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Omicron poses a grave risk to the US health care system. The US has a low rate of vaccination and obtaining boosters, and a relatively large segment of our population is elderly or immunocompromised. A 2-dose mRNA vaccine's immunity appears to rapidly wane and unlike South Africa, many in the US were fully vaccinated very early in the pandemic.
Data is starting to emerge on the Omicron variant and is good news for those who are healthy and have had a 3-dose mRNA immunization but a stark warning for our Delta stressed health care system and our society in general. The good news is that Omicron appears to cause less severe disease. Compared to the first wave of the virus, hospitalizations from the Omicron variant are decreased by 29% in those who have not been immunized or previously infected by SARS-CoV-2. The Omicron variant is highly infectious, replicating up to 70 times more than the Delta variant. Those who are not vaccinated or immunosuppressed are at risk for severe disease. Just these additional patients alone could easily collapse our overrun health care system. A transitory collapse has already happened in many regions of our nation during this pandemic which resulted in needed and sometimes urgent non-COVID-19 care to be delayed and sometimes unavailable.
Data released by the South African insurance company, Discovery Health, reported that for those who have received a 2-dose mRNA vaccine, there is a 70% protection against hospitalization
from the Omicron variant and a 33% protection against infection. We need to remember these data are from South Africa. In the United States, many were fully vaccinated very early in the pandemic, much earlier than in South Africa. Unfortunately, immunity induced by a 2-dose mRNA vaccine appears to wane rapidly. The Omicron variant evades immunity to a higher extent than previous variants making protection from vaccines, plasmam and monoclonal antibodies problematic. Those in nursing homes and the elderly will be at an extremely high risk of reinfection and possibly severe disease. Thus, one would suspect that the US will not fare as well as the South African data indicate. Laboratory research supports obtaining a booster can provide good protection from the Omicron variant, but the durability of the immunity is not known.
Those with previous infections are also not assured of protection.Initial reports from South Africa found that reinfection rates were three times more common with the Omicron variant.Preliminary results from the United Kingdom Health Security Agency indicates that reinfection with the Omicron Variant occurs 3.4 to 7.6 times more often.Discovery Health reported indivuduals previously infected have a 40% to 73% chance of Omicron infection compared to those without a previous documented infection, depending upon the time period and variant they were originally infected with.The earlier the infection, the greater the chance of reinfection.
The Discovery Health data also observed that children were at 20% higher risk of being hospitalized with the Omicron variant. This supports the initial report from South Africa that children less than age 5 are targeted with this virus at a rate reported to be second only to those over the age of 60.
The high rate of infection of the Omicron variant, which is beginning to eclipse Delta infection in the United Kingdom, poses a grave risk to the US health care system. It should be remembered that the US has a low rate of vaccination, a low rate of individuals obtaining boosters, and a relatively large segment of our population which is elderly or immunocompromised.
Over the course of this pandemic we have seen the infectivity and lethality of SARS-CoV-2 increase with each surge, from the wild type virus to the D614G, Alpha, and Delta variants. SARS-CoV-2 has firmly established itself in animal hosts. Some have proclaimed that the emergence of Omicron is a sign that we may be at the beginning of the pandemic’s end. That the virus is mutating to a less severe form and that a virus cannot kill its host and maintain viability.
We need a reality check. Species have gone extinct from viruses. Omicron did not mutate from Delta, it arose from a completely different evolutionary path. There is concern that Omicron arose in rodents, which were initially infected by humans, and then the virus jumped back into the human population. This etiology is supported by the plethora of different mutations, seven of which are associated with transmission between rodents. The bottom line is that SARS-CoV-2 does not need humans. The next virus that jumps hosts may be even more infections and more lethal. Anything is possible with a highly mutating virus which is circulating among multiple different animal hosts.
We must adopt a different approach in combating this virus. Our current disjoined public health care system that is riddled with conflicting goals and statements is fueling misinformation and blunting our nation’s response. Now more than ever we need to have a uniform National Public Health Care system to respond to current and future biological threats. To this end, we need to reenact the Coronavirus Response Team which will bring many top individuals from around the nation to guide national policy. But most importantly, we should expand the US Veterans Administration Fourth Mission, to aid the US in health care emergencies, transforming this Cabinet into a national public health care delivery system.