A newly detected variant of the virus that causes COVID-19 could complicate efforts to control the pandemic, but Arizona public health officials say more investigation is needed to clearly understand the situation.
"Omicron, with a high number of mutations, is indeed concerning, hence the attention from public health leaders worldwide," Arizona Department of Health Services interim director Don Herrington wrote in a blog post on Monday afternoon. "But too much remains unknown for it to be more than that at this time."
The omicron variant, first detected in South Africa, is an added threat during a pandemic that in Arizona already has caused three major waves of illness, hospitalization and death.
The first known U.S. case of the omicron variant was identified Wednesday by the Centers for Disease Control and Prevention and the California and San Francisco departments of public health.
No cases of the omicron variant had been identified in Arizona as of midday Wednesday.
The latest Arizona wave of COVID-19, fueled by the highly transmissible delta variant of the COVID-19 virus, has persisted since the summer and is putting pressure on a health system contending with severe staffing shortages.
Last week, hospital leaders in Arizona pleaded with the public to get the COVID-19 vaccine to help preserve medical resources.
As of Sunday, more than one-third of Arizona's intensive care unit beds were occupied by COVID-19 patients. At the same time, hospital leaders are dealing with more patients because of winter visitors, increased non-COVID patient demand and a looming flu season.
Here's what we know about omicron so far:
What is the omicron variant?
B.1.1.529, also known as omicron, is a highly mutated variant of the SARS-CoV-2 virus that causes COVID-19. It was first detected in South Africa and has since been discovered in several other countries. The first U.S. case was identified Wednesday.
On Friday, the World Health Organization labeled omicron a "variant of concern" because it has several mutations that may affect how it behaves, including transmission and the severity of illness it causes.
The first known confirmed B.1.1.529 infection was from a specimen collected Nov. 9, WHO officials say.
Has omicron been detected in the US?
Yes. The first U.S. case was identified in California on Wednesday. It was the only case identified in the U.S. to date. The individual who tested positive for the omicron variant was a fully vaccinated traveler who returned from South Africa on Nov. 22, the CDC said.
The individual had mild symptoms that are improving and has been self-quarantining since testing positive, according to a news release. The CDC says the individual's' close contacts have been notified and have tested negative.
The omicron variant has also been found in several other countries, including Canada, the United Kingdom, Belgium, Germany, Italy, and in Hong Kong, a special administrative region of China.
Why is omicron a 'variant of concern'? What does that mean?
The WHO said that a variant of concern has genetic changes that are predicted to affect virus characteristics and also has been identified as "causing significant community transmission or multiple COVID-19 clusters." In addition, a variant of concern is associated with an increase in transmissibility or virulence, or a change in clinical presentation or effectiveness of therapeutics or vaccines.
Essentially, omicron “has a large number of mutations, and some of these mutations have some worrying characteristics,” said Maria Van Kerkhove, the COVID-19 technical lead with the WHO Health Emergencies Program, in a video posted by the WHO.
Exactly how those characteristics will manifest remains to be seen.
How is Arizona working to detect omicron?
The Arizona State Public Health Laboratory at the Arizona Department of Health Services and partner labs at TGen and Arizona State University conduct whole genome sequencing on a subset of positive COVID-19 samples in Arizona, state health officials say.
A sequencing dashboard is available at https://pathogen.tgen.org/covidseq-tracker/.
Only PCR (polymerase chain reaction) tests — not rapid antigen tests — can be sequenced to identify variants, said Dr. Regina Van Buren, medical director of Phoenix-based Sonora Quest Laboratories/Laboratory Sciences of Arizona.
If I test positive for COVID-19, how do I know if I have the omicron, delta or another variant?
Right now, data about coronavirus variants is decoupled from identifying personal information, meaning that individuals can't find out what variant is responsible for a positive test result.
Is it possible #OmicronVariant sets us back to square one?
We have lots of tests that'll detect Omicron
We have therapies that'll work
Our vaccines MAY take a hit but will still provide some (may be a lot) protection
We are in a MUCH better place
This isn't March 2020
— Ashish K. Jha, MD, MPH (@ashishkjha) November 28, 2021
What is the most common variant in Arizona right now?
The delta variant is still by far the predominant strain circulating in Arizona, accounting for more than 99% of samples sequenced by labs in the state, according to TGen's sequencing dashboard.
Should I be worried about omicron?
"To me it looks pretty concerning, although I do think for most people, the vaccine, particularly if you get a booster, will probably prevent serious disease and death," said Michael Worobey, an infectious disease expert who is head of the University of Arizona's Department of Ecology and Evolutionary Biology.
Dr. Bob Wachter, who is chair of the department of medicine at the University of California San Francisco, tweeted on Monday that we should be "prepared mentally to act more cautiously if omicron proves to be more infectious, immune-evasive, or both."
Are we heading into another big pandemic wave like we had last winter?
Even if omicron is highly transmissible and vaccine-resistant, it won't be like going back to "square one" of the pandemic, Dr. Ashish Jha, who is dean of the school of public health at Brown University, tweeted Monday.
"Our vaccines MAY take a hit but will still provide some (may be a lot) protection," he wrote. "We are in a MUCH better place This isn't March 2020."
Biden on Monday said controlling omicron would not include "shutdowns or lockdowns." But he did say widespread vaccinations, boosters and testing would be needed. He also advised Americans to wear face masks when indoors.
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What do health officials in Arizona say about omicron?
Herrington, the interim state health director, wrote in his Monday blog post that his recommendations to the public remain the same, "even after the discovery of a new COVID-19 variant, omicron, started generating intense global interest."
His advice is to get vaccinated if you haven't yet; get a booster if you are 18 and older and eligible based on the timing of your previous shot or a breakthrough case; wash your hands; physically distance; stay home when sick; and follow other prevention steps at azhealth.gov/COVID-19. If you are exposed to COVID-19 or have symptoms, get tested and see if you qualify for monoclonal antibody treatment to reduce the severity of your illness.
He also noted that the state officials would keep up to date on national information.
"We are in regular contact with federal partners on matters related to COVID-19, including the omicron variant, and will share important information as soon as we have it," he wrote.
Officials with the Maricopa County Department of Public Health say they are working with both the Centers for Disease Control and Prevention and the state health department to perform enhanced surveillance to identify the strain if it appears in Arizona.
"We will also be working with ADHS and airports to message to international travelers about the potential risk of exposure to COVID-19 during travel, including the omicron strain, and will provide specific recommendations based on CDC guidelines," department spokeswoman Sonia Singh wrote in an email.
What questions are scientists trying to answer about omicron? How long will that take?
Changes in transmissibility, clinical presentation and ability to evade immunity “are going to be the three key pieces to look for as more is learned about the variant in the next several weeks,” said Dr. Joe Gerald, an associate professor of public health at the University of Arizona.
Still, it will be "a couple more weeks to months before we actually (see study results)," said Efrem Lim, an assistant professor at the Arizona State University Biodesign Institute.
Will vaccines work against omicron?
"If (omicron) does spread, I think likely what we'll see is that the vaccines will work a little bit less well, at least in terms of keeping you from getting infected in the first place or preventing mild infections," said Deepta Bhattacharya, a professor of immunology at the University of Arizona.
But Bhattacharya said that the immune system has multiple ways of identifying and fighting viruses, and that this variant won't bring us back to a pre-pandemic state of vulnerability.
"For a lot of reasons, I think that (immunologists are) all pretty confident that it's not like we're going to be starting over for protection against severe disease," he said.
Should I wait to get a booster?
While it's possible a booster vaccine specific to omicron could be developed, it likely won't hit the market for months, Gerald said. Health officials don't advise delaying a booster until that happens.
Bhattacharya concurs. Waiting for an omicron-specific booster might be getting "too far out ahead of ourselves," he said.
"We focus on the problem that's before us, and right now that is delta," he said. "Boosters do a pretty amazing job of reducing the chances that you get sick with delta."
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How is omicron different from other variants? And why does it matter?
This variant has a large number of mutations, some of which are concerning, WHO officials say. The high number of mutations makes it harder for scientists to predict exactly how the new version of the variant will behave, Bhattacharya said.
He said the types of mutations present in the omicron genome concern scientists because they suggest changes to the virus' spike protein, which our antibodies can target to prevent our cells from getting infected.
"Preliminary evidence suggests an increased risk of reinfection with this variant, as compared to other (variants of concern)," a Nov. 26 WHO statement said.
In addition, omicron may be contributing to an increase in cases in South Africa, although it remains too early to tell whether it will become dominant in other countries.
"The epidemiological situation in South Africa has been characterized by three distinct peaks in reported cases, the latest of which was predominantly the delta variant. In recent weeks, infections have increased steeply, coinciding with the detection of B.1.1.529 variant," the WHO statement said.
Will omicron cause milder illness?
It is inaccurate to presume that COVID-19 eventually will become less severe, immunologists said.
"This virus transmits mostly before people get really sick," Bhattacharya said, so the "virus doesn't really have any (evolutionary) pressure one way or the other to become more mild or more severe."
While more data is needed on the clinical effects of omicron, "I don't think we can assume (that it's likely for the virus to become milder) here," he said. "We didn't see that for alpha and delta (variants). Both of them tend to make people a little more sick, not the other way around."
What to do now?
1) If not vaxxed, get vaxxed
2) If not boosted & >4-5 mths out, get boosted
3) Get prepared mentally to act more cautiously if Omicron proves to be more infectious, immune-evasive, or both
4) Follow the news & science – will be much clearer in 2-3 wks
5) That's it
— Bob Wachter (@Bob_Wachter) November 29, 2021
Republic reporter Alison Steinbach contributed to this article.
Melina Walling is a bioscience reporter who covers COVID-19, health, technology, agriculture and the environment. You can contact her via email at email@example.com or on Twitter @MelinaWalling.
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This article originally appeared on Arizona Republic: Omicron variant: Questions and answers on what you need to know