Dr. Loh: A flickering light at the end of the COVID tunnel

Please just go away and let us get back to our lives. That’s what the majority of us were feeling and saying a couple of months ago when it appeared that the Delta variant was perhaps burning out after wreaking havoc on mostly the unvaccinated. But then the Omicron variant appeared and what was scary about it was that it had so many mutation changes on the spike protein, the target of the mRNA vaccines, that vaccine evasion would occur.

First thing is that the Omicron mutations did give the virus some ability to evade the most popular mRNA vaccines, and because of its cloaking, it created some reinfections in patients who already had COVID in the past. Note that this is not ineffectiveness of the vaccines, but a diminished effectiveness. The FDA classically approves a vaccine if it can show a 50% reduction in infections. The mRNA vaccines were showing 90-95% effectiveness in the early clinical trials, which clearly was and is fantastic.

The current studies from around the world are showing that against Omicron, the mRNA vaccines are only 50% effective in preventing infections, even with the boosters, and less effective with only two doses. So, against Omicron, these vaccines remain effective, just not as much as we had gotten used to from all the early vaccine studies hyped up in the media.

The second thing is the observation that although Omicron is much more infectious than the already very infectious Delta variant, patients don’t seem to get as sick with it. Hallelujah. But the problem is that people at risk are still getting quite ill, being hospitalized, and still dying from COVID, not just with COVID. So there seems to be a split from early COVID where the morbidity and mortality of COVID were tied to getting infected with and without prior high risk factors present. Delta was worse because it was more infectious and the complications were similar to the original strain. So the virus has been behaving like most mutations do — enhanced replication is the goal.

All the mutations in Omicron have indeed made it more infectious, but it seems to be a milder disease unless one is in the well-characterized higher risk groups. And, if one is unvaccinated or undervaccinated, then that’s simply more people to infect and statistically, more people with the potential to get sick and hospitalized, but not necessarily die at the same rate as before. But these patients still take away hospital beds and finite medical resources for those who could not choose whether or not to get sick.

Some readers of my columns have said I’m blaming the pandemic on the unvaccinated. They clearly don’t get the message about what I’ve been writing. The virus thrives by definition by replication. The more it replicates, the more opportunity it has to tinker with its genetic code, empirically looking for jackpot mutations that will allow it to be even more infectious.

Unvaccinated populations are the breeding ground for mutations. That’s how Delta evolved, in the huge unvaccinated populations of India. That’s how Omicron evolved, in the young unvaccinated populations of Southern Africa. The more unvaccinated people we have, the greater the opportunity to have the virus develop more infectious mutations. That’s not blaming the pandemic on the vaccinated, but it is suggesting that prolongation of this pandemic may be tied to having large populations of unvaccinated or undervaccinated people.

There are novel vaccines, so called pan-coronavirus vaccines, and those administered orally or by nasal sprays to block the virus’s ability to infect or be transmitted. Vaccines have been the product of hardcore science, not metaphysical forces, magic, and certainly not politicians (except for the allocation of money to facilitate the science). One may have perfectly legitimate reasons to decline vaccination on moral, ethical, religious or chosen facts grounds. It certainly is one’s right to do so. But those are personal decisions and when those decisions impact others who may not share one’s views, then society must provide safety for the greater good. That’s why there are stop signs and speed limits so one can’t drive 100 mph in a school zone even though one can choose to do so in their personal car. If you have a young child at that school, you would probably agree.

The next variant, or next generic pandemic, will always be looking for the reproductive advantage. We may not be as relatively lucky as we may be with Omicron if the mutations also enhance lethality. And whether one likes it or not, Omicron has been a peek at a future pandemic pathogen and the lessons humanity has learned, or not, will play a determinant role in the eventual outcome.

We should hope that society has learned lessons from this experience, that the science steps up again, and society embraces the scientists and healthcare professionals who have voluntarily stepped up to help us all in this battle.

Irving Kent Loh, M.D., is a preventive cardiologist and the director of the Ventura Heart Institute in Thousand Oaks. Email him at drloh@venturaheart.com.

This article originally appeared on Ventura County Star: Dr. Loh: A flickering light at the end of the COVID tunnel