Omicron: Expert answers to 9 of your most pressing Covid variant questions

Virologist Dr Stephen Griffin dedicated an hour to answering your questions about the omicron variant

The Independent
Friday 03 December 2021 21:42
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To help answer questions around the situation which faces us now cases of the latest Covid variant omicron cases have arrived in the UK an expert in virology held an ask me anything event with The Independent.

Dr Stephen Griffin, a virologist at the University of Leeds, answered questions live on this article for those who are registered with The Independent.

Dr Griffin spent time addressing the risk the new variant poses, how we can better protect ourselves, how positive the future looks for the situation in the UK and whether we are set to be met with a never-ending list of Covid variants over coming years.

Here we have compiled nine of Dr Griffin’s answers to your questions putting the latest expert information at your finger tips:

Question - Chrisw27

Hi, I was interested to see you say, in another response, that "immunity formed after the latter [previous infection] certainly seems to not protect well against omicron...or delta, for that matter." I has assumed that it was about as effective as vaccine-generated immunity.

Given that most of the immunity in South Africa is from prior infection and not vaccination, can we be hopeful that Omicron will spread less quickly in the well-vaccinated UK than in SA? Rate of increase over there looks quite shocking.

Answer - Dr. Griffin

Agreed, it certainly is shocking. The response to infection is unpredictable. It also tends to be more broad (as you’d expect, involving elements additional to spike) but generally not as potent, certainly compared to 3 doses. Frankly, the notion that some push where they support becoming infected...to become immune to the thing they want to not be infected by, is bonkers and also irresponsible. Whether deliberate or not, this is happening in children at the moment and it is just shocking in my opinion. The whole premise of vaccines is to evoke immunity in the safest possible way. We have fantastically effective tools to do so, I would caution strongly against anyone not getting their vaccine, and also strongly support vaccines in 5+ for this reason.

It is hoped, and we should find out soon, whether a high vax rate will slow or prevent omicron, or indeed whether it can compete with delta in such a setting...but we should not leave vaccines to deal with this on their own - when omicron becomes established, having Rt>1 (as we did for delta) across the country is, frankly, crackers...

Question - JT203

If a new virus (or mutated covid) came along with huge mortality rate of 30% or something, would it have less pandemic potential because it would kill people faster than it could infect new ones? Is covid at a ‘sweet spot’ because it’s transmissible but leaves enough people alive to keep spreading it?

Answer - Dr Griffin

The point about killing before infecting more people is the key here - viruses are the ultimate "selfish" genes. They don’t care whether they make us ill, so the key here is that COVID tends to be lethal/severe AFTER the infected person has become infectious (including asymptomatically) and passed on to pastures new. If the first SARS had been better able to spread prior to symptoms (it did to an extent, but nothing like SARS2), and was also more transmissible (SARS2 spike binds ACE2 much better, and the furin cleavage site also increases infection rates) then we’d have had an even worse problem. So, yes, SARS2 is dangerous because of the combination of high transmission BEFORE lethality and with lack of symptoms, via aerosol predominantly.

This is also why the notion of viruses becoming benign over time is wrong. We change, not the virus, it’s a race between virus evolution and our immunity that eventually results in an equilibrium of sorts where Rt~1, which we call endemic...of course, endemic doesn’t mean benign either, just more predictable. Smallpox, polio...endemic infections! Measles causes severe disease when vaccine coverage drops, which is why Wakefield’s nonsense about autism was so damaging. Vaccines can accelerate progress towards endemicity...there are certain folks banding "endemic" around in an effort to minimise COVID who, frankly, ought to know better...

Question 2 - JT203

Hi Dr G. Given that, as we’ve just seen, new variants can occur in and circulate even in highly-vaccinated populations, how does the pandemic ever end? Surely we’ll be playing catchup forever, regardless of boosters?

Answer - Dr Griffin

Hi JT203. Well, for me, there’s a difference between relying upon vaccines in isolation whilst the pandemic is ongoing, compared to when things are under better control.

I favour the "Swiss Cheese" model (Ian Mackay) for controlling SARS-CoV2 (or indeed, any respiratory virus outbreak) such that vaccines are supplemented by mitigations. Otherwise, what we end up with is cyclical lockdown/unlocking as we try to keep up with the virus...we do this with influenza to an extent, but we simply don’t know if this is feasible for CoVs.

My personal view is that, having brought things under control with the spring lockdown in 2021, we should have maintained sufficient mitigations whilst we rolled the vaccines out to as many people as possible, including children. This does NOT mean more lockdowns, it’s a bit like keeping a fire down by watering the ground compared to fighting to put it out. It’s so much easier to control a new outbreak if you’re starting from a low level of infection, especially in a highly vaccinated population.

Now, it’s important to emphasise that this would be precisely to AVOID more lockdowns - much like the fire analogy, if you turn your back when the fire still smoulders, it will inevitably come back. Lockdowns are extreme measures, the fact we’ve needed three points to a failure of policy in my view, and it also leaves us with fewer options going forward due to the damage that’s been done...

This is also not necessarily "elimination" (although this would be the ideal to aim for imo) where there’s no community spread, but instead a VERY low level of endemic infection where our immunity outpaces the ability of the virus to change and Rt is always ~1...much like measles.

Question - EnglishandProud6621

Hi DrSteveG,

Please can you confirm or deny that pharmaceutical companies fund vaccine research and lobby/donate to the government to create policies which are favourable for them? Many feel this is an important topic as it clearly creates a conflict of interests.

All the best,

EP

Answer - Dr Griffin

Hi EP.

Not to my knowledge. The purchase of vaccines was/is run via the vaccine task force, independent of government. The MHRA and JCVI are also independent bodies. Obviously the need for vaccines is driven by public health. Companies are required to submit a huge amount of data to obtain approval from MHRA - this was done via an EUA to expedite things in terms of red tape, but this is being completed in due course, FDA gave full approval to Pfizer, for example.

We should remember that AZ are supplying their vaccine at cost, but pharma companies are obliged to recoup their investments and indeed, to make profit in answer to their shareholders. If we rely upon pharma companies to generate and test medicines then this will be the case.

Question - Starbust 1953

We have heard the omicron produces mild effects in those cases mentioned so far. They seem to be in the younger age group. People with triple doses of the vaccine are also being found to be positive. Are there any results showing the effect of omicron on the elderly?

Answer - Dr Griffin

This is a tricky one as you wouldn’t necessarily start to see lots of severe disease yet as there’s always a time lag between infections taking off, hospitalisations, and then sadly deaths...the hospitalisations do seem to be increasing in Guateng and elsewhere in South Africa. The population also has a different age distribution in South Africa (generally a little younger on average) and obv older people are more likely to have been protected by vaccines. There’s probably also a difference in vaccination rates between more/less affluent regions.

We should remember that most SARS cases are "mild" (i.e. short of hospitalisation, still v unpleasant and can cause long COVID), so again, there’ll be a lag between seeing the more severe cases...but they’re certainly starting to increase I’m afraid...

Question - Doralora

Which is the greater threat for the omicron strain of coronavirus? The high infectivity or the potential to mutate into something more deadly.

Answer - Dr Griffin

Hi. It’s probably already just as deadly as before. There may well be increased transmissibility compared to delta, but we need more data to be sure. The immune evasion is possibly the greater concern as this means the proportion of susceptible people will increase. Instead of R0, we need to think of Rt (the rate of spread in the susceptible population) which is essentially the R0 (inherent transmissibility) multiplied by the proportion of susceptible people in the population - an increase in either can convert into increased spread of infection.

Question - Clairesbears

I would like to know more about how it affects children. Im following some fantastic scientists who are looking at the data coming out of SA currently saying Omicron is anything but ‘mild’, and that children under 12 seem to be the hardest hit. It ‘might’ be mild in vaccinated adults but not in the unvaccinated child population. I worry so much for our primary aged kids over here in the UK with Delta, let alone a more transmissible Omicron, and what it means for those kids in unventilated schools, there are no mitigations in place apart from open a window and wash your hands! #SafeEdForAll

Answer - Dr Griffin

There is certainly an increase in childhood infections in SA. This may be, like the UK, because adults are more likely to have been vaccinated and/or had previous infection. However, immunity formed after the latter certainly seems to not protect well against omicron...or delta, for that matter.

I agree we need to be massively concerned for children and would strongly support double vaccines in ages 5+. Whilst there may be a proportionately smaller risk for kids getting severe disease, the % chance is swamped by a huge denominator at the moment - we’re seeing ~1000 hospitalisations in under 18s per month at present, and deaths are increasing in 2021 compared to 2020...over 100 now, sadly. Then, there’s also long COVID to consider, which affects 10s of 1000s of under 18s. The UK policy at present ignores the unvaccinated cohorts, clinically vulnerable and long COVID, this could be even worse if omicron becomes established.

Question - M1K3hunt

In terms of anti-viral treatments; the past 2 years has seen an exclusive promotion of vaccination as the most efficient form of clinical intervention. Given a viruses life-cycle, would there not be greater benefit in disrupting it’s microcellular effects earlier on with alternative interventions?

(e.g - nucleoside analogues, entry-inhibiting agents, ribozyme anti-virals, protease inhibitors etc)

In addition, the widespread and excessive use of Antibiotics has led to resistant strains appearing, and prompted the concept of "Antimicrobial stewardship" amongst clinicians, is there not a risk this same pitfall will occur with this virus given the widespread administration of inoculation therapies in many low risk groups? (especially at a time when circulating virus levels are particularly high)

Answer - Dr Griffin

Hi. Yes, well, we’ve recently had molnupiravir approved, which is a nuc inhibitor of the viral replicase, plus remdesivir is already licensed. The latter seems to work better in trials where it’s used early, but of course it’s IV administration...there’s also the Pfizer protease inhibitor drug, which has some encouraging announcements but data not yet posted.

In terms of resistance, yes, I would be very cautious using mono-therapies in great numbers and would advise them being retained for clinically vulnerable patients at present - this could be important as omicron may evade monoclonal antibody therapies. They are to be added to vaccines, not to replace them.

Question - StephenBank

Omicron has a lot of mutations in S2. Do you expect those mutations, e.g.:D796Y, to help omicron evade immunity? Does this have any significance for vaccine-derived vs infection-derived immunity?

Answer - Dr Griffin

Hi. Yes, I’m afraid so. Omicron has mutations in three out of the four major binding sites for antibodies that we know do the most in terms of neutralising infectivity. The caveat is we’ve not seen this particular constellation of mutations all together before, but most people are expecting a degree of antibody escape.

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