Omicron - Have Vaccines Met Their Match?

So here we are – mid-January, 2022 and in the US we are seeing the highest COVID-19 case numbers we’ve seen at any point in the pandemic. How? With the vaccine out and the majority of Americans vaccinated, it is easy to ask…how can this be?

Many people have asked me why the vaccines don’t seem as protective against the Omicron variant, so I like to remind people what a vaccine is. The COVID-19 vaccine, like vaccines in general, are designed to prevent the severity of the disease, not guarantee that you won’t contract it at all. The analogy I always use is that the vaccine is like a seatbelt. A seatbelt does not prevent a car accident, but it will limit the extent of injuries. The COVID vaccine, and all other vaccines, are the same.

That has been forgotten by many of our patients who got the vaccine and have thus far been able to avoid any breakthrough infections. And who can blame them? We have all needed a ray of hope during this pandemic and the vaccines provided that. So in many of our patients’ minds the vaccine didn’t just decrease the likelihood of catching COVID - it was a guarantee. Clearly that is NOT what a vaccine is.

There are a few reasons why we are seeing more breakthrough infections with Omicron. Bottom line is that Omicron appears to replicate much more efficiently than previous variants and if people who are infected have high virus loads, there’s a greater likelihood they’ll pass it on to others, especially the unvaccinated. Luckily those of us who are vaccinated may avoid it altogether or we may have mild symptoms because the vaccines trigger multiple defenses in our immune systems and makes it much more difficult (not impossible!) for Omicron to slip past them all.

Also consider that the variant showed up at a bad time. More and more vaccinated Americans were experiencing waning immunity from their first set of vaccines and not enough people had yet gotten the booster by the time Omicron showed up on the scene. Take New York City for example. The Omicron variant hit there first it seems, and it hit hard. In mid-December, early on in the Omicron spike, around 7,000 cases per day were being reported even though 71% of the population in the city is fully vaccinated. A relatively small percentage had received boosters.

As I said earlier, the vaccines were not created to stop infections but instead to render them less dangerous with reduced chances of more severe disease. But nearly 40% of the U.S. population, including children under the age of 5, remain unvaccinated. Infections will more readily spread among that group, further straining our already over-stressed healthcare system. With so many healthcare workers unable to work because they are sick, our hospitals are as pressured as ever. More infections are being uncovered since every patient who goes into the hospital for an elective surgery is now being tested. That means there are extra precautions that must be taken with these patients to isolate them and in most cases, the procedures they came into the hospital for are something they end up having to cancel. At one New York hospital it is being reported that 2/3 of patients coming in for things such as hip replacements, childbirth, or broken bones are testing positive for COVID. Those are being called incidental infections.

While Omicron is not causing symptoms as severe as Delta did, there are still individuals who will be hospitalized by it. When that demand is added to hospitals with lowered capacity, you end up with hospitals and teams of physicians, nurses, and other supporting staff once again feeling the strain of this pandemic as it enters its third year. I should add that the lower staffing levels many of our hospitals are facing are also being caused by high rates of burnout and resignation that have forced many hospitals to operate with skeleton crews.

Let me emphasize that COVID-19 vaccines are working so well that only a small percentage of breakthrough infections are likely to lead to severe disease. Unfortunately, because the Omicron variant is so transmissible, it could cause a large number of people to get sick. This has already lead to some hospitals being overwhelmed. Projections are showing that the strain on hospitals will be felt more acutely in areas of the country where a high number of the population remains unvaccinated. Those individuals are not protected at all and are more likely to suffer higher rates of complications and severity than those who are vaccinated.

But projections aren’t always right. For example, take the projections by some COVID forecasters and modelers who thought that the variant would bring something like 400,000 new cases every day. The reality is that we are already at nearly 7000,000 cases a day, almost double the forecast. That means if Omicron is half as severe, but it is causing twice the number of infections, we are sending the same number of people to the hospital! Even if the cases are less severe, there is always a chance that it can trigger serious illness or long-haul COVID-19.

As usual our message to our patients remains the same: get vaccinated. Get the booster. Wear a mask. As physicians we are the most trusted source of vaccine information to our patients. That was recently validated through a Kaiser Family Foundation survey that found 80% of survey takers trust their doctor first and foremost when it comes to vaccine advice.

What we must remember is that the reasons why some individuals are vaccine resistant and have not gotten the vaccine are likely due to an overt mistrust issue and/or people who just believe in their personal autonomy and don’t want to be told what to do by an authority figure. With that in mind, research shows that if we as physicians talk with our patients and not at them, we are more likely able to engage in a meaningful dialogue that lets us talk through their concerns in a more objective and less judgmental way. There are resources out there to help physicians have those conversations and they’ll be linked in the sources below this blog.

Sources:
 

Why is Omicron Causing a Rise in Breakthrough Infections? – NBC Chicago 

Omicron Is Changing Our View of Breakthrough Infections | Time 

This Covid Surge Feels Different - The New York Times (nytimes.com) 

Arizona health officials say 'mild' omicron still a risk (msn.com) 

Why there are so many breakthrough COVID cases amid omicron surge (bangordailynews.com) 

Talk With -- Not To -- Your Patients About COVID Vaccines (medscape.com)