Health

Dealing with Omicron – Why Are There Variants? Interview with Infectious Disease Specialist Dr Jennifer Wang

Over the past few years, the world has been dealing with the perils of the COVID-19 pandemic, and all the havoc that it has caused. To make matters worse, on 26 November 2021, the World Health Organisation (WHO) designated the Omicron variant as a variant of concern, due to its impact on the spread and severity of the virus. Just during the week of 3-9 January 2022, the total number of reported infections worldwide was 1.5 million, and as of 9 January 2022, there have been a total of 304 million reported infections globally since the start of the pandemic. Commenting on the surge caused by Omicron and its trajectory, the head of the World Health Organisation’s emerging diseases and zoonosis department said, ‘This is off the charts’. With so much uncertainty, many people have a lot of questions about the virus, the vaccine, the future of the virus, and what our world is going to look like. To help answer some of these questions, The Review of Religions spoke with Professor Jennifer P. Wang M.D, who is an infectious disease specialist at the Division of Infectious Diseases in the University of Massachusetts Medical School and UMass Memorial Medical Center. The following is an edited transcript of the conversation between Dr Wang and The Review of Religions Editorial Board Member, Sarmad Naveed.

SN: Dr. Wang, welcome and thank you so much for taking some time out.

JW: Thank you for inviting me.  Pleased to be here.

SN: So just to start, if you could explain some of the research that you’ve been doing since the start of the COVID-19 pandemic.

JW: So, here in Massachusetts, I am a virologist and immunologist, and I normally study things like influenza. When the pandemic emerged back in early 2020 here in the United States, I shifted a lot of my research efforts towards SARS-CoV-2 and this is both in the laboratory, looking at various models, tissue culture in human cells, and animal models, to understand how this virus causes such a broad spectrum of disease. I also worked on a number of clinical studies and continue to work on these to evaluate prevention and treatment for SARS-CoV-2 infection or COVID-19, and how we can use evidence-based medicine to treat optimally.

How is Omicron Different from the Original Virus?

SN: Now, coming to the Omicron variant, could you explain what this variant is and how it differs from what we know to be COVID-19, the original virus, if you will?

JW: The information that we’re obtaining here in Massachusetts, changes every single day, so what I’m saying today may not apply tomorrow or next week, or even next month. The variant was originally detected largely in South Africa in a young population, and it became the dominant strain in South Africa regionally and then across the nation and there were scattered reports across the world. It was really through high surveillance and studying the virus at the sequence level that South Africa was able to stay on top of the surge and create a broad foundation for understanding this virus strain. So that was very helpful and informative, and it allowed us to be prepared for what we might expect and have been seeing worldwide, including in the United States and in the UK. Here in Massachusetts, we were already having quite a few cases of Delta, the previous variant of concern – the one that was causing a large amount of disease in our population. Since becoming aware of Omicron, with travel and holidays, we’ve really seen a surge in our numbers, where at least half of all cases now are reported to be Omicron, and it’s a tough number to get an estimate on in real-time, but it seems to be outcompeting the Delta and taking over as the predominant SARS-CoV-2 [variant] right now.

Why are there Variants?

SN: What exactly is causing these variants to come about?

JW: That’s a great question. We know that RNA viruses like influenza and SARS-CoV-2, by their nature, they make errors, and these errors are detected as mutations, and a lot of the mutations that occur, make no impact on how the virus behaves. They are silent, and there also may be an occasional variant which makes the virus unable to survive. It disappears, and that is what we call a ‘a decrease in fitness.’ However, there may be mutations that alter the behaviour of the virus so that, say, with Omicron, there may be an increase in its likelihood to infect a human, and it may change how the body responds – our immune [system] response. So, this is not unexpected for these RNA viruses, similar to what we see with flu, just on a very high number scale. So, with flu, we need to change the vaccine every season, and that’s in part because flu is constantly changing and evolving and so we need to try to keep up with that, in prevention.

Is Omicron Less Dangerous?

SN: With Omicron, what we’re hearing, is that, perhaps it’s not as dangerous or not as fatal as the COVID-19 virus. Is there truth to that? And what is the bearing of being vaccinated to that?

JW: We know that Omicron, appears to be causing, for most people, a milder disease. So, it’s more like a common cold than what we would expect, and less severe disease [than that] requiring hospitalisation with complications and pneumonia and respiratory distress. So, there is evidence that if a person is vaccinated then they are more poised to fight Omicron, as well as other variants of SARS-CoV-2, such as Delta, and this directly is associated with less severe disease. So, one concern is that, there’s a number of people who don’t have access to the vaccine or opt not to get vaccinated, and in this case [with] Omicron, just because the sheer numbers are high, there’s a lot of it going around. It continues to cause hospitalisation across the population, and the number of people requiring hospitalisation is really causing a hit on healthcare systems in the US.

Does Access to Vaccines Impact the Spread of Omicron?

SN: You mentioned a little bit about the vaccine and some people not having access to it. Is that a factor in how much Omicron has been spreading?

JW: I think it does impact. Omicron continues to spread even amongst vaccinated individuals, so I don’t know the exact impact of vaccination on the spread [of Omicron]. But I think of the spread and the disease, as two separate areas. So, we know its impact on the disease. We’re hoping [vaccination] would decrease the spread, but I don’t know that we have a lot of evidence for that.

Will there be More Variants?

SN: Should we expect another variation [of the virus] in the future?

JW: I think that’s very likely. Omicron is a bit of a surprise because there were so many mutations and because of it the high transmissibility, it’s hard to know what to expect with the next variant. We certainly hope that our immune systems will be collectively better able to handle the next variant and the goal would be that eventually SARS-CoV-2 will become something like the common cold for most individuals who do get infected.

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Do Current Vaccinations Protect Against Omicron?

SN: There are a lot of questions about the vaccinations that are currently available, that the people have had. Do those protect them against Omicron? And if we’re expecting more variants are there going to be changes in the Covid vaccine?

JW: I certainly encourage vaccination. Again, it prevents severe disease and there’s lots of evidence for that against SARS-CoV-2. It may be, [that] with future variants we will potentially have less protection, given our current immune responses to the vaccine strain and also the infection and exposure to these new variants. So, it is possible that there will be adjustments made to the vaccine, so that we have better responses to the next variant. But I think we just need to wait and see. It’s hard to predict. There’s so many factors that play into this and I think we have a lot to learn over the next several months, and whether we will need to have annual vaccinations against specific strains of SARS-CoV-2.  We’re certainly thinking about it. Whether that will become the reality remains to be determined.

Are Vaccines Safe?

SN: There are people who still have their reservations about the vaccine and the ingredients that are found in it. In terms of the safety of the vaccine and for those who still aren’t convinced about it, what can you say to that in terms of how the vaccine is made and its safety?

JW: In the US, the recommended vaccines are the RNA vaccines – the messenger RNA vaccines. These are a newer type of vaccination in the broader sense, but they’ve actually been studied for several decades. There’s certainly evidence all around – I’m convinced, and many public health officials and experts are convinced – that it is safe. And the risk of having COVID without vaccination and developing severe illnesses is much greater. So, the benefit of getting the vaccine is much greater than the risk. Every vaccine that’s been given in the last century has risks and benefits.  Vaccines are not meant to prevent disease 100%, they’re meant to prevent severe disease in many instances. In some case it has eradicated certain infections completely, which is wonderful. In the case of SARS-Cov-2 it seems unlikely that it will become completely eradicated, but the vaccines are protective. The mRNA vaccines seem to have a rare complication of myocarditis which is inflammation of the heart. This may not be the RNA itself causing this, but the components of the vaccine – the carrier – one of the other ingredients. Because people are concerned about such side effects and complications from the vaccine, even though it’s a small percentage, the developers are trying to address that and trying to understand, how can we minimise the risk for complications such as myocarditis. Given that, the recommendations are still to get vaccinated given this risk benefit ratio.

How Are Vaccines Made?

SN: For those who don’t have a medical background and are just trying to understand more about the vaccine, how can you broadly explain what goes into making that vaccine?

JW: Every organism, every living being has different types of cells in the body. The RNA – the messenger RNA or mRNA – is kind of the template for making every building block in the body. We have it naturally; we couldn’t live without it. Many of our older vaccinations or currently used and non-mRNA vaccines are made of proteins and they are components of the virus or pathogen that we’re trying to get the body to recognise in advance so the immune system can be prepared once the real virus comes around. So, what the mRNA does, it’s not for the entire virus, it’s just a small piece of the virus. When it gets injected into the arm, then the arm cells make a little bit of the protein from that RNA –the building block – and it looks like the outer part of the virus; the SARS-Cov-2 virus. That triggers our immune system to recognise that and should we become exposed to the virus, to better fight it off.

Is there Truth to Some Alternative Treatments for Covid?

SN: In the media these days, especially on social media we’re hearing a lot about these alternative treatments. We’ve heard a lot about Ivermectin for example or different sorts of various alternative treatments whether it’s vitamins or whatever the case may be. So, what is the medical perspective on that?

JW:  I think it’s good for people to have open minds on what the treatments are. What we want to make sure is that before embarking on a potential treatment [is that] is it safe, first of all, and is it effective? Just like with getting a vaccine, what is the risk to benefit ratio? So, with Ivermectin, there is evidence in the laboratory that it can reduce the replication of the virus under specific circumstances and that doesn’t always translate into taking care of oneself or making recommendations for somebody who does have an infection. [There are questions like] what would the right dose be? How long would it need to be given? You’ve got to make sure you don’t take too much of it because it can lead to seizures as a side effect. So, that’s why we like to do clinical trials, and there are actually a number of clinical trials ongoing to see whether Ivermectin is beneficial, and I think the question is still out there. Here in the United States, in Massachusetts, there are studies [exploring] what if you get Ivermectin and you take it for five days versus [taking] nothing and if you get a number of people who agree to be in such a study, then we can actually get data [which might show] everyone who got Ivermectin, did well and stayed out of the hospital compared to the somebody who got nothing, or a placebo pill. And we’re looking for information as such before making broader recommendations. And there’s also [the aspect of] safety – did the people who took Ivermectin have a higher rate of seizures than those who got the placebo? So really, having data like that before making a broader decision, something that the Food and Drug Administration is going to recommend, they’re going to be looking for data like this before approving Ivermectin for such a purpose. And there are, like I said, a number of factors. So, we want to keep people safe, we want people to be treated the best, but whether a specific drug or not would help in that situation – we’re still working on that.

Can Omicron Cause Long Covid?

SN: Something that we’ve heard about and learned about over the course of this pandemic is Long Covid. Is Omicron something that can also cause Long Covid?

JW: I think it’s so new, we’re going to see. We’ll probably have information out of South Africa first because that’s where the first wave was with Omicron. It’s interesting because things move so quickly with Covid, it’s hard to keep up and you really have to look at all sources; all news sources, publications multiple times every day. So, given that it hasn’t been around that long and whether people who got Omicron infection do go on to get long Covid – we’ll see. I wouldn’t be surprised if it does. Long Covid is a complicated area and we don’t understand enough about it, but it is a documented and known consequence of infections, so it’ll be fascinating to see if you were vaccinated and you got an Omicron infection, are you less likely to get long Covid? We’ll just have to see and be alert. It’s certainly a concern – for an otherwise healthy person who’s vaccinated and boosted and has an immune system that’s prepared to handle Omicron; are they in a better position not only against the complication of having severe disease, but are they also safer in terms of [being] less likely to get long Covid syndrome?

How Important is Ventilation?

SN: One thing that has been talked about a lot is ventilation, especially indoors. Even some schools coming back from the winter break held off opening so that they could bolster their ventilation systems. Given the situation with the pandemic and the world, how important is ventilation to have in mind?

JW: So, the transmission of SARS-CoV2 is largely by respiratory droplets and there is some evidence that it can also be spread by even smaller particles, and it can be transmitted by aerosolisation. So given that, having adequate ventilation; open windows, open spaces, definitely decreases transmission and people who have HEPA filters at public spaces like workspaces, that is certainly a measure that can help when the numbers are so high. In the long term when there isn’t a high number of infections the benefits of having this extra filtration system is unclear, but for the short term there is evidence that it can help prevent transmission.

Amidst the Uncertainty, What’s the Best Way to Move Forward?

SN: It seems, no matter how much information we gather about the vaccines, about the virus, there will always be an aspect of uncertainty in the future, because it’s so rapidly changing like you’ve mentioned. What would you say to people who are trying their best to get through the pandemic, deal with the virus, taking whatever precautions they can; but even with the uncertainty what would you say is the best course of action moving forward for people to stay safe for themselves, for their families, their communities?

JW: The best way is to think about your personal situation and your family and your immediate environment and keep up with the news and the guidelines and recommendations. If you have access to vaccinations and qualify for vaccinations, which is nearly everyone, then go for it. It’s a modern luxury I would say, to be able to have access to this. Years ago in the pre-vaccination era, we used to see graveyards just full of children – babies and young children – and what has changed over time is there are fewer infant mortalities and childhood deaths and much of this is because of vaccination. So, we should view it as a great progress that we have vaccines available to SARS-Cov-2 and to other pathogens that are out there everywhere. Certainly keep up with recommendations with boosters. The messages may be confusing because they change frequently and first ‘no boosters’, then it changed into ‘certain people should get boosters’, and then ‘certain age groups should get boosters’, then ‘everyone should get boosters’. So, I think it’s a lot of information over a short period of time. It’s like, why does this keep changing, why do public officials keep changing these. It’s because this is evolving in real time and we’re learning and keeping up as best as we can. Expect that what was recommended a few weeks ago or even a month ago, may not apply today, but you want to move in the overall flow with what is being recommended and keeping up with that.

SN: Dr. Wang I really appreciate you taking the time to speak with us and give some of your very valuable insight, so once again thank you very much for taking the time.

JW: Very happy to be here today, thank you.


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