Email: Dr.Q@goodheartshealth.com
Phone: (786) 747-7904
Email: Dr.Q@goodheartshealth.com
What I have learned in the first two weeks of the Omicron outbreak
This update was prepared by Dr. Mario Quiros. Board Certified Emergency Medicine Physician
What I have l learned
I just finished working 7 of 8 days in the Emergency Department in Miami, FL and experienced Omicron firsthand. I am writing this update to share what I have learned, hopefully ease some tension, and give readers a realistic expectation of what is to come. Omicron seemed to have hit out of nowhere. We literally went from seeing very little Covid -19 cases at the end of November to being inundated with patients the week of December 13th. All of the sudden several of my friends were getting ill at the same time, nearly all of them vaccinated. At the time it was still felt that the majority of circulating Covid -19 cases were still attributed to Delta, but I knew something different was going on. I have never seen so many completely vaccinated (many with a booster dose), previously infected patients, and patients who had been infected and were also vaccinated become ill in such a short period of time. We knew Omicron was starting to circulate in our communities but the rate it has eclipsed Delta as the dominant strain of Covid-19 in Miami was astonishing. We now know that Omicron makes up over 73% of Covid-19 cases nationwide and over 90% of cases in certain regions. Omicron is likely responsible for 90-95% of Covid-19 cases in Miami-Dade county currently. How is Omicron Different from Delta? Most of my patients have tended to be younger, vaccinated, and/or previously been infected with Covid-19. Typically new waves start in younger healthier populations so we will learn more about how it effects older patients and patient with more co morbidities over the next few weeks. Patients:
Generally had mild symptoms compared to the Delta surge over the summer which hit unvaccinated patients particularly hard. However a large proportion of infected patients were fully vaccinated which we did not see with Delta
Had more upper respiratory symptoms such as runny nose, congestion, sore throat, laryngitis, burning in the chest, and bronchitis
Did not lose their sense of taste and smell like we were seeing commonly with other variants
Had little pulmonary (lung) involvement. Less of our coughing patients had pneumonia on their chest X rays or abnormal breath sounds on exam.
Were much less likely to be hypoxic (low oxygen levels) compared to prior variants.
Omicron patients were more likely to have their asthma exacerbations triggered by their infection Prior strains caused pneumonia at a high rate but normally did not trigger asthma. Omicron has been causing more bronchitis than pneumonia and this bronchial inflammation was triggering patients asthma.
Fatigue, body aches, headaches, fever, and chills all remain common symptoms.
The Good News:
This is the mildest strain of Covid-19 I have treated to date. So far I have seen less critically ill patients, admitted less patients to the hospital, and far less patients have required supplemental oxygen or any form of ventilatory support.
We have more tools than ever before to prevent severe disease in the form of Vaccines that prevent severe illness and Monoclonal antibody therapy to treat patients once they become ill.
I think this is going to burn through fairly quickly. Most Delta surges lasted 6-8 weeks. Based on the rate of infection this will probably spread very quickly but hopefully burn through very quickly as well, likely in 2-8 weeks
The Bad News: 1. Omicron appears to be much more contagious than previous strains and seems very effective at evading immunity provided by vaccination. Recent data suggests 2 doses of the Pfizer vaccine is 33% effective at preventing infection compared to the unvaccinated. The protection against hospitalization is 70% compared to being unvaccinated. These numbers are significantly down from what we saw with prior variants, both these numbers were well over 90% previously. Booster doses are recommended at this time to to decrease the chance of infection and severe disease. The exact efficacy is unclear as I have seen conflicting data on 3 dose vaccine efficacy and this is something we are still learning about on a daily basis. The CEO of Pfizer claims 3 doses of Pfizer provides similar immunity to Omicron that 2 doses of Pfizer provided to the original Covid strain. From what I have seen clinically to date this does not correlate but we need more data to know for sure. 2. The timing is terrible, right before the Holidays. When you combine this with how contagious Omicron is and many patients having mild symptoms the chance for widespread transmission is very high. I feel we are only going to learn about the severity of this strain on the high risk population in the next few weeks. Unlike Delta, we are likely to see widespread disease in the elderly population and in patients with more co morbidities as Omicron is very effective at evading immunity provided by the vaccine. We can only hope the symptoms are mild similar to what I have seen in the younger and healthier population. Only time will tell. In the mean time my advice is to practice an abundance of caution for those around you who would be considered high risk from a Covid-19 infection. This disease has humbled us all and I think prudence is the wisest course of action this Holiday Season.
I wanted to take the time to address some controversies regarding Covid -19 vaccination. As a healthcare provider I find it very important to deliver the best possible information to my patients and present information in a fair and unbiased way. I wanted to discuss 3 topics in greater length to help clear up some controversies and misconceptions regarding Covid-19 Vaccination.
1. Is the Vaccine Safe?
I try and look at things as objectively as possible. At this point I feel you have two options. Either you get vaccinated or you will ultimately develop a Covid-19 infection without the protection of prior vaccination. While there are some very rare side effects from the vaccine, the benefits far outweigh the risks according to any objective measurement. Furthermore if you look at any of the side effects of vaccination, they occur at much higher rates with natural infection.
Recently there has been a lot made about the development of myocarditis/myopericarditis in children who had received mRNA Covid vaccines. This is true and vaccination does carry a small risk of causing myocarditis/pericarditis. However, when you look at the incidence of this complication due to vaccination vs. natural infection the risks are not nearly equivalent. The risk of myocarditis in someone who received the Covid vaccine is between 1 in 40,000 to 1 in 60,000. The risk of myocarditis in someone who has a natural infection is closer to 1 in 45. While most people do well with appropriate treatment this nonetheless scares a lot of people and pushes them away from vaccination. When looked at it objectively there is a 1000 x greater likelihood of developing this from natural infection and does not appear to be reasonable reason not to get vaccinated from that perspective.
2. I no longer have detectable Antibodies so I need a booster!
I do not think we will ever eradicate this virus but we can live with it. If we can prevent severe illness and death then we are winning the fight agains this pandemic and over time the threat it poses to our society will decrease immensely. In my opinion too much emphasis is placed on the vaccine completely preventing Covid-19 infections. Even if the vaccine does not prevent acute infection at as high a rate over time there are still tremendous benefits from vaccination whether it being a much lower chance of contracting Covid-19 if exposed, milder illness if you do develop symptomatic infection, and a narrower window of transmissibility if you do become infected,
3. Do I need to get vaccinated if I have previously been infected with Covid-19?
I understand why one would feel that a vaccine is not necessary if they have recently recovered from Covid even if vaccination would provide additional protection. However, I do not think there is evidence that vaccination is unsafe in this population and the societal benefits for the individual in the world of vaccine mandates likely far outweigh any risks of vaccination.
Thanks for reading,
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– Dr. Q
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Copyright by VMG 2024. All rights reserved.