Transcript

Dr. Nick Gilpin (00:04):
Coming to you from Beaumont, this is your HouseCall.
Dr. Nick Gilpin (00:13):
The Omicron variant is here and Dr. Shajahan and I are here to present the facts. What we know, what we think we know and what we have yet to know. Keep it here, the HouseCall podcast has the latest on the Omicron variant.
Dr. Nick Gilpin (00:31):
Hello, and welcome to the Beaumont HouseCall podcast. I'm Dr. Nick Gilpin.
Dr. Asha Shajahan (00:34):
And I'm Dr. Asha Shajahan. We're here to help you and your families live smarter and healthier lives. Today's topic is Omicron, the new COVID-19 variant.
Dr. Nick Gilpin (00:45):
That's right. Asha and I are here today to do a special edition podcast on the Omicron variant. And we can debate whether it's Omicron...
Dr. Asha Shajahan (00:52):
Omicron...
Dr. Nick Gilpin (00:54):
Tomato, tomato.
Dr. Asha Shajahan (00:55):
Nobody knows. Everyone says it different.
Dr. Nick Gilpin (00:57):
Apparently it's Omicron.
Dr. Asha Shajahan (00:58):
It is Omicron.
Dr. Nick Gilpin (00:58):
I did have to look this up. This is the new COVID variant that was recently identified in South Africa and is now starting to pop up in other parts of the world, including the United States. So we're here today to try to address your burning questions with the most up-to-date information.
Dr. Nick Gilpin (01:15):
And just as a timestamp, I want to let you know that Asha and I are here in the studio today talking about Omicron, it is December 2nd, 2021. Much about this variant still remains to be understood and we expect to be learning much more in the coming days. We will do our best to keep you updated as we learn more.
Dr. Asha Shajahan (01:34):
All right. So let's talk about it. So Nick, we have been hearing about this variant and there's rumors that it could be more transmissible. There's so much that people are worried about. What's true? What's not true? What do we know about this variant and what don't we know?
Dr. Nick Gilpin (01:49):
So Omicron is the latest COVID variant of concern that was identified in South Africa in late November. I think it was around the 26th of November. Remember the old classification of variants was the numbers and the letters, right? So we had to B.1. ...
Dr. Asha Shajahan (02:06):
B.1.6.1.6.
Dr. Nick Gilpin (02:07):
Yeah, B.1.1.7. was the first iteration. And now we're up to B.1.1.5.2.9. That is the Omicron variant. And obviously when we learn about new variants, there's a lot of questions that come into our minds, about transmissibility, about severity of illness, about whether the vaccines work or whether our immunity provides protection. So at this point, what we know just based on facts, this variant has emerged in South Africa. It does appear to be causing a lot of disease in South Africa. There is concern that it may be more transmissible than the Delta variant. And the reason I say that is because it does seem to be outpacing Delta in South Africa.
Dr. Asha Shajahan (02:52):
So I have a colleague that works as a physician, that works in South Africa, in Johannesburg. And when this news came out, I texted her immediately and said, What are you seeing on the ground? What's going on there? And she said they do have a very sophisticated way of testing the different variants. And she said that does seem to be in the last just week and a half, a higher rate of the Omicron. But she did say that the hospitalizations were not higher. So it starts begging the question of, Is this... Provide more severe illness? It seems to be more contagious, but is it causing more illness? Is it worse than Delta? Thoughts on that.
Dr. Nick Gilpin (03:33):
Yeah, a few. So I've heard the same thing. And as we've looked at the cases and heard the reports from South Africa, first of all, none of this is definitive just yet. This is a lot of anecdotal information. But we've heard that the cases they're seeing in South Africa are generally somewhat more mild. We're not seeing as severe of hospitalizations and deaths.
Dr. Asha Shajahan (03:52):
It's good news. Yeah.
Dr. Nick Gilpin (03:53):
It's potentially good news. Some of the cases that we've seen outside of South Africa, they've had cases in Israel and parts of Europe and Hong Kong. And now in the U.S. Also seem to sort of fit that M.O. You know, somewhat less severe disease. Now, some of that could be because this is occurring in a vaccinated community. It could be because it's occurring in a community that's had exposure to prior COVID. So there could be some existing immunity that's providing some protection. Or it could just be that this variant is more transmissible, but causes less severe disease. Either of those is possible. We still have yet to learn about exactly how severe this variant is.
Dr. Asha Shajahan (04:34):
Yeah. Because I think when people hear the word variant, it's like everyone just freaks out and says, always assume that new variant means it's worse or more dangerous. And then there's always a concern of is the vaccine going to be less effective or effective at all? So what are your thoughts on that? At first it was Delta, everyone was worried about Delta. It was causing more severe illness, it appeared, or more people were getting hospitalized.
Dr. Nick Gilpin (05:00):
Right.
Dr. Asha Shajahan (05:01):
And that's the predominant strain that's here right now. And now we've got Omicron. So are we worried that the vaccine could be ineffective, or our current treatments, even?
Dr. Nick Gilpin (05:11):
It's a possibility. And that's about all I can say at this point. So, what concerns the scientists on the ground is the number of mutations with this new variant. So for perspective, when you look at the Delta variant compared to what came before it, Delta had more mutations. It specifically had more mutations in a region called the receptor-binding domain, the part of the virus that makes contact with the cell. So Delta had two significant mutations in that region, that made it bind more effectively, therefore made it more transmissible. By comparison, Omicron has 10. So it's a very good chance that it will be more transmissible. Now, will it be able to escape or evade our existing immunity? We just don't know yet. It will probably take some time for the WHO and the NIH and the scientists to really hash that out.
Dr. Asha Shajahan (06:05):
So doesn't Omicron, though, have 30 mutations on the spike protein itself-
Dr. Nick Gilpin (06:09):
That's right.
Dr. Asha Shajahan (06:09):
And like 50 new mutations in general.
Dr. Nick Gilpin (06:11):
Lots of mutations.
Dr. Asha Shajahan (06:12):
So I feel like that in itself seems kind of scary.
Dr. Nick Gilpin (06:16):
Yeah.
Dr. Asha Shajahan (06:17):
You know, to the general public. And especially those that are worried about vaccination.
Dr. Nick Gilpin (06:20):
Yeah.
Dr. Asha Shajahan (06:21):
So I guess my question is, which a lot of my patients have been asking, for those who are vaccinated, should they get boosted now or do you think there's going to be another vaccine? I know it's very easy with the mRNA vaccines to create new vaccines in a matter of six weeks or so, they could create a new vaccine that might be more effective for different variants. Do you think it's best to get boosted at this point or to wait?
Dr. Nick Gilpin (06:45):
I do. And let me take a couple of pieces of that question. So for starters, whenever we hear about a new variant, I think it's important to keep a few things in mind. Because some of this information can be sensationalized, right? It's a new variant, it's emerging in this part of the world and it's making people sick. And that information alone can be frightening. And especially when you find out that this new variant has several different mutations, we can jump to conclusions very quickly.
Dr. Nick Gilpin (07:12):
So go back to the facts. Is it more transmissible? Is it causing more severe disease? Does our existing immunity, whether from vaccine or from prior infection, offer some protection? Do our treatments still work? Those are the fundamental questions that we have to answer before we can really decide if a variant is just a variant, or if it's a variant of concern, or a variant of great concern.
Dr. Nick Gilpin (07:38):
We consider Omicron at this point, still a variant of concern. Again, it does seem to have opportunity to be more transmissible. We don't know yet if it's causing more severe disease, we don't know yet about the immunity piece. We should have more information there.
Dr. Nick Gilpin (07:53):
Now to the booster question, the answer I would offer today is yes. If you have not already received your booster, don't wait. You should get your booster. Here's why. The part of the world that we're in right now, in the United States, in Michigan specifically, there is a lot of COVID. Transmission rates in the community are sky high, right? Community positivity rates in the 15 to 20, and even higher in some parts of the state right now. Meaning there is widespread transmission.
Dr. Nick Gilpin (08:23):
With the holidays just around the corner, I think now is the perfect time to get boosted. Don't wait and say, I'm going to wait and see if Omicron turns out to be something to worry about before I get boosted. Get boosted now. In all likelihood, your booster dose, your vaccine will offer you some protection. We don't know how much or how little, but it will more than likely offer you some protection against [variants 00:08:46].
Dr. Asha Shajahan (08:45):
Because the purpose of getting vaccinated is to raise your antibody level, correct?
Dr. Nick Gilpin (08:49):
Yes.
Dr. Asha Shajahan (08:49):
And so if you've been vaccinated in the past and it's been more than six months, the likelihood is that your antibody levels are waning. And especially also if you've had natural infection.
Dr. Nick Gilpin (08:59):
Correct.
Dr. Asha Shajahan (08:59):
So getting boosted is going to help you in any way, shape or form in terms of improving your immunity levels. And like you said, we may not know by how much, but I would say I would take getting a boost than not being boosted. I have a colleague actually who had both vaccines, him and his family, but did not get boosted and was sort of just kind of waiting a little bit and ended up getting COVID, and he's not doing fantastic. He's not hospitalized, but he was just not doing fantastic. And I was talking to him the other day and he said, I should have gotten boosted earlier. I just kind of put it off. It wasn't even really intentional. It was just kind of, put it off. And I think it's something that you should really have on your radar. Let's schedule that appointment. Let's get that booster shot in.
Dr. Nick Gilpin (09:41):
Well, and just to put a finer point on it. Yeah, right now what we're dealing with in the United States, in Michigan, in the Midwest, is predominantly the Delta variant.
Dr. Asha Shajahan (09:51):
Yeah.
Dr. Nick Gilpin (09:51):
And the vaccine that we have now offers protection against the Delta variant. So it could take time for the Omicron variant to completely displace Delta, if it's going to do that at all. Another reason not to wait. Just go ahead and get that booster now. Get it over with, have that protection, protect yourself now around the holidays. That to me is the smart move.
Dr. Asha Shajahan (10:11):
So speaking of the holidays, so how much do you think Omicron is going to affect our holiday plans? If you are vaccinated, meaning you've got vaccine one, two, and you've been boosted, can you still travel? Should you travel? Can you meet with family? What are your thoughts on that?
Dr. Nick Gilpin (10:26):
I think you can do the things that you want to do. I think that I would put an extra little bit of caution on international travel right now. A lot of countries are locking down and putting in extra travel restrictions because of Omicron. Now we can debate whether those travel restrictions are effective at limiting the spread. I would argue they're probably not, the cat's probably already out of the bag in many of these places.
Dr. Nick Gilpin (10:50):
But as far as getting together with family, there's a safe way to do it, there's an unsafe way to do it. Nothing right now that we do is zero risk. I would prioritize, as we've always said on this podcast and in other venues, trying to gather with vaccinated individuals, prioritizing getting together with other vaccinated people. If you don't know the vaccinated status of the people that you're going to be around and if there's going to be many of you, wear your masks, wash your hands, do all the things, right? And those are the things that we know offer the best protection. The variants don't seem to have the ability to get around masks and social distancing and hand hygiene, as much as they may or may not have the ability to get around a vaccine.
Dr. Asha Shajahan (11:35):
Yeah. So those are the basics that we should stick with, for sure. And then just the one thing about variants, variants are kind of, here to stay. Meaning there will be more and more, as long as this virus is still around and as long, until we can get more people vaccinated. And I think vaccine equity is a huge deal internationally and probably one of the reasons why variants are emerging, especially in South Africa. I think they're only 30% vaccinated there.
Dr. Nick Gilpin (11:59):
Yeah.
Dr. Asha Shajahan (12:00):
So what's your advice to the general public when they hear about variants? What should be the approach?
Dr. Nick Gilpin (12:05):
Well first of all, variants happen because when the virus invades a person's body, the virus will hijack our cells and the cellular machinery to make more copies of itself. And that process of making more copies of itself is not perfect. And occasionally there are changes to the virus's genetic material that can render it different from what came before it. And if something changes within that virus that renders it more effective as a virus, in other words more fit, biologically better than what came before it, it will become sort of the dominant strain if it's allowed to continue to reproduce.
Dr. Nick Gilpin (12:45):
So variants will continue to happen. Right? The Greek alphabet has several letters. We've got nine more letters before we get to omega. There will be more variants to come. And every time we see a new variant, we have to go back to those fundamental questions. Is it more transmissible? Is it causing more severe disease? Does our immunity protect us against it? Do our treatments work?
Dr. Nick Gilpin (13:07):
And just to go back to Omicron, we don't know yet if it's causing more severe disease, we don't know yet if our existing immunity offers good protection, okay protection, or no protection. I suspect it will be at least some protection. But we also know that our treatments, the current treatments that we use for COVID, do seem to be effective. Right? Steroids, remdesivir, the antiviral that we're using in patients that are hospitalized with COVID. Those medications we anticipate will continue to be effective as treatment options. Whether some of the more sophisticated treatments, the monoclonal antibodies, that's another outstanding question that we have to answer. And the WHO and the NIH will help us get there.
Dr. Asha Shajahan (13:47):
I'm seeing so many people in the outpatient that are not necessarily coming into the hospital with COVID, which is good, but not good. How do people know, if they're in the outpatient setting and they're sitting at home, they've been tested for COVID, if they have Omicron? Or are they testing for that? Is it Delta? Is it Omicron? Or do we not know?
Dr. Nick Gilpin (14:05):
So, South Africa identified this variant because they're doing routine surveillance on all of their COVID in the country. So all of their COVID, or a sample of their COVID, gets sent to a reference lab and it gets sequenced. South Africa by comparison samples about 1% of all their COVID and does sequencing. And that's how they were able to identify this variant.
Dr. Nick Gilpin (14:27):
By comparison, the U.S. does their own sequencing. The CDC reports that they do about 4% of all COVID cases are sequenced to find out what type of variant it is. And based on that information, it's 99.9% Delta. Now in Michigan, all of the major hospitals and reference labs send samples of COVID-positive to the reference lab in the state of Michigan and the state does their own sequencing as well. They sequence about 1% of cases. And based on that information, they can find out.
Dr. Nick Gilpin (15:01):
Now that's really more helpful from a public health perspective. In other words, we will know what virus is circulating in the community, but you, the individual, may not know which variant you're infected with. In other words, if you come to the hospital and say, I want to know if I've got Omicron or if I've got Delta, unfortunately we're not that sophisticated yet. We're really doing this sequencing more for a public health epidemiology surveillance.
Dr. Asha Shajahan (15:29):
But does it even matter to know what kind? I mean, COVID is COVID.
Dr. Nick Gilpin (15:33):
I would argue that it does not matter.
Dr. Asha Shajahan (15:34):
You do the same things. And whether it's Delta or Omicron, the treatment, as of right now, is still the same.
Dr. Nick Gilpin (15:40):
I agree.
Dr. Asha Shajahan (15:40):
The prevention is the same.
Dr. Nick Gilpin (15:41):
I completely agree. I would argue that at this point, it really doesn't matter. Right? Until we have a reason to believe that it does matter, it does not matter at this point if it's Delta, if it's Omicron, if it's alpha, if it's mu, if it's anything else. It is what it is, our treatments and our prevention is the same, as you said.
Dr. Asha Shajahan (15:58):
How about a little bit of good news? Do you think that since Omicron seems to be, as of now, not as severe an illness for people... And again, we're not sure if that's because some of the people that have gotten it are already vaccinated, but you know, in South Africa they have a low vaccination rate and people have Omicron, it seems to be somewhat mild. Do you think that it would take over the dominant variant of Delta? And if so, does that mean the virus is weakening?
Dr. Nick Gilpin (16:27):
Well, I'll try to be a good news guy. Throughout this whole experience, I've been a bit of a wet blanket. But here, I think the answer is it's possible to have a variant that's more transmissible, but doesn't necessarily cause more severe disease. In other words, it's more fit as a pathogen, it's more capable of invading a host. But the disease that it causes might not be as bad as what came before it.
Dr. Nick Gilpin (16:54):
In other words, the virus itself could weaken over time. Right? It could be better at spreading but causing less severe disease, more akin to what we think of as a common cold. Now, that could be because of the characteristics of the virus itself, which is fine. Or it could be because we, as a collective society, are getting better at dealing with the virus. Either because we've been exposed to versions that came before it, or because we've gotten vaccinated.
Dr. Nick Gilpin (17:21):
And I suspect this is how we will eventually reach what is called an endemic state of COVID. In other words, we're in a pandemic right now. What does endemic look like? Endemic looks like, when the virus is widespread everywhere but it's causing a relatively stable amount of disease in the community, that usually happens because we as a society have adapted to the presence of the virus. It's not making us as sick as it once was. And that process could take time. It could take several more years before we ultimately get there. So I just want to say, there's the good news. The bad news is we don't know how long that process is going to take. The bad news is we could still continue to see peaks and valleys for the next foreseeable future. Just like we're seeing right now in Michigan with our fourth surge, we could see a fifth surge and a sixth surge and a seventh surge. But with time, those surges should get less and less severe until we sort of reach a more plateaued experience. Does that make sense?
Dr. Asha Shajahan (18:22):
Totally. I am really hoping that we come to an endemic and not to omega.
Dr. Nick Gilpin (18:28):
Agree.
Dr. Asha Shajahan (18:29):
Okay, well, Nick thanks so much for this conversation. I think so many people are just worried and just want to know more facts. And as usual, it's a pleasure to talk to you and get the facts out there.
Dr. Nick Gilpin (18:42):
Yeah, it was great. Thank you.
Dr. Asha Shajahan (18:43):
Thanks everyone for listening. If you aren't vaccinated, please get vaccinated. If you aren't boosted and it's been more than six months since your last shot, get boosted. Vaccines are the way to prevent infection and get us through this holiday season safely. So keep masking, washing those hands. Get tested if you have symptoms or you've been exposed and are concerned. And stay safe this holiday season.
Speaker 3 (19:09):
Continue new your journey to living a smarter, healthier life. Visit beaumont.org/podcast to access information and resources related to today's podcast.