Omicron…New York in a State of Emergency

Saturday, November 27, 2021. 1:00 PM

Yesterday morning we had not heard of SARS-CoV-2 variant B.1.1.529. The New York Times did not mention it and The Economist had no information in their morning news feed. It was then one of many variants of the virus that causes COVID. Then the World Health Organization named it Omicron. WHO reserves Greek letter names for variants of particular concern. Omicron is one of them.

The global stock markets plunged with U.S. major indices losing more than 2% in a half day of trading. Lockouts have been instituted and announced. Governor Hochul has declared a state of emergency. Doctor Fauci is making the rounds of all the major media news organizations. How severe Omicron will be and whether the current vaccines will be effective, and if so, to what extent is unknown.

Below is a compilation of what is known and unknown as of the time this article is being written. Most of it is open to revision.

What we know:

On Thanksgiving Day, Nov. 25 news started to spread about a new variant of SARS-CoV-2 labelled B.1.1.529 that was spreading rapidly. There were more than 50 mutations compared to the Delta variant, 31 in the spike protein alone. The Delta variant became prominent with only two mutations from prior principal variants.

In South Africa, cases went from 300/day to greater than 1,200/day from Nov. 16 to Nov. 25, only 7 days. It started to spread throughout the country from its apparent origin site around Johannesburg. In South Africa, only 35% of the population are fully vaccinated but only 10% in the younger age groups (which Omicron is primarily been identified).

Many countries announced immediate travel bans. The U.S is ordering bans of travel from South Africa, Namibia, Lesotho, Eswatini, Mozambique, and Malawi but these do not go into effect until Monday, Nov. 29. The ban will not stop the spread but will slow it down to allow time for more study and to mount treatment and possible reformulation of vaccines. The South African health minister announced that the variant was contained to his country but this is now known to be false. It has already been identified in Hong Kong, two cases, Israel, 2 cases, and in Belgium, one. The probability of these number holding is essentially zero. Scientists world-wide have expressed concern with how rapidly Omicron is spreading.

Pfizer, Moderna, and Astra-Zeneca have all announced that they have started research to determine the effectiveness of their vaccines. Pfizer announced that they would be able to re-evaluate their vaccines in six weeks and ship a reformulated one in 100 days. Merck announced that their new drug Mulnapiravir, which was touted as being 50% effective in stopping hospitalizations and deaths if begun in the first 5 days of infection, is actually only 30% effective. Millions of courses of this drug have been shipped world-wide. Pfizer has not changed its statement that its drug for use in the newly infected, ritonavir, brand name Paxlovid, is 90% effective.

Governor Hochul of New York yesterday announced a state of emergency effective until January 15. This described as “surge and flex” and will allow the Department of Health to limit non-emergent and non-essential hospital admissions and procedures in situations where the hospital has less than 10% staffed bed capacity.

What we don’t know:

Exactly how serious this form of COVID is or will be. There have been conflicting statements made by scientists around the world. Will current vaccines work against it and to what effect? Will it remain primarily in young people?  Is that because vaccination rates in older populations are greater in South Africa or because they are more socially active and more likely to spread it to each other? Will other oral medications for treatment, like Paxlovid, be equally effective against Omicron as they are against Delta?

Government scientists are again urging the unvaccinated to get vaccinated and people with symptoms or contacts to get tested immediately. The effect on the international economy is of significant concern.

Richard J. Sternberg, MD