Three years ago I purchased a 1000 piece Star Wars puzzle thinking it would be a fun family activity throughout the holiday season. We started putting the puzzle together during the Thanksgiving weekend while my parents were in town (my mom loves puzzles). We worked tirelessly (and often begrudgingly) on the puzzle for nearly four weeks. One Sunday morning we were all set to place the final pieces. It was then that we realized that a single piece of the puzzle was missing.
We spent hours searching in our living room for the remaining piece, as a 1000 piece puzzle is not complete with a mere 999 pieces. The missing piece was not in our living room. We then searched the trash and the dirty laundry and the Lego bins. The piece was nowhere to be found. After all of the searching, we remembered we had temporarily moved the puzzle from the coffee table to one of the bedrooms. A frantic search of that bedroom resulted in one of the kids finding the missing piece in between the bedsheets (do not ask how it got in between the sheets; it is still a mystery). Finally, we were able to place the last piece; thus completing the puzzle and seeing the epic scene from Star Wars (“Never tell me the odds”) in all its glory.
I tell this story because putting together a puzzle is HARD WORK. And that is exactly what public health, clinical, and laboratory researchers are doing right now in order to understand Omicron.1 And these researchers (who are working around the world and around the clock) do not have a box top showing them what the final puzzle will look like. They do not know how many puzzle pieces there are, and there is no guarantee that all the pieces will fit together into a simple/clear picture of Omicron.
However, the puzzle must be solved/completed in order for effective public health policies, recommendations, and interventions to be put into place.
Since Omicron was named a variant of concern nearly two weeks ago, the race to answer all of the questions has begun. Key questions that need to be answered (in order for the puzzle to come together so that the public health workforce can quantify and communicate the risks associated with Omicron and the policies, programs, or interventions necessary to slow the spread of disease) include —
How transmissible is Omicron?
Specifically, we are looking for the R-nought (aka the reproductive value, which is the average number of people a single case will spread the disease) of this variant. Preliminary data from South Africa hint that Omicron is highly transmissible. Cases in South Africa are growing exponentially (more than 10,000 incident/new cases per day on several occasions in the past week).Early estimates of R-nought of Omicron in South Africa are between 2-3. This means that each case of Omicron is transmitting the disease to 2-3 additional people (hence the exponential growth in daily case counts). Reports coming out of the UK estimate the R-nought to be higher (~3.5). Additionally, the UK is reporting that 2% of all COVID cases are caused by the Omicron variant. While this is a small percentage, it has huge implications — Omicron is showing signs of spreading quickly and being able to do so faster and more efficiently than Delta. With exponential growth, Omicron could be the most dominant variant in a matter of weeks.
Will Omicron escape our immune system?
Since Omicron has 32 mutations/differences in the spike protein, there is concern that our immune system may not recognize this variant of the SARS-CoV-2 virus, and therefore, it will be able to cause more infections (even among individuals who have previously been infected, vaccinated, or both).
Yesterday South Africa released the results of laboratory analyses that showed a marked (40%) decrease in the number of neutralizing antibodies among vaccinated individuals (2 shots of Pfizer) when the immune system was exposed to the Omicron variant. HOWEVER, this does not mean the vaccines are ineffective or that Omicron can evade/escape vaccine-induced immunity. My interpretation of these findings is that we will see more breakthrough cases of disease, especially among those who have not received a booster shot. Preliminary data from Pfizer supports my thinking — they found that individuals who are boosted have a stronger immune response to Omicron compared to those who have only received their first two shots.Will Omicron cause less serious disease?
In Gauteng, South Africa - which is currently the epicenter of Omicron - the number of COVID cases requiring hospitalization is growing exponentially.I also think it is important to note that it is NOT just the elderly who are being hospitalized. There is a wide range of ages among those who are hospitalized with Omicron.
On a more encouraging note — an early report out of South Africa has provided evidence that individuals hospitalized with Omicron require fewer treatments (fewer people requiring supplemental oxygen or a ventilator) and their hospital stay is considerably shorter than individuals hospitalized with Delta-COVID. BUT this is a small (only 42 cases) study in one location. More information is needed (remember: hospitalization and death data lag behind - often by weeks - the new case data). Time will tell…Will Omicron spread more readily among children?
An initial report from South Africa noted an uptick in hospitalizations among children under the age of 5. But the question about the spread of Omicron in children remains unanswered at this point in time. If you are worried about your children, get them vaccinated and make sure they wear a mask. If your kid is younger than 5, make sure all of the individuals that they interact with (and who are older than 5) are vaccinated and try to have them wear a mask while they are indoors with other kids at daycare, preschool, or other activities.
As more Omicron puzzle pieces are identified, there is going to be a flood of information. Please keep in mind that public health policy, programs, and interventions will not change based on a single piece of information or one report (those are just pieces of a much larger puzzle).
It is neither helpful nor healthy (individually or as a community) for us to treat each data report as public health gospel (read: a fact/thing that is absolutely true).
Instead, we need to remind ourselves that each report or new piece of news that is reported is just a piece of the puzzle. The puzzle itself is NOT yet complete. And what we know now may be amended, changed, or not generalizable (the ability to apply the results of a study to a broader group of people/situations).
My advice as we enter the holiday season is to get vaccinated, get boosted (if eligible), wear a mask indoors, and stay home if you are not feeling well. Stay tuned for more information about Omicron. And you can do that (easily) by subscribing here —
Fun fact: the Wall Street Journal published an entire article on Monday about the pronunciation of Omicron. According to the WSJ it is AWE-mee-kron.
Awesome article!!!! You certainly have a gift for explaining things so everybody can understand that is laced with humor. I absolutely LOVE the video!!! Thank you as always for sharing your knowledge with us!!!