Omicron Update

Submitted by John on Fri, 12/17/2021 - 03:38

Alright folks, it's time for an Omicron update.

I mean, it could be worse. But if you look at "how bad is this going to be for the health care system", it's going to be quite bad, and possibly even worse than that. 

You've probably heard that Omicron is milder than other forms of Covid. This is true, and it's good news! So why would a milder form of Covid be bad for the health care system?

First off, it's looking like Omicron is more transmissible than Delta. This means that if someone gets Omicron, they're more likely to pass it on to more people. 

The second bit of bad news is if you get Delta, it doesn't do a good job of protecting you against Omicron, and if you get Omicron, it's not going to do a very good job of keeping you from getting Delta. 

These two facts combined are going to be quite bad for all of the hospitals out there. For one thing, we are already in the middle of a Delta wave in the United States. Some doctors and nurses have been raising the alarm about how bad Covid is getting this winter. A wave of Omicron on top of our existing Delta wave is going to push hospitals to the breaking point, and possibly past it. Some hospitals are already turning away patients, the Delta wave is still not peaking, and Omicron hasn't even hit in force yet. 

Even though Omicron gives milder cases, people are still dying from Omicron. Omicron is still sending people to the hospital. It's still sending people into the ER. It's still going to be a big strain on the healthcare system as a whole. 

So what's the good news? 

The first bit of good news is that even though Omicron is better able to slip past the natural antibody response of the adaptive immune system, the killer T-cell response is mostly not going to be fooled. So if your adaptive immune system has been exposed to Covid, either through infection by Covid or through a vaccine, you have some level of protection against serious disease or death.

The second bit of good news is that we have a vaccine that is protective against the Omicron variant. It's three shots of Pfizer or three shots of Moderna. 

Are you going to ask "Why do we need three shots if one or two shots didn't work the first time?" Are you going to make me answer this question when it's already way past my bedtime?

Alright, but only because I love you and don't tell Mom we stayed up this late. 

Your immune system has two parts. The first part is known as "innate immunity." You can think of this part as the first responders, because that is what they are. The biggest chunk of this innate immunity are the neutrophils. They attack every germ they see, whether they have seen the germ before or not. They can chase germs down, break apart connective tissue between cells to squeeze in there if there's a pocket of germs hiding away, call in more neutrophils for backup, and more. 

If neutrophils are so great, why don't we have more of them? Well, it's because they are fairly expensive to make, in terms of body energy. So you just have enough for day to day needs (like when you eat your fries without washing your hands), with a reserve force in case you get a small cut or something like that. 

If a neutrophil catches a germ, they engulf the whole thing, and take apart the germ and split it up into proteins. Then they examine each protein a very small piece at a time, looking for any spots in the protein that an antibody could possibly attach itself to. 

These spots where antibodies could attach are called "epitopes". The neutrophil slices out the epitopes and sends each one along with a message to the bone marrow that says: "Hey, I found this thing, I think it's important! Start making antibodies for it!"

And this brings us to the second part of the immune system, the adaptive immune system. The bone marrow gets all of these requests for antibodies, all over the time, all over the place. It makes antibodies, but it also makes more antibodies for an epitope if it gets more messages about the epitope. 

It tunes the immune system response based on what it has seen before!

The bone marrow really starts remembering all of this, remembering just how many messages it gets for each epitope. The more messages, the stronger the memory. The stronger the memory, the longer it will take for the memory to fade, and the quicker the body can gear up the antibody factories in the future. And the more recent the messages are, the more likely you are to have antibodies in your blood stream. 

Why is your body doing this? Well, in part it's because antibodies are super cheap for your body to make. One cell can make MILLIONS of antibodies! 

Amd here's a cool thing about this memory response of the bone marrow. If an immune system cell captures a germ with antibodies attached to it, it immediately tells the bone marrow all about it. And the bone marrow then pays closer attention to those antibody messages, because it knows for sure that that particular antibody is working!

So the first shot of the vaccine just gets the bone marrow started, and kicks off that initial antibody response. 

When the second shot hits, since you still have antibodies in your blood stream, some of the antibodies bind to the spike proteins. This is a much stronger signal to your bone marrow! This new stronger signal, plus the existing signal coming from the innate immune system, provides a good level of memory response, good enough that your body can handle the Delta variant effectively. 

The third shot deepens the memory response of our bone marrow even more, which enables our immune system to mount an effective defense against Omicron. Even though Omicron is evading a certain amount of our antibodies because of the mutuations in the spike protein, the third shot boosts the level of all of the rest enough that it (very nearly) makes up for it. 

And that's why three shots provides robost protection against Omicron!

Which brings me to my final point. Omicron is going to be all over the United States by January. And it's growing at an exponential rate. "Oh boy, here we go again" I hear you say. And oh, I am right there with you friend. I'm tired, and not just because it's 3:30 in the morning when I'm typing this. 

But, here's what I'm asking you to do. To the extent that you have the energy or capacity to do so, please consider taking your Covid precautions back up a notch. Right now, wearing your mask is the most bang for your buck you're ever going to get for the next year or more. Maybe you wear a mask in more places than you have been doing before. Or you upgrade from your old cloth masks to a new pack of N95 masks. Keep more distance away from others, linger less in the grocery store. Order some food to go instead of dining in. Stay out of all stores during peak hours. 

I do not want to be sitting here asking you to do this. I don't want to do a bunch of this stuff myself. Earlier in the week, I was supposed to go eat lunch with my mom. Instead of dining in or even sharing a to-go meal in the car, she went to the store and picked up some sandwiches, drove to my work, and she ate hers in the parking lot in her car, while I stood 6-8 feet away and I ate mine. 

I just want you all to be prepared and have a good understanding of what's coming. By the time January rolls around, all of the news reports will be about how many "fully vaccinated" people are getting sick with Covid. Or unvaccinated people who already had Covid so they thought that they didn't need the vaccine, but then they got it a second time. Don't be surprised when you see it.

Stay safe.