Transcription:
Understanding the Omicron COVID-19 Surge: Symptoms, Tests, Vaccines, and Treatments

Amanda Wilde (Host): Two years now into the worldwide Coronavirus pandemic, the virus keeps evolving. Dr. Gian Varbaro is Chief Medical Officer at Bergen New Bridge Medical Center here to unpack what we need to know about the Omicron COVID-19 surge. We'll talk about symptoms, tests, vaccines, and treatments. This is Wellness Waves, a Bergen New Bridge Medical Center podcast. I'm Amanda Wilde. Dr. Varbaro, thank you for being here. The evolution of this pandemic is a lot to keep up with. One thing we've learned is that viruses change. We had the Delta variant and that was more infectious than the original COVID. Now that Omicron variant has taken over, do we think the Omicron is making people less sick? Is it affecting more young children? Does it give us immunities? What are the characteristics of the Omicron variant that we should all be aware of?

Gian Varbaro, MD (Guest): Well, thank you for having me. There's several things that we should be aware of with it, and I'll go through some of the various aspects you alluded to when you asked your question. The Omicron variant does appear to be less virulent. It makes you less sick than the previous strains.

However, that doesn't mean that it doesn't make you sick at all. Right? I've heard very extreme things in both directions. I've heard, oh, this means it's just like a mild cold. And then I've heard, it's gloom and doom and everything's terrible. The truth likely, most times is somewhere in the middle, you know, it's, it's less virulent than the original strains were. It's less virulent than Delta was, but it is more infectious and that's something we kind of expect to have happen. If you look at the history of pandemics in general, there's been one about every hundred years in human history and they all ended the same way.

The way that they all ended was by the virus changing to become more infectious, but to make you less sick. And if you think about it, from this is a weird way to phrase it, but from the viruses point of view, virus doesn't have opinions, but, for the virus, the ideal for it is for it's to spread very easily but for you to not know it's there. Because that means it can keep replicating and you don't change your behavior. If it kills you it doesn't spread. If it makes you very sick, you don't go around other people. So, eventually it's just evolution that these are the steps it goes through. The 1918 flu is still part of our seasonal flu mix.

Bubonic plague still exists. Syphilis was a pandemic in the early 1500s. It's no longer as deadly as it was or it spreads in a similar way that it wants to. This is what happens eventually with these. We're not totally at the point yet where COVID is something that's just part of our yearly routine. But eventually that's what it's going to become. So, when we started, roughly the original strains were about 20 to 25 times more deadly than flu is typically. Right now with Omicron, it's about 15 to about 15 times. So that's definitely less than it was before, but that's still way more dangerous than flu is.

So, the other thing that's very protective is if you're vaccinated. So, if you're vaccinated and boosted, the effects on you are, much, much, much less. It doesn't mean you can't have effects, but they are significantly decreased. Basically, it's generally not that scary, the Omicron variant if you are these three things, if you're under age 75, if you are vaccinated, and if you are not immune compromised. The problem is that there's a lot of people who missed at least one of those three things.

Host: And is variant affecting more young children?

Dr. Varbaro: Well, again, mostly because it's spreading more rapidly. If it spreads more rapidly and it spreads more easily, it's going to catch more people. In addition to, you know, younger children have lower vaccination rates than older people do. The last time I looked, I think in the United I think somewhere between 95 to 99% of people over age 75 were vaccinated. But for children under age 12, it's like 30%. So, that's also going to create a different population. So, we are seeing a higher percentage of the patients being children. We're seeing more children hospitalized, but that's also because it's spreading more easily.

Host: But in the beginning with COVID I children were mainly carriers.

Dr. Varbaro: Not infected. Right. So yes. One of the interesting characteristics of COVID is that children tend to carry last and to have much less effects, which is interesting cause most viruses, it's the elderly and it's children who get hit hardest. With COVID, it hasn't really hit children. That's still true. It's just again, if you turn up the rate of something, it's just going to make the numbers higher. Right? So, if suddenly this thing is, again, I'm making up a number, 10 times more infectious. Well, you'd probably expect to see 10 times more kids than you were seeing before. Right? Just because it's more infectious. So you know what I mean? It's not like there were zero kids who got just you make it more infectious, more children are going to catch it.

Host: There's just more population.

Dr. Varbaro: Exactly. You're just upping the numbers. It's the laws of numbers.

Host: I see, well, why is it that if this is a less virulent strain, that hospitals are full again and well, we're seeing more cases because as you just explained, it's much more infectious. So, people are going to get it more easily, but if it's not powerful, doesn't make you as sick, why are filling up?

Dr. Varbaro: So, again, this just math. I know everybody hates math, but I was a math major. So, I don't hate it as much, but if you take the virus and you make it, again, I'm not using the exact numbers just to make it easier for people to understand. So you make it half as deadly, but you make 10 times as many people catch it, you're still going to get more people who are sick enough to get into the hospital. You're balancing out two things pulling you in different directions. So that's kind of what we're seeing. So it's that combination of the two factors. Now, again, we're also going into this in a very different state than we were before. We have a large portion of the population vaccinated, and that is significantly slowing it down. So, even though that 10 to one half thing, you'd expect it almost to multiply by each other. You would expect it to be like five times the patients. We're not seeing that because the number of people who can get as seriously ill is decreased because of the vaccination programs.

Host: But does seem that there are a lot of breakthrough cases with this particular variant. Is that true?

Dr. Varbaro: That is true. So, there are a couple of good analogies that I like that I've heard other people give and I wish I could remember who said them so I could give them credit. One very good one I heard was that in some ways the vaccines are like a Kevlar vest. It can't prevent you from getting shot at, but it makes it a lot harder for the bullet to kill you. And so that's kind of what the vaccines do. It slows down your rate of getting infected, but it doesn't 100% say you're not going to get infected, but it makes it a lot harder for it to kill you. Another good analogy that I've heard used is that the immune has different layers to it. So it's almost like a medieval castle defense system where there's your antibodies and the systems that prevent you from getting infected. That's almost like the wall and the moat but if the invaders get over the wall and the moat, in other words, if you get infected, there's still a bunch of knights there ready to attack and kill the virus.

And that's, what's called T-cell immunity. One of the interesting things we're finding is that each time you get vaccinated, not only does it rebuild the wall and moat, it makes the wall and moat better. And it also makes the knights better. They become higher quality. So you become, the better able to fight of the virus with each dose, which is why the booster has been effective against Omicron, because it's made both the initial wall stronger and it's made the backup attack stronger. So again, nothing's a hundred percent. We live in an imperfect world. That's another thing I've heard people say, well, the vaccines don't work because people get infected. Well, you've probably met people who were on chemotherapy who died of cancer. That doesn't mean that chemotherapy doesn't work. You've probably met people who, or knew people who died of heart disease, even though they were on heart medications. That doesn't mean that the heart medications don't work. It's just that they're imperfect. But they're still very, very good and they're very, very strong and they're very, very protective.

Host: So, when we're saying there are more breakthrough cases with this Omicron, is that again, a matter of numbers, there's more breakthrough cases cause it's being spread more widely. And so we're seeing more breakthrough cases, not because of the vaccine, the vaccine being ineffective, but only because more people are getting it. So, there are going be breakthrough cases like there always were.

Dr. Varbaro: It's a combination. That's part of it. There is one aspect to Omnicon where it is a little better, at getting people infected even if they're vaccinated, but if people are boosted, but the vaccines still do slow it down. It's not like it's not effective at all at preventing the infection.

But being boosted is further protection, and it's pretty strong protection, but then that's where you see. Well, again, people have heard of, and know of, and I've seen it too, people who were boosted, who got COVID. That being said, they tend to have much milder cases. And, that's where you're seeing a large number of them because it's more infectious. So you're seeing larger numbers.

Host: Do you think COVID-19 is then following patterns we've seen in other pandemics and this latest variant is part of the way to herd immunity?

Dr. Varbaro: Yeah, or at the very least towards that evolution I was talking about earlier. If anything, it's happening faster than it, the past ones have happened. If you look again at the history of these things I mentioned before, how they all end the same way with it evolving to a certain point. So, I'm going to put a warning before I say this, because people hear me say this and they freak out and get very nervous. But I'm going to have something better after it. The history of these is that they've typically all lasted seven to 14 years with the average being 10 years. That mean we're only two years in, and we're in for five to 12 years of this. That's not the case. We're actually moving faster than in other ones. And that's most likely because of the large vaccination campaign. We didn't have that with other pandemics and that puts greater pressure virus to change. That's part of the reason why you're hearing, if you follow the public health space very well, which I do, there's a lot of push to vaccinate countries to take away other places where it can evolve and again, make a greater push towards it becoming weaker and going away.

Host: Yeah, I was to ask what are you seeing terms vaccinations right now both in the US how we're affected countries around the world where there's real imbalance, there are people who are getting third and fourth shots, then, then are people in the world, you know, large numbers have not been vaccinated at all. And if anything, this pandemic has showed us how interconnected we all are. So, how is that going to affect the evolution as we make our way through this pandemic?

Dr. Varbaro: So you're absolutely right. That's a huge part of it. When it's harder the virus to infect people, it also doesn't have a place for it to mutate and change in other ways, particularly ways that could get it around the vaccines and so forth. When you put greater pressure on it, it's going to make it more so, so that, any change in it that makes it again, quote, unquote sick making, but more contagious is going to make it, become the dominant strain more quickly. So, what you really want to see is, all of the reservoirs of it kind of eradicated around the world if possible. So, to that end, you're seeing in some countries they're already approving forth shots for people. But one of the bigger pushes is to get to parts of the world where the vaccinations have not gotten in as much where they haven't gotten the vaccine to as people. So that we can also prevent it mutating there. Like you said, we live in an interconnected world. So, it behooves all of us to eliminate this in other places so that don't have to deal with it afterwards.

Host: So the other strains like going away as Omicron takes over?

Dr. Varbaro: We don't know that a hundred percent yet. be interesting to see how that plays out, but typically what happens is Delta pretty much wiped out the other strains here in the US was so much more contagious than the other ones that it out competed them. And the other ones just really couldn't get a foothold because Delta was flying around.

Omicron seems to be doing a similar thing. We'll have to see if it's able to completely push the other ones out like Delta did, but seems like that's what's happening. But again, that's one where I have a little less confidence on it. So take that one with the grain of salt.

Host: Okay. Besides vaccinations, are and tests still the best we can do to stay ahead of Omicron?

Dr. Varbaro: There's four things we found that help prevent the spread of COVID. The best one, we've talked about it quite a bit already, which is the vaccinations. That's the best one. Number two and three are pretty close to equal, which is frequent testing and actually ventilation. So, it's the whole, do things outside thing that you've been hearing for the last two years. It spreads a lot less effectively outdoors or in well ventilated spaces. So ventilation and frequent testing are two of our strongest tools against it. Just, under the vaccines. Masking is effective as well, but not as effective as those other three things. And then it depends on what kind of mask you're wearing. Right?

So, N95 gives better protection than a surgical mask which gives better protection than a cloth mask. And the other thing that people should understand that a surgical mask or a cloth mask is actually more about protecting other people case you're carrying it. It does protect you somewhat, but not as much as it protects other people. Whereas an N95 protects you as well. That being said, if you can't tolerate wearing an N95, a mask is only as good as you're able to wear it. I always hesitate to tell people that they should use a particular kind of mask because the most effective mask is going to be the best quality mask that you will wear for the longest. Right? So if it's, if you're wearing a really high quality mask, but you're taking it off 90% of the time, well, that doesn't do anything. Right? So, you really need to do whatever kind of masking you will tolerate the longest that has the highest quality is going to be the best thing to

Host: But why effective in protecting other people from you then protecting you from people?

Dr. Varbaro: So it's different kinds of masks. An N95 is specifically made to prevent things from coming in. Without getting overly technical, there's a thing called source control versus respiratory control. Source control is preventing things from being spread out. So, that's the surgical mask and if you stop and think about it, it makes sense.

Surgical masks are designed for surgeons to wear during surgery. They're designed to prevent them from breathing on an open surgical wound and infecting them with the stuff that they're breathing out. That's their design. They're designed to prevent things going out, but not as much things coming in. It's just how they're designed. Whereas an N95 is created specifically for going into areas where there's pathogens in the air, you know, I've been a doctor for over 20 years. Traditionally I've worn a N95 prior to COVID, I wore it whenever I was going to see a tuberculosis patient, for that reason to protect myself from breathing in the tuberculosis, in the air. And that's what that's designed for. So the surgical mask, it's just how it's designed. That's what it was designed for originally.

Host: When the pandemic started, you said in a previous podcast that we will get back to normal. Do you still believe we can get back to normal or are we in a new normal now?

Dr. Varbaro: think we will get back to normal. And I'm feeling pretty good about where it's that, that sounds strange considering, we're in the middle of a spike right now. But I do think it will get back to normal for the reasons I said at one point, this was going to become something that's just a seasonal illness like there's yearly flu season. There's yearly COVID season. And when COVID is such that it's not dangerous, then it'll be like that, you know? And who knows, maybe it'll become part of a yearly flu shot, like everything else, or maybe it won't. Maybe these vaccines will last longer and we won't need to do it as frequently. We don't totally know the answer to that yet.

But that will happen eventually. I do think it's going to happen more quickly. This, Omicron change is actually a big step. The other big thing that's going on that really talked about is the new therapeutics that have come out. Particularly the pill, antiviral medications, there's two of them, there's one by Merck. And then there's the one by Pfizer, that's called PAXLOVID. PAXLOVID is more effective than the Merck pill. It's more effective and it has less side effects. There's not a huge supply of it yet, but once there is, it's a very effective treatment when you're early infected. I talked earlier about how many more times it was deadlier than flu, but you also have to realize that, that calculation takes into account that for flu, we have a medication called Tamiflu, which I don't know if you've ever had flu or when one of my children have caught flu and had to take Tamiflu and it makes them get a lot better, a lot more quickly. And PAXLOVID works in a different way. So it's not accurate to say it's Tamiflu for COVID, but it's kind of at least in a conceptual way, a similar idea.

And when you add that in, now all of a sudden that deadliness goes down even more. We're not quite at flu levels, even with the medication, but we're getting close to that and might there be another wave or two, yeah, it's definitely possible. I wouldn't be surprised. I think that, we're getting close to that next wave or, maybe two waves being the one where it becomes, okay, now this is something we can deal with. Again, I don't have a crystal ball. I can't tell you that, that's for sure what's going to happen in the next year, but it's happening very quickly. Again, if you compare it to the historical record books of other pandemics.

Host: And you're actually saying Omicron is kind of a positive turn of the pandemic.

Dr. Varbaro: It is. I mean, it's not right now, and look, nobody's more exhausted by the pandemic, than I am. I'm a frontline physician and run a large hospital and a large public health program. So it's been a long two years. But once we get through this actual wave, it's actually a good long-term step. So it's a bad, short term, but good long-term thing to have had happened.

Host: Dr. VArbaro, thank you for helping make sense of this latest twist in the evolution of the COVID-19 pandemic.

Dr. Varbaro: Thank you for having me. It was a pleasure. I hope, I did help it make some sense.

Host: Yeah. Lots more clarity. And I'm sure we'll talk to you about it again.

Dr. Varbaro: Probably yes.

Host: As evolve. That's Dr. Gian Varbaro Chief Medical Officer at Bergen New Medical Center. Visit Newbridgehealth.org to schedule testing and view more information on COVID-19. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you.

Thanks for tuning in to this episode of Wellness Waves. I'm Amanda Wilde. Until we meet again, be well.