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Despite omicron, reasons for hope in fight against COVID-19

If you are like me, you woke up the day after Thanksgiving with more than a turkey hangover.

Scientists in South Africa had discovered the most recent variant of SARS-CoV-2 (the virus that causes COVID-19). It came to be known as omicron, according to the naming convention adopted by the World Health Organization, in which variants of concern receive a moniker from the letters of the Greek alphabet.

It was likely already widespread by the time genomic sequencing confirmed its 50 mutations. Thirty of these mutations are in the critical “spike protein” region of the virus, which is needed for the virus to bind and gain entry into human cells. The spike protein is the target of COVID-19 vaccine antibodies and also certain treatments, such as monoclonal antibodies.

The dawn of 2022 marks the beginning of the third year of the COVID-19 pandemic. The road has been long, and many, especially those in front-line occupations, are tired. The fourth surge, sparked by omicron, is just beginning as we head into the dark and cold days of our third COVID-19 winter. Yet perhaps there is a glimmer of hope.

The beginning of 2021, amid a similar winter surge (that one was attributable to the alpha variant) brought hope from the rollout of COVID-19 vaccines. These have been and will continue to be the most important tool in the fight against COVID-19. Many lined up early to get immunized, and by spring, vaccines were widely available for adults. Since then, vaccine access has increased to include extra doses and boosters, as well as eligibility for children as young as 5.

The fully vaccinated were largely spared the severe illness associated with the delta variant in the summer and fall. Similarly, full vaccination accompanied by a booster dose for those eligible, is proving effective in preventing severe illness from omicron for the vast majority of people.

To be clear, omicron poses a real threat. It is much more highly contagious than previous variants and likely less responsive to some monoclonal antibody treatments. Breakthrough infections among vaccinated people are more likely, albeit also likely to be mild or asymptomatic.

It appears to spread earlier after infection, making the period of isolation or quarantine shorter (as little as five days if no symptoms). For those who are unvaccinated or partially vaccinated and for those with weakened immune systems, there is a significant risk of severe illness.

Now is not the time to risk another COVID-19 surge without getting vaccinated (and boosted if age 16 and older).

There is also hope in the New Year. Vaccines continue to be widely available and more people are eligible. They are generally effective in preventing severe illness. For the fully vaccinated, omicron appears to primarily cause mild illness, similar to the common cold. New treatments are being approved, including a long-acting antibody and two new antiviral pills – all within the last few weeks.

Increasing treatment options, like the third leg of a stool (along with public health measures, such as masking and vaccines), may begin to stabilize the pandemic even as omicron displaces delta. This offers the hope that the virus may gradually begin to enter its endemic stage as a common infection that poses less threat to the increasing proportion of vaccinated people.

Dr. Matthew A. Clark, a board-certified physician in internal medicine and pediatrics, works for the Indian Health Service.