The first confirmed cases of COVID-19 caused by the Omicron variant have been detected in the United States.
The Omicron variant of COVID-19, first called B.1.1.529, was identified in Botswana and South Africa. The rapid spread in South Africa's Gauteng province created a red flag because it appears to be effectively outcompeting other variants, including the extremely transmissible Delta variant.
South Africa and Botswana identified the variant early because they have strong genetic sequencing networks, a very robust public health testing system, and perform more extensive testing than many other countries related to infectious diseases. This is important because South Africa has more than 8 million people infected with HIV, the most in the world.
According to the World Health Organization, the strain poses a very high risk, so it has been added to its list called "variants of concern." With cases popping up worldwide, governments have responded by restricting travel to reduce the spread, fearing that Omicron could cause a surge in COVID cases, overwhelm health systems, and frustrate efforts to reopen economies.
Variants are characterized by variations in how the virus is built. The Omicron variant is most notable because of many changes in the spike protein, which the coronavirus uses to enter cells and cause an infection. Mutations could make the pathogen less recognizable to the antibodies produced in response to the current COVID vaccinations or natural infection. This increases the risk of an Omicron infection in people who would otherwise be protected. The changes in the spike protein may be responsible for making the Omicron variant more transmissible and help the virus escape detection in the body.
The CDC has been actively monitoring and preparing for this variant and has started the exchange of science with global public health and industry partners on these elements:
- How severe the disease is for patients infected by this variant
- How transmissible it is
- How can it be detected, as opposed to other variants (Delta remains the predominant strain in North America)
- Can it cause new and serious infections in persons who have already had another variant of COVID
- How effective the current vaccines are against it
- How effective the current treatments are against it (like monoclonal antibodies)
This week, the CDC has offered the following guidance.
The emergence of Omicron further emphasizes the importance of vaccination, boosters, and general prevention strategies needed to protect against COVID. Everyone 5 and older should get vaccinated, and boosters are recommended for everyone 18 years and older. CDC information on the Omicron variant is available at https://www.cdc.gov/coronavirus/2019-ncov/variants/variant.html
Important items to remember: There is so little science on Omicron that it is hard to know its exact impact. There have been a series of variants that have caused initial alarm, only to prove largely unimportant in the course of the pandemic.
This winter, the biggest real impacts on Fire Rescue EMS systems are going to be the spread of multiple respiratory bugs and the very busy hospitals that are struggling with staffing levels. There will be many extremely overcrowded hospitals and many authorities encouraging the continued use of distancing and masks.
Here are action points for Fire Rescue EMS personnel at the present time:
- Get vaccinated against COVID, and get boosted, and get vaccinated against influenza
- Don't come to work sick
- Wear a mask indoors
- Keep your hands clean
- Sneeze and cough into your elbow
Stay vigilant. Stay safe.
James J Augustine, M.D., FACEP, currently serves Medical Director roles with fire services near Atlanta, Georgia; Naples, Florida; and Dayton, Ohio. He is a Clinical Professor in the Department of Emergency Medicine at Wright State University in Dayton, Ohio. He serves as the Chair of the Georgia EMS Medical Directors Advisory Council. Dr. Augustine is a member of NAEMSP and is a key member of the "Eagles" group of Fire-EMS Medical Directors.