An Omicron Christmas?

Published December 21, 2021, 12:05 AM

by Raymundo W. Lo, MD, FPSP


Dr. Raymundo Lo

As we approach the Christmas holidays, the news about the Omicron variant is turning ominous. The DOH announced the identification of two Omicron variant cases, which was really to be expected, as no measures can completely prevent entry of new variants into the country. We said: wait for the data. Well, the data is coming up with increased infectiousness (5x more than Delta) and surges in the USA and Europe. The jury is still out on whether Omicron comes with increased severity. Though, with more people infected, there will of course be proportionately more severe cases.

Further, it appears that vaccine efficacy has dropped versus Omicron from 80 percent to 30 percent. Thus, more vaccinated persons may be infected. But, even if with breakthrough infections, vaccines still offer 70 percent protection (versus 90 percent against previous variants) against severe disease. It is still the unvaccinated who are being hospitalized more than the vaccinated.

Pfizer and BioNTech also offered evidence that a third dose of their vaccine boosted neutralizing antibody titers 25-fold compared to two doses against the Omicron variant, which is associated with high levels of protection.

What to make out of these data? One, it is still the unvaccinated who are bearing the brunt of the pandemic. If you’re not yet vaccinated, get your shots NOW. Two, boosters will reduce the risk of breakthrough infections. Recent data shows that vaccine efficacy tends to drop after six months. Thus, a third shot, whether of the same or another brand is recommended now that we’re facing more and more variants. So, if you haven’t gotten your booster, do so now.

Herein lies the rub though. I’ve heard of people who were rejected for a booster dose because they were a few days short of six months after the second dose. That’s preposterous. Our immune systems don’t really keep track of time. What’s important is that our antibody levels are dropping over time, and a few days really don’t make much difference in terms of when you get your booster.

A plea to our vaccinators: Please don’t reject those who are within days or weeks from their sixth month. That shot just might save these people, especially the elderly and immunocompromised, from getting severe Covid, now that Omicron is rearing its ugly head in the country. If you reject based on this flimsy excuse, and that person has a breakthrough infection and dies, it will be on your conscience.

But wait, you say, our daily case counts are now very low for the past two weeks or so. Sure, we might have crested in our cases and are now enjoying a more relaxed regime. But it’s not time to let our guard down. Expect more Omicron cases to come in and it will be a matter of time before we have community transmission. Here’s hoping this is not the calm before the next surge.

Aside from vaccination and boosters, let’s continue with our non-pharmaceutical interventions that have proven very effective against virus spread: masking, physical distancing and hand washing. Right now, surgical and KN95 masks are very much better than cloth mask. Their prices have dropped markedly. Let’s encourage more people to wear these by gifting friends and family, with surgical/KN95 masks. Wear them properly too. Not with the nose exposed or on the chin but snugly fitted over nose and mouth with no gaps around the nose and sides of the mouth. Yes, I mean YOU! During this season, it will be hard to distance with our partying and merry making. Let’s not get too carried away by the spirit of the season and drop all precautions. Get together only with fully vaccinated persons. Gather in open spaces if possible. If not, open windows and ventilate enclosed spaces by pointing fans toward open doors and windows. Don’t eat in close quarters with others outside your bubble. While eating, refrain from talking and laughing too much. You want to reduce aerosol generation as much as possible to avoid virus transmission to each other.

Speaking of aerosol generation, fecal aerosols are another way of getting infected. Flushing the toilet after a bowel movement generates what some euphemistically refer to as a “toilet plume” which is an aerosol of fine water droplets containing bits of fecal matter. The SARS-CoV-2 virus can also be transmitted via the oral-fecal route as well as inhaling the fecal aerosol. It’s best to avoid public toilets if possible and if you have to, keep your mask tightly applied and leave as soon as possible. If you just did number two, close the toilet seat cover before you flush as a courtesy to the others in the room.

Lastly, wash your hands and sanitize as soon as you finish your ablutions as well as frequently when in public since you’ll be handling high contact surfaces With these precautions, let us celebrate Christmas safely and welcome 2022 with hopes of a better tomorrow. Cheers!