name of a number of different viruses.  Called corona because its protein coat is studded with spike shapes that form a crown, halo, or corona of spikes
• SARS-CoV-2– the specific name of the new coronavirus
• COVID-19-the name of the illness that the new coronavirus is causing
• Endemic– an illness always present in a region.  One could say strep throat is endemic in the US
• Epidemic– a sudden burst of an illness that comes and goes over a limited time
• Pandemic– an epidemic that bursts across the world not just one region
• Spreadability– how contagious is the disease, how many people will end up infected
• Symptoms- the experience of being ill, for example- fever, cough, headaches, loss of smell etc.
• Asymptomatic– literally means “without symptoms”.  For COVID-19 it refers a person infected with the virus but has no and will have not symptoms
• Presymptomatic– This is a person who was infected with SARS-CoV-2, and will feel sick, but hasn’t yet
• Severity– what harm does the disease cause, in terms of  how sick you get and how many it will kill
• Mask- a mask is a loose-fitting cloth or textile that covers the mouth and nose loosely.  A surgical mask is a mask used in surgery
• Respirator-  for the purposes of the COVID-19 pandemic and other respiratory illnesses, a respirator is a mask that fits very snugly or tightly to the user’s face.  An N95 mask is a respirator.
• PCR Test–  swabs the nose to detect the genes of the COVID virus.  The genes if detected are almost certainly there, but they can persist long after contagion ends.  Very few false positives, positives can be trusted.
• Antigen Test (the home kit)- swabs the nose to detect the proteins on the coating of the COVID virus, the spike proteins.  If it does not detect those proteins, you are almost certainly not infected, negatives can be trusted.  These proteins are also on the coating of many common cold viruses, so one positive test may indicate you have a cold rather than COVID.  Two positive home tests though reliably indicate you have COVID.
• Vaccine Terms
• Vaccine or Immunization– a dose of a substance that activates your immune system, as if you have the actual infection you are hoping to prevent, leaving you in fact protected from having that infection.
• Efficacy– the percentage of people immunized with a particular vaccine who will not get infected if exposed to the target infection.  For example, a COVID-19 vaccine will be said to be 95% effective if 95% of people immunized with that particular COVID-19 vaccine will not get COVID-19 if exposed to COVID-19
• mRNA– DNA works by dictating exactly which proteins your cell will make.  The message on how to construct each protein is delivered to the cell machinery that makes proteins by a piece of genetic material called messenger RNA, or mRNA
• mRNA vaccine– an mRNA vaccine places a small bit of mRNA code that makes your cells make a protein that is the protein from a virus that alerts your immune system and activates it to make protections against you being infected
• Viral vector vaccine– a viral vector vaccine takes a harmless virus that is known to infect people reliably and places that weakened virus in a person where that virus will in fact infect the person.  The virus is not only weakened, but also attached to a set of genes  that makes your cells make a protein that is the protein from a virus that alerts your immune system and activates it to make protections against you being infected.

As our United States approaches the tragic loss of 1 million of our lives, nearly everyone is deeply familiar with the connection between the emergence of variants and the recurrence of a surge.

As the newest variant, the COVID Omicron variant BA.2 sweeps across the world, this turns out to be a great time to consider, what determines which variant will be the main variant in our neighborhood?

This post will help us understand how that works.

A Brief Review of What is a Variant

Every virus is comprised of two key elements:

1. A package of genes and
2. A protein coat surrounding those genes.

The genes of every virus, in turn, have only two essential functions:

1. To attach the virus to a target cell, help it gain entry into the cell, and deliver its genes to the cell’s genes.
2. To force the target cell to make zillions of copies of the viral genes and the viral protein coat, which then assemble into zillions of new viruses to do the cycle all over again.

You might notice that all the details about the virus’ protein coat and genes, are defined entirely by the virus’ genes.   Only if the gene of the virus changes do any aspects of the viral coat or viral gene change.  And so, only by changing the gene of the virus are new varieties created.

A particular species of a virus, such as the one and only species that causes ALL COVID-  SARS-CoV-2-  may have a variety of small differences in their protein coats and genes, but all such varieties are all very similar, and create a virus that looks very much the same from variety to variety.

So, a variant of a virus, such as the major variants of COVID- Original, Delta, Omicron- result from changes in the genes of the COVID virus, SARS-CoV-2.  All the variants of this virus remain called SARS-CoV-2, and all these variant viruses cause the illness called COVID.

If a virus’ genes change enough that they no longer cause the same disease, then that new virus is not a variant of the same species, but a new type of virus all together.   That has never happened with SARS-CoV-2, the COVID virus.  All its variants are still COVID viruses.

How Do Variants Get Created?

If you think about it, the story of a virus really can be summed up in one word- a copier.  A virus is a very effective device to make copies of itself.

All life has this function too.  Every animal, plant, and bacteria on the planet is the result of an animal, plant, or bacteria very much like itself making a new copy.  For us humans, that copying process takes, on average about 20 year to create at least one more human.  One bacteria can copy itself to make one more bacteria in about 20 minutes.

Viruses copy themselves more rapidly than any other form of life.  One virus can make 100,000 new copies in 8 hours!!

But speed comes with sloppiness.  To copy a human requires 10 trillion cells to grow in working order from one fertilized egg.  Small errors in this copying process lead to massive errors that would leave the new person unable to live.   A bacteria can make so many more mistakes when it simply divides into two, and it does.

No form of life makes more mistakes in copying itself than viruses.  For the influenza virus, when one virus enters one cell in your nose, and makes 10,000 copies of new influenza virus from that one, about 99% of the new copied viruses are so terribly wrong that they can’t even live or copy themselves!

And so more than any form of life, virus copying is riddled with errors.  Any aspect of a copied gene that is different than the original is called a mutation, and so viruses mutate vastly more than bacteria, and vastly vastly more than animals or plants.

As you might gather from the influenza story, if a virus mutates too much, it hits a dead end, the new mutation cannot copy itself further and it dies off, never to be seen again.

But sometimes the vast multitudes of viral mutations yields a new type that can live, can do what the original did to a large degree.  These successful mutations are what we call variants.

Variants That Matter and Those That Don’t

Let’s consider one COVID virus, one SARS-CoV-2 virus.  It enters one cell in my throat, starting an infection that is called COVID in me.

In the process it copies itself as all viruses do, as noted above.  In the case of COVID, many of the newly copied viruses will work quite well to cause COVID in other cells, in me, and in other people.

We can forget about the very defective copies that can no longer continue to copy themselves, and focus only on the copies that will continue to copy, that is, infect.

Many of these effective copies will be so very close to identical to the original single COVID virus that we will say they are not variants, but true copies.

All the other copies that are different enough that a difference can be detected are variants of COVID.   Now some of these new variants will spread and harm the infected person just like the original.  These are variants that do not matter.

What Makes Some Variants Matter, and Others Not So Much?

The one group of copies of that first COVID virus that landed in my throat that really matter are the variant copies whose properties of behavior are very different than the original.  And the two ways that differences matter are variants that are much better and variants that are much worse.

And there two ways that a new variant can be different, for better or worse:  how well it makes copies and how sick it makes you in that process.

So a better variant would be one that copies so much better than the original, and barely makes you sick.   And of course a worse variant would be one that copies so much better than the original, and makes you much sicker.

You have likely noticed that the one property all variants that matter, whether for better or worse, are the ones that make the most copies.  We have seen this in real world trends over the last 12 months.

The original COVID virus, as readers of Real Answers know so well, spread to an average of 2.5 people per infection.  That means if I had COVID, took no precautions, and was around lots of people, on average I would infect 2.5 people.   That number reflects how successful a virus is in getting out of an infected person, being caught by another, and copying itself enough to spread very well.  Now if any virus spreads to an average of 2.5 people from every single infected person, then one person will lead to 2.5 cases, and each of these 2.5 cases will spread to 2.5.  That would mean one person with COVID would lead to 10,000 new cases if each round infected an average of 2.5 people.  And that original COVID virus took 5 days to copy itself rapidly enough to be able to spread to those others.  So 10 rounds would take about 50 days.

From November of 2020 to April of 2021, there were millions and millions of cases of COVID and huge numbers of variants, but none of those variant COVID viruses copied themselves better than the original, so none of them mattered that much.  Some were named, the UK variant, the Brazilian variant, but none took the place of the original.

Until Delta.  In April of  2021, someone in India got COVID and one of the copies of their COVID virus suddenly jumped to be able to spread to 6 people on average, instead of 2.5.  Still took 5 days to spread.  But If one person infects 6, and 6 infect 6, after 10 rounds of this level of spread one case becomes 60 million cases in 50 days, not 10,000.  As you can see when a variant copies itself better, it can overwhelm its ancestor, and Delta did.  In a few months, around the entire globe, nearly all cases of COVID were now the Delta virus, and it not only spread better, but it made you sicker.

From April 2021 to November 2022, Delta ruled despite many if not all people with COVID spewing out variants.  It’s just that none of those variants copied themselves better than Delta, so none pushed Delta away, until Omicron.  Somewhere in The Netherlands or South Africa, someone who caught Delta variant COVID made a copy whose error created a new variant, the Omicron variant.

Omicron took the average number spread up from 6 to 12, and critically, shortened the time from breathing in the COVID virus to breathing out spreadable virus from 5 days to 2 days.   Any virus that can copy itself so massively that one case on average spreads to 12 new infections is an historic copier.  Almost no germs known to humanity achieve this level of spread.  Measles spreads at the level of 12, and TB at 16, but not many more.  And the result is overwhelming.  If a virus spreads from one person to 12 and each of those 12 infect 12 leading to 144 new cases in just 2 rounds, imagine what 10 rounds can do- the number explodes to 61 billion cases.  And now 10 rounds happens in 20 days not 50.

And this is why Omicron has taken over.  Essentially every case of COVID on the planet is caused by an Omicron variant.  Again, everyone with Omicron variant COVID today is exhaling variant copies of their virus, but until a new variant emerges that can copy itself so well, infect so well, Omicron will remain the dominant variant.

The Current COVID Champ- Omicron Variant BA.2

And again, we see this happening in real time, there is a variant of the Omicron COVID variant, not different enough to call it a new variant all together,  but it is  several times more contagious than the original Omicron virus, and is called BA.2.  Today the World Health Organization reports that of all the tested cases around Planet Earth from Feb 16-March 17, 86% of the COVID infections are caused by the BA.2 Omicron variant.  In the US at this time, about 33% of new COVID cases are caused by BA.2, but since it copies itself better and more effectively infects, it is right now rapidly taking over all US cases.

Lucky for the world, the Omicron variant is the first major COVID variant that is milder than its predecessors.  This means even though it is a better copier and infector, the disease it causes is milder.  And it is also very good news that the COVID vaccines still work to keep those with Omicron infection from getting severely ill or from dying.

Tragically, all the Omicron variants, though milder, are still very capable of killing healthy people who have chosen to not be immunized.  Even though nearly all COVID infections in the US are from the weaker Omicron variants, still about 1,000 Americans are dying every day from these weaker variants.  If that rate was kept up for a year that would mean another 365,000 Americans would die from COVID, nearly all by choosing not to be vaccinated.

Bottom Lines

1. Viruses change astoundingly rapidly as they copy themselves during infection.  Most of these changes are meaningless, leaving the virus broken, or weaker, or about the same as the original, so the original dominates.
2. Rarely, someone with COVID will make copies of the COVID virus and one of the copies will have differences that let the virus copy itself and infect others far better.  Such a copy can push other versions of COVID aside as it copies so much better around the world, and becomes a variant of concern.
3. So far, out of the trillions of trillions of COVID virus copies made across hundreds of millions of COVID infections around the world, only two copies have yielded variants that could dominate global COVID infections:  Delta in April 2021 and Omicron in the fall of 2021.
4. Each of the two successful COVID variant winners won solely on their ability to copy better, and once landed, to infect better.  The improvements have been stunning.
5. In the case of Delta, the better copier made people sicker.
6. In the case of Omicron, the better copier made people less sick, but still plenty deadly to the unimmunized.
7. In both cases, the variant broke through the wall of not getting infected the vaccines held against the original COVID.  But neither variant has broken through the wall the vaccines still hold against COVID making you very sick or killing you.
8. Omicron variant BA.2 is right now taking over the planet, of course, including us in the US.  Fortunately its emergence does not indicate, at this time, a troubling surge of serious hospitalizations and upticks in death.  But like the original Omicron, it can kill the unimmunized.
9. Every time someone gets COVID, the virus copies in them, and then is breathed out.  In every such infection, copies that are breathed out are different than the one breathed in.  And so the chance a new, more deadly, variant emerging capable of causing a massive surge and sinking us back into caution, remains.  And whether that happens depends entirely on the virus and how it copies itself in each infection, not us.
10. Right now, the dominant variant, B.A2 and the use of vaccinations, allow us to move about without much risk, COVID is not spreading too wildly, hospital and death rates continue to drop even as we gather without masks.  Let us hope it stays that way. Let us keep our eye out for new variants of concern.  Let us all be vaccinated!

My Two Takeaway Sentences:

The SARS-CoV-2 virus will never go away, and so our experience of COVID will flow 100% on the chance that the next person to get COVID will allow the virus to make a mistake in copying itself that unleashes a new, deadly variant capable of a fourth great surge.

And so, as desperate as we all are for COVID to end, we need to remain vigilant for new, more dangerous variants, and MAKE SURE EVERYONE WE LOVE IS FULLY IMMUNIZED AS SOON AS POSSIBLE- the one great action each of us can take to save the lives of those we love.

To your health,
Dr. Arthur Lavin