• Original Articles By Dr. Lavin Featuring Expert Advice & Information about Pediatric Health Issues that you Care the Most About

    COVID Update November 29, 2021: The O Variant – Omicron – What We Know, What We Don’t Know, What to Do Right Now


    • 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 Delta.
    • 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.
    • Live Virus Swab– this is the swab which attempts to swipe live virus from one’s nose or throat to see if you are currently infected.
    • Antibody Test- (aka serology test) this is the blood test which looks for antibody to the SARS-CoV-2 virus to see if you have been infected in the past.
    • 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.


    A Reminder on Variants

    Readers of Real Answers know that some viruses change as they copy themselves during infections.  Some do not.  For example, the measles virus today is pretty much the same virus as the one that infected people 100 and more years ago.  The same is true of the chickenpox virus, and many others.

    But many viruses actually do change during infection, how is that done, why does that happen?  To understand the very idea of variant, one simply has to think about what a virus infection, and virus infection, is.  It is the landing of a tiny bit of genetic information on a cell, information that gains entry to the cell’s own genetic machinery, takes over that machinery to force it to make zillions of copies of itself, and then those copies do that sequence over and over again.  When we say a virus has infected someone, we are really saying it has found a way to make copies of itself that then make more copies of itself.   It is the destruction of our cells in that process that cause all viral symptoms and suffering.  But at the heart of the reality of a virus is the copying of the virus.

    Now, imagine a copy machine that copies a copy of your original document, say 100 times.  Can you recall how that image gets distorted as you copy a copy of copy, etc.?  After awhile it is hard to read the copy.  The measles and chickenpox viruses have extremely accurate copying powers, no distortion over time to speak of.  One of the worst copiers is the influenza virus, which does such a terrible job that about 99% of its copies can’t work anymore, no longer can make new copies, and so cannot infect.  We have influenza around because 1% of a zillion is still plenty to cause epidemics.   But all those errors mean that the influenza virus changes like crazy during any epidemic and across any year.  That is why the flu vaccine fails to protect for more than about a year, by the time the new influenza epidemic rolls around every year, it is like facing a nearly new virus all over again.\

    The SARS-CoV-2 virus, the virus that causes COVID-19, is somewhere between measles and influenza.  It does not create wildly different changes as it copies at the level of influenza, but far more than the staid measles virus.

    When a virus, during the copying that is at the heart of any viral infection, makes a different version of itself, that change is technically called a mutation, but we have come to call COVID mutations, variants.

    The COVID Variants

    If you look very closely at the genetic sequences of the SARS-CoV-2 virus after someone has COVID, you will often see some changes in just about everyone.  That is the virus you breathe out during your COVID infection will likely be different than the one that landed on you to cause your COVID.

    Fortunately for all humanity, nearly every SARS-CoV-2 virus that comes out of a COVID afflicted person that has changed, is a change with no real worries.

    How can this be?   Because the virus’ genes really serve only a handful of purposes.  Those are:

    1. Survive the time from those infected to those to be infected.
    2. Once landed on a person, be able to attach to their cells and enter their cells.
    3. Once in the cells of a new person, make zillions of copies that can do all these steps over and over again.

    Change the genetic directions for any of these a tiny bit, and the virus will do all 4 steps about the same way.  These countless variations that have happened since COVID first appeared are meaningless, because they do not change how the pandemic behaves much at all.  We  have no names for these billions upon billions of variants.

    But every now and then, one virus coming out of someone with COVID will allow the SARS-CoV-2 virus to wreak more havoc.

    We call these variants now, variants of concern.  Only variants of concern get tagged with a Greek letter.

    But there is yet another level of danger when we rank new variants of the SARS-CoV-2 virus, that is a level at which the concern becomes a new reality.

    Here is where we stand in our history of COVID variants:

    1. The epidemic started with the original virus.
    2. Since that time there have been countless variants of no concern, variants that behave very much like what is already all around.
    3. There have been many variants of concern, these include the UK, Brazilian, and even a South African variant, the alpha, beta and gamma variants.  And more recently the mu variant.   But you don’t hear much about alpha, beta, gamma, mu, or others, because they did not take over, they did not change the world’s actual deep experience of COVID.
    4. Only one variant of concern, so far, has made the leap from a variant of concern to a real change of reality, the Delta  Delta became a new reality because it was wildly more contagious, and in just a few months took over the COVID epidemic.  Now across the planet, nearly everyone with COVID today has the Delta variant.

    How Major New Variants Warp Reality

    The only major variant to twist reality substantially was, as noted, Delta, which appeared first in April and has since taken over all COVID infections.

    Before Delta, it looked like if a nation achieved 55% of its population immunized, COVID would essentially cease to spread across the land.   The choice of 45% of people to refuse to be protected, would harm no one.   This was our reality in the US in May and June.

    But with Delta, it is now unclear what level of immunization will actually stop spread.  The unimmunized are so susceptible, that Delta can light the deadly fire of COVID surging even if only 20% have chosen to refuse protection.  And so the death proceeds, and the need for everyone to be careful continues.

    And Now Come the O, the Omicron Variant

    Readers of Real Answers may recall that as long as COVID is allowed to spread, the threat of major variants hangs over our heads.  Fortunately we have not seen a variant of concern as worrisome as Delta since April, until, perhaps now.

    Keep in mind, what is bad news when it comes to COVID variants?  Only 3 things:

    ONE – how well does it spread?

    TWO – how sick does it make you?

    THREE – will the new variant kill the immunized?

    Let’s look at all 3 worries:

    ONE- Omicron spreads better

    Omicron appeared in South Africa and as of the morning of November 29, 2021 is in 17 nations despite rapid actions to slow travel.  Those studying Omicron are united in thinking Omicron is almost certainly in the US.  The data strongly indicate that Omicron spreads better than Delta, and is poised to push Delta aside and become the new face of COVID.

    TWO- We don’t know if Omicron makes you more ill than the original or Delta, but we should know in a few weeks.

    THREE- This is the one that scares me.  If a new variant cannot kill the immunized, then we all have the answer in hand today for that new variant, get the vaccine and be safe.   But if a new variant should arise that can kill many how are fully immunized, that would be so, so painful and harmful.

    And on this most crucial point, we simply do not know the answer, Omicron is too new.  But we are seeing some worrisome trends.  There are already a number of people who are fully immunized who have been infected by Omicron, we do not know if they are less sick than the unimmunized, but again should know in a few weeks.

    So, Omicron clearly has the potential to be not only a variant of concern, but one that changes reality, the first really s6ince Delta.

    The Omicron COVID variant is being studied around the globe and we should know more about it in a few weeks.

    Bottom Lines

    1. Some viruses make mistakes when they copy themselves in the process of viral infection.  Some don’t.  For example, measles today is much the same as 100 years ago.  But influenza viruses change radically all the time.
    2. The virus of COVID, SARS-CoV-2, changes with infection, not as much as influenza, but clearly more than measles.
    3. To date, only one change has come to take over the world of COVID, the Delta variant.  It did so because it spreads way, way better than other versions.  It achieved the ability to infect the immunized, but not to kill many of the unimmunized.
    4. Now comes Omicron.
    5. SPREAD. It appears to spread even more wildly than Delta, which means big surges of COVID, especially in those who have chosen not to get protected with a vaccine, are likely.  In a very short time it is spreading across 17 nations, and likely will spread across the globe.
    6. DEGREE OF SICKNESS.  It is too early to know if Omicron will make one sicker.  But we will know as it spreads.
    7. WILL THE VACCINE STOP IT?  It is too early to know if you are immunized against COVID whether Omicron will not only infect you but put you at serious risk of deadly level of disease.  If it does, new vaccines against Omicron may be required.
    8. While we wait to see if Omicron makes people more dangerously ill, and whether it can break the shield of COVID vaccination, we sadly are thrust back into the position of trying to stop its spread.   Four words summarize what we must do RIGHT NOW:  Mask, Vaccinate, Don’t Gather.
    9. MASKS.  For the wildly contagious Delta, masks cut the risk of getting COVID in half!
    10. VACCINATE.  There is no doubt that the number of us who will be killed by Omicron will be less if we all get the vaccine.  IF YOU ARE NOT VACCINATED, OR GOT VACCINATED MORE THAN 6 MONTHS AGO, GO GET VACCINATED RIGHT NOW.  The vaccine is free, it is everywhere, it can save your life, and a new danger looms, please, please, please get the vaccine now.

    My One Takeaway:  

    Omicron could be a devastating variant, the first since April, and it demands that we act NOW to slow its spread, or suffer its harms.   Wear Masks, Get Vaccinated, and rethink large holiday gatherings, until we know more.  Everyone of course hopes this new variant will be a dud, but until we know that, why not act to limit its punch?

    To your health,
    Dr. Arthur Lavin



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