• The Allergy Station

The Winter Gift... Omicron

Updated: Jan 4

As described in the following article as a “wild card” of sorts, SARS-CoV2 made a strange “mutation of demise” … Omicron. This mutation has exploded across the globe, and probably for the better.


I give full disclosure – I am not a virologist, nor do I hold a degree in public health. I’m a clinician with a research background (20 years of experience) and I try to use my eyes, ears, hands, and even nose to sample the world around me.


On February 8th, 2020, I asked my wife to buy as many cleaning supplies, N-95/respirators, and soap as possible, once we returned from my CME conference in Hawaii. I knew very tough times were ahead.


This has not been an easy 21 months.


I have good news! The end is near. I can see it. I can feel it. I can hear it. I can smell it.


Omicron is what I would call a “mutation of demise”. You may ask “What does that mean?”


We have seen Omicron in the office, on the phone, and across our platforms. These last few weeks, likely 50% of our COVID + patients have had Omicron.


How do you know that, Dr. Miller? Are you genotyping these patients’ cultures?


No. We don’t have (or need) that technology. My father used to say “keep your eyes and ears open, mouth shut, Travis”. And low and behold, it works. If I could go back, I would listen to my parents more!


Omicron is a predominantly upper respiratory illness. The major symptoms are nasal congestion, headache, and sore throat.


Unlike its big, bad predecessor brother, DELTA, there a lack of disturbance of sense of smell, which was a classic feature. Also diminished in prevalence (%) are: cough, shortness of breath, and lower respiratory symptoms. Fatigue is still a major symptom.


So, let’s get to some basics and some predictions.


Basics:

  • Viruses and humans have been in an awkward dance for millennia


  • Vaccines have changed the world for the better. My dad gave me a book in 1997 written by a retired Merck PhD scientist that estimated 1 billion humans were alive since the 1950s attributable to the benefit of vaccines – pneumonia, meningitis, brain abscess, measles, polio, sepsis, etc. So, if you want to debate with me about vaccines, come prepared. I am so saddened by how polarized our media has pushed us to become. It needs to change. Quickly.


  • Natural immunity is a REAL THING! We have talked about it for centuries. It did not become a non-issue in the last 2 years. I’m an immunologist. I have been evaluating patients’ immune systems for the last 26 years. Our immune system is built to protect and defend against 3 major threats: catastrophic/lethal infection, progressive autoimmunity, and cancer/unregulated, uncontrolled growth. Period. And our immune system faces these challenges millions of times a day.


  • Our government health agencies are sending VERY confusing messaging, confusing policies, and therefore have seen an erosion of trust and adherence to guidelines. This is both tragic and preventable.


  • We have faced bigger challenges. World War. Civil War. 9/11 - Terrorism. Bioterrorism. The Great Depression. Even Y2K. We will weather this storm. But our actions, our words, our teamwork, our sacrifice and our respect for others will dictate how long we suffer. I would argue that until we believe, and pivot our behavior, to model that of an underdog team (not 325+ million angry people hurling grenades on Twitter or Insta), our suffering will continue and be prolonged unnecessarily. *See my Wooden quote below.


So, my predications for 2022 are:


  • COVID-19 is nearing the endemic phase. Brilliant scientists have predicted this phase would come. Omicron is just accelerating that point. Surprisingly so, beyond what anyone could predict or model.


https://www.nature.com/articles/d41586-021-03619-8

(Note: this was published on Dec 7th, and much more has been learned about Omicron since).


  • Herd immunity (driven by a combination of vaccine and recovered infection) will approach 100% globally before January 31, 2022. This version of the virus is sooo contagious that it’s going to burn itself though the population.


  • There is one more “big whammy”. In the classic 1980s game show, Press Your Luck, contestants would settle on a prize, or money, or GO FOR IT! “Big Money, Big Money, no Whammies” they’d yell as the squares would light up. The “Big Whammy” is where you would lose it all. In COVID-19 (are we still calling it that!?), that’s ICU admission, mechanical ventilation, and death. Delta did it. I’m guessing it’s Sigma, Rho, or Tau (letters further in this Greek alphabet soup) in February, March or April that will be the killing months. So, to say it, we have one more big whammy left. Bottom line: vaccines prevent hospitalization, ICU care, death, and destruction. That’s how they were engineered to perform.


  • Antivirals will make a difference. Not huge, but they will. For 15 years, Tamiflu (and to a lesser extent, Relenza and Ziflueza) have allowed us to support patients who could not receive vaccines against influenza. These are important tools and should be respected as medical breakthroughs.

https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-authorizes-additional-oral-antiviral-treatment-covid-19-certain

  • Grandpa and Grandma’s 2022 “flu shot” will be super-charged. The FDA has created the pathway to combine a 4-strain influenza vaccine with a circulating endemic, yearly coronavirus strain.

https://www.fda.gov/drugs/coronavirus-covid-19-drugs/coronavirus-treatment-acceleration-program-ctap see ACTIV

  • And finally, I believe there will be a global, and domestic, reckoning for the culture of shame which has been borne of this pandemic. Never in my history of healthcare have I been so awed and saddened by misdirected emotions. I think we need to trust each other, help each other, and work to get out of this.

https://news.northwestern.edu/stories/2021/12/covid-shame-torments-the-infected


John Wooden used to talk to his players and staff about “using all your tools” among his many other timeless principles. I would like to leave you with a quote from the Wizard of Westwood:


“A player who makes a team great is more valuable than a great player. Losing yourself in the group, for the good of the group - that's teamwork”. - Coach


Consider joining a team, and let’s finish this!


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