omicron – a new pandemic driver?

Will a vaccine mandate and a lockdown be necessary?

December 13, 2021

Started in February 2020, the SAJO blog is providing a thread through the pandemic with up-to-date information and suggestions around SARS-CoV-2.

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Dear readers,

The current situation is a s follows:

Internationally, Germany is placed second when it comes to new infections. We count 6.5 M infected, with over 105,000 registered casualties. Worldwide, more than 270 M people were infected. These are the numbers of the Johns Hopkins University on December 13, 2021:

The US are leading the “World Ranking” of new infections, followed by Germany, the UK, Russia, France, Turkey, Poland, and The Netherlands.

About two weeks ago, a new variant emerged, near Johannesburg, South Africa. Infection numbers there suddenly doubled. The R-value had been pushed down to below 1, and suddenly jumped to more than 2. This alerted the scientists to take a closer look. That is how this variant was detected. (Nature News, December 2, 2021).

The Omicron variant is capable of infecting those recovered and vaccinated, which is giving it a perfect prerequisite for immune escape. Scientists reported the variant could overcome antibody treatment in laboratory settings. This was also reported by the renowned laboratory of Paul Bieniasz at the Rockefeller University in New York, one of our colleagues, whom we know from several Cold Spring Harbor Retrovirus Meetings. His statements are trustworthy.

In return for the early warning, South Africa was put on a no-fly-list by numerous countries. To us, this is incomprehensible. The variant was found very quickly in South Africa, and it was immediately reported to the WHO. At that point it was already circulating around the world. No-one knows in what country and region this variant had its origins. What will this tell other countries, that identify a new variant? Whoever reports further variants will be penalized. South Africa had acted admirably, and now in return they are running out of diagnostic supplies. Bravo, Europe! This must change immediately.

What are omicron’s properties?

We know little about this new variant, except for the fact that it is spreading very fast, and shows more than 30 mutations in spike, at positions where antibodies (may) bind.

Part of these mutations are known from the alpha and delta variants, but 26 mutations are unique. This is bringing up the questions of the viral origin. Three hypotheses are currently being discussed by virologists.

  1. Maybe the virus was circulating within an immunocompromised person. A weak immune system is giving the virus time to adjust to the pressure by mutation.
  2. Possibly, the virus emerged in a region where testing is not available, and infection numbers are not being traced. After some time, the virus could accumulate numerous mutations, that are not found in other places.
  3. SARS-CoV-2 is infecting many different mammalians, among them are pets! Cats are susceptible to the virus. Last week, three snow leopards died of it in an American zoo. Thus, one hypothesis would be a ping-pong infection between animals and humans. Each jump across the species barrier forces the virus to adjust to its new host.

The virus also took another chance to change. Sequence analyses showed that Omicron contains an insertion, acquired from another coronavirus. It had exchanged genetic material with its cousin HCoV-229E. Such exchanges are happening all the time in the viral realm. HCoV-229E is circulating in humans for many decades, with little pathogenicity, it is well adapted. This may be good news or bad news. We just don’t know yet.

Its reproduction rate is astounding, though. In Denmark within three days a tenfold increase in Omicron infections was recorded.

Denmark is sequencing most PCR samples therefore they know exactly what variants are circulating. Not so in Germany, where a minuscule number of samples is being sequenced. No-one knows how far Omicron is distributed here.

If Omicron is resulting in different pathogenicity compared to other variants, i.e. being more or less aggressive, we cannot say, since this depends on who is infected. It is depending on age and predispositions. In general, though, non-vaccinated people will be more affected, as well as more vulnerable populations.

Preliminary data from South Africa are indicating that with drastically increased infection numbers, hospitalization numbers remain steady. Should this be confirmed, it would be the best news since February 2020. However, these data need to be taken with care, since South Africa was hit hard by the Delta variant infecting a big part of its population. South Africa is a young society, there are far more youths than elderly. In Europe this is the opposite. Hence, we cannot draw any conclusions yet.

Since this variant obviously is spreading a lot faster, it will “hit” more people than previous variants. Precautions and protective measures are necessary. Yet again, we are appealing for mandatory vaccinations of people working in areas such as nursing homes, childcare, schools, universities, hospitals and others, as fast as possible. Indoors, donning N95 masks in combination with a vaccination is a MUST!

Omicron will become most dangerous for the unvaccinated. This will become interesting for countries like the US, where vaccination rates are around 60 %. What will happen, should omicron get a foothold in China? More than 1 billion unvaccinated people, the virus would hit a largely naïve population. Let’s hope this will not happen.

Will booster shots help against Omicron?

Again, we are pointing to Paul Bieniasz, who thinks an antibody bulwark will protect from Omicron. We agree, it may work, if antibody titers are high enough at the time of infection. Hence our call: Get vaccinated, get your booster shot, make sure your antibody titers are high.

In scientific journals it was published that antibody titers are dropping by 50 % after 90 days, depending on age.

Thus, booster shots are not enough. Other measures need to be taken, most of all the most efficient and easy instruments: N95 masks AND a polite distance! In closed rooms distancing is not enough without N95 masks.

Please, accept a booster shot offer, even after only five months. There are numerous reasons for this.

It will take several weeks to find out how well current vaccines will protect from the new variant. First data are indicating a reduced activity. However, we should acknowledge that each individual vaccination will be better than no vaccine at all. In the end, this might be the tip of the scale when it comes to a life and death situation, even with younger people.

Each and everyone may be infected – vaccinated or not – and give the virus to others. Most of the rapid tests only identify individuals with the highest viral loads. Only PCR tests will identify all infected people. They are extremely sensitive. We are repeating ourselves – N95 masks, distancing, air exchange every 20 minutes, are reducing the risk of infection.

In the current situation it is important that even with 2G (German abbreviation for recovered or vaccinated), 2G+ (2G with additional negative tests) or 3G (recovered or vaccinated or negatively tested) N95 masks are worn indoors. Avoid gatherings.

N95 masks are providing a high if not 100 % protection.

This has been demonstrated by a recent scientific study of the Max-Planck-Institute in Göttingen, Germany:

Bottom line: It is N95 masks that will protect you. All others are worthless.

N95 masks are the easiest and most effective tool to protect yourself. They need to be applied correctly, though. This might be an issue for those among us sporting a beard, as an amusing illustration of the American Centers for Disease Control and Prevention shows:

It is a mix of all the measures that makes the difference: N95 masks, vaccination, a polite distance, reduction of contaminated air by ventilation or AC, and finally tests to have some peace of mind. Generally, is means to avoid situations bearing a danger of infection. This is called avoidance strategy.

Will politics guide us from the pandemic through a vaccine mandate?

The political strategy to vaccinate is good, but it will NOT lead us out of the pandemic. We expect more variants to come, that will more and more evade the vaccines. This virus is changing at a scary pace, there is no lifelong immunity, which means a strategy based solely on vaccination will not lead us out of this situation. Once politics is reacting, measures are obsolete already. A long-term strategy is needed, as to how to deal with the pandemic in the coming years.

Does a mandatory vaccination make sense?

German lawmakers are aiming at a general vaccination mandate by February 2022.

As scientists, we want to mention: A mandatory vaccination and the associated enforcement we consider wrong for the following reasons:

  1. Against this virus, neither a vaccine nor an infection will provide a lifelong immunity.
  2. February 2022 is way too late, since we expect that on the viral side we shall be confronted with more mutants, after Omicron. The current vaccines will become obsolete. Hence, new vaccines or adjusted ones need to be developed.
  3. The pandemic, as its very name suggests, is a global problem. As long as the populace of whole continents are not being vaccinated, new variants will emerge. There vaccines are needed!

The motivation of politicians to impose a mandatory vaccine are based upon a total previous failure on political and societal grounds. A vaccine mandate now is supposed to correct this.

Psychologically a vaccine mandate will result in the opposite in parts of the society. It is putting unnecessary pressure upon these people. We do not think of this as a solution. You better explain, show the consequences (triage, no medical treatments due to overburdened hospitals) and give people who will or can not be vaccinated protective tools: N95 masks, keeping a polite distance, avoiding mass gatherings. The risk people are willing to take, is an individual one.

Those, who decide to take a risk of infection due to their behavior, could be answered by a higher health insurance fee.

In our view, everyone may decide on their own, but will have to bear the consequences. These may include not getting an ICU bed, or to pay part of the treatment costs, or to accept higher health insurance costs. The higher the risk of getting the disease by negligence such as refusing a (free of charge) vaccine, the lower our acceptance of the community having to bear the (avoidable) burden.  Carelessness may be penalized and sanctioned ahead. Why should the community bear the costs vaccine deniers are causing, without any medical indication against it. These are a very small number, that cannot be vaccinated. They need to be protected.

This is our suggestion as an alternative to a vaccine mandate.

Vaccine opponents are found mostly in regions where the catholic church is having a big influence, or where in the past a distrust in government had grown. Mothers and wives are the central figures in such families, having great impact. Meaning is depending on general education. According to the old-fashioned role models prevailing there to-date, this is rather low. Information is drawn from yellow press, the German tabloid BILD, and other gutter press, as well as from dull social media channels with their much-feared misinformation campaigns. Mothers are educating their children. These central family figures are imposing their power. The mother/wife is mirroring the behavior of family members. She is relishing the trust, which is given to her naturally. When there is no counterweight by schools and education, this influence is crucial.

Will a mandatory vaccination replace the wearing of N95 masks?

Today, we know N95 masks AND distancing AND air exchange (your behavior), together with a comprehensive vaccination campaign, are providing the best protection against Omicron and further variants – in combination. Should all this be implemented, there is no need to close shops, schools, or theaters. It is the individual behavior and the acceptance, that the virus is here to stay. We have to act accordingly to minimize infection risks. Returning to old habits after vaccination simply does not work.

It is a must: When in closed spaces, wear an N95 mask. If you cannot avoid mass gatherings, wear the mask, too.

A call to our politicians:

We, the whole world, is facing an emergency. We are experiencing one of the worst epidemics, of which we might just have seen the tip of the iceberg. We need capable people in such a crisis. One general will not suffice. You better educate, so that people may deal with dangerous situations.

Perspective: Co-infections with SARS-CoV-2 are happening!

What will the evolutionary track of SARS-CoV-2 be like, under selective pressure, with co-infections? One hint we got as described above. SARS-CoV-2 had met a related cousin (HCoV-229E) in a patient and made some “exchanges”. It will acquire more properties, in spreading, producing progeny, in stability, in immune escape, and others.

Would a lockdown help?

A short, but complete lockdown, would help to relax the situation in hospitals. However, since we may anticipate that after a lifting of measures, people will go back to “normal”, things will start again as last year, it will lead to nothing. We are missing responsible behavior. To “penalize” with a lockdown, just to return to old habits will not work. “Normalcy” must be redefined. The pandemic will keep us busy for years to come. Intelligent people have the capacity to adjust to changing circumstances.

Once again: Most important are booster shots and wearing N95 masks in closed spaces, in addition to distancing, and air exchange (a complete one once every 20 minutes). Each and every-one of us is capable of doing so. Additionally, an avoidance strategy is advisable, to reduce the risk of getting infected. If all of us were to adhere to these simple rules, a lockdown is unnecessary.

Stay informed and alert!

Yours, Joerg and Sabine

SAJO – for a healthy and better future!

SAJO is consulting all around infectious diseases. We are applying our know-how, that we have acquired in more than 20 years. We do what we can to fight this pandemic.

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