The Omicron Wave Seems to Be Receding — What’s Next?

Caesar Djavaherian, MD, MS, FACEP
January 21, 2022
5 mins

Editorial note: This blog post was updated on January 22, 2022, to reflect our current understanding of the Omicron variant:

The COVID-19 surge brought about by the Omicron variant is still raging, but as infection rates drop rapidly in some areas of the U.S. and some other countries, the WHO (World Health Organization) and other organizations have expressed hope that the worst of the surge is over.

However, health experts agree that COVID-19 remains a serious threat, and that a prevailing narrative of “milder illness” shouldn’t be seen, at this time, as license to relax protection measures. There is still much to be learned about the COVID-19 Omicron variant as scientists continue to study its severity, its transmissibility, and whether current vaccines are effective against it. Here’s what we know and what we don’t:

+ Why are people concerned about the Omicron variant? 

The new Omicron variant is highly mutated when compared with the four other variants of concern (Delta, Gamma, Beta, and Alpha). For example, it has 50 mutations, 32 of them found in the spike protein, which the virus uses to get into our cells. In comparison, the Delta variant has only 19 mutations (and 8 of those are in the spike protein). However, it is not only the number of mutations that is concerning; it is also the fact that this virus has a set of mutations that have been shown, in the past, to result in increased transmissibility and/or virulence.

In fact, it has been proven that some of these mutations in other genes (including N and ORF9b) allow previous variants, including Alpha, to evade our immune response. This allows the virus to replicate more easily in our cells. 

All that said, it is still too early to make many concrete assertions about the Omicron variant. 

+ Is the Omicron variant more transmissible than previous variants?

Clinical data shows that Omicron replicates much faster in the upper airways of patients and is therefore more transmissible than the other variants we have seen to date.

+ Does the Omicron variant cause more-severe disease?

In vaccinated, boosted, healthier patients, Omicron can be milder than the Delta or Alpha variants were. But the difference is unclear when you look at unvaccinated or partially vaccinated patients with other medical conditions, who continue to be at risk for severe illness.

+ If Omicron causes less-severe disease, why are we worried about it?

Although in general Omicron seems to cause less-severe disease, it can still result in severe illness, hospitalization, and death. This variant is also highly contagious. And the more that COVID-19 spreads in a community, the likelier it is that severe cases will rise to a point that hospitals are overwhelmed with sick COVID-19 patients. This will impact the healthcare system’s ability to care for people with non-COVID-19 related illnesses and urgent healthcare needs as well.

+ If I’ve had the Omicron variant and recovered, am I more immune to COVID-19? 

Getting your vaccinations and booster shots as recommended remains the best way to protect yourself from COVID-19. However, some recent studies have shown that while vaccines are effective against severe illness, their ability to prevent catching COVID-19 can wane after several months.

COVID-19 antibodies from natural infection have been shown to give an immunity boost for at least a short period of time, and this seems to be true of the Omicron variant. It appears that people who are vaccinated (and boosted) and have recovered from Omicron have an “extra” layer of protection. But as with vaccine effectiveness, this immunity boost wanes over time (and varies from person to person) and should not be thought of as complete protection against COVID-19. 

+ Will this variant overcome immunity that is the result of vaccination and/or previous infection?

Vaccines remain our best defense against COVID-19. The mutations identified in this variant are a concern, but recent data has shown that patients who have had a full course of an mRNA vaccine and a booster are most protected against Omicron. While many breakthrough infections have been recorded, people who are fully vaccinated with a booster shot are much less likely to develop severe illness if they do become infected with the Omicron variant. The CDC (U.S. Centers for Disease Control and Prevention) is currently recommending booster shots for all eligible people, as a necessary measure of defense against COVID-19. 

+ Will the Omicron variant still be affected by the antivirals that will soon be available?

The antivirals from both Merck and Pfizer are targeting parts of the virus that have not mutated in Omicron, and these medications are currently approved for use against Omicron.

+ What are the symptoms of the Omicron variant?

Omicron symptoms seem to present as sore throat, cough, and body aches in fully vaccinated people; however, symptoms in those who are unvaccinated or partially vaccinated can be more severe and include the more typical symptoms we saw with the Delta variant. 

+ How can I protect myself against the Omicron variant? 

The best protection against all COVID-19 variants is to get vaccinated and to get your booster shot when you are eligible. Continue practicing all recommended protection measures including social distancing, masking in public places, staying home if you feel ill, and washing hands frequently.

Editorial note: On December 27, 2021, the CDC updated their recommendations for quarantining and isolating after exposure to the virus that causes COVID-19. In a statement, the CDC announced, “People with COVID-19 should isolate for 5 days and if they are asymptomatic or their symptoms are resolving (without fever for 24 hours), follow that by 5 days of wearing a mask when around others to minimize the risk of infecting people they encounter. The change is motivated by science demonstrating that the majority of SARS-CoV-2 transmission occurs early in the course of illness, generally in the 1-2 days prior to onset of symptoms and the 2-3 days after.” Read the full announcement.

Carbon Health’s medical content is reviewed and approved by healthcare professionals before it is published. But note that our knowledge and understanding of COVID-19 are developing and changing very rapidly; if you have questions or concerns about COVID-19 precautions, treatments, and vaccinations, please talk to your healthcare provider.

Caesar Djavaherian, MD, MS, FACEP

As Carbon Health’s Chief Innovation Officer, Caesar Djavaherian, MD, MS, FACEP, guides clinical innovation through product development, service expansion, and partnerships with transformative companies working to improve the healthcare ecosystem. He is an emergency medicine physician, a former high school teacher, and a reformed academic researcher. Caesar co-founded Direct Urgent Care to deliver technology-enabled urgent care throughout the San Francisco Bay Area. He has practiced at New York-Presbyterian Hospital, the University Hospital of Columbia, and Weill Cornell Medicine. In his spare time, Caesar advises healthcare startups, cheers on the Warriors, tries various HIIT workouts, and daydreams about what the future of health will look like.