The Good News About Omicron

In December 2021, western governments enforced stricter NPI’s (non-pharmaceutical interventions) and pushed the message of vaccine boosters for all in a bid to reduce disease severity and prevent hospitals from being hospitals.

This public health response to the new Omicron variant of SARS-CoV-2 was based on modelling from various institutions, such as SPI-M in the U.K, which stated that without further restrictions, there could be up to 6000 deaths per day peaking between mid-January and mid-March 2022.

Today, based on U.K government data, deaths average 153 per day. As discussed in other posts, “in silico” modelling sits at the bottom of the evidence-based medicine hierarchy.

The most efficacious response might well include modelling as part of the overall process, but based on established principles of evidence-based medicine, public health should first look to high-quality, impartial data published by systematic reviews, meta-analyses, randomised controlled trials and observational studies.

Sadly, around the world, much of the public health response to Covid has been driven by forecasting and theories rather than facts and scientific insight published in peer-reviewed literature.

When data was limited at the start of the pandemic, taking an approach dominated by modelling might have been justified, albeit for a brief time. There were a lot of unknowns.

But data from Italy and China quickly emerged in the peer-reviewed literature identifying age and inflammatory markers as key risk factors. Here’s an example of an early paper published on 12 March 2020, right at the start of the pandemic.

At this point, when high-quality peer-reviewed studies began to flow in and we understood the pathophysiology of the virus, it was possible to do so much more to repurpose different combinations of generic drugs to provide early care and a more proactive approach.

This preventative approach could have kept people out of the hospital, stopped healthcare systems from being overwhelmed, and saved lives. Instead, public health policy continued to rely too much on modelling to drive lockdowns and other non-pharmaceutical interventions.

Today there are 4170 peer-reviews papers in PubMed on Covid-19, which anyone can access, all of which provide fantastic insight into SARS-CoV-2, the efficacy of different interventions, and the safety and effectiveness of vaccination in diverse populations. Go and look studies up for yourself here: https://pubmed.ncbi.nlm.nih.gov/.

This brings us to Omicron.

In November 2021, Dr Angelique Coetzee, Chair of the South African Medical Council, notified the world of a possibility of a new variant. But she was also at pains to say that based on real-world data of GPs treating individuals with this new variant from home, the virus was much milder than before, with symptoms lasting a lot shorter than previous variants like Delta.

Dr Coetzee was quoted by Reuters on 28th November saying,

“We have seen a lot of Delta patients during the third wave. And this doesn’t fit in the clinical picture. Most of them are seeing very, very mild symptoms and none of them so far have admitted patients to surgeries. We have been able to treat these patients conservatively at home.”

This was good news when put in the context of the broader tragedy of the pandemic. South Africa also had much lower vaccination rates compared to the U.K.

In addition, the U.K government reported that 97% of the population had antibodies to SARS-CoV-2 in the middle of December 2021.

In short, it was a double positive. Omicron was proving to be milder, and the U.K had a robust level of circulating immunity. Our position was as strong as it could be in many respects. But you did not get to hear this vitally important and hopeful detail.

In December, pre-print studies emerged that supported the positive South African picture described by Dr Angelique Coetzee. For example, a paper from the International Journal of Infectious Diseases reported on the clinical picture in a hospital in Tshwane, comparing the differences between Omicron and previous variants.

This observational study found that on every level, Omiron was milder. ICU admissions, deaths, bed occupancy, and need for oxygen supplementation were statistically much lower with Omicron when compared to previous waves.

In addition, 63% of Covid-19 patients were in the hospital for alternative diagnoses but happened to test positive for Covid-19 once there.

Independent researchers on social media tried to share this good news based on real-world observable data. Still, the fear cycle had begun, and people were again thrown into a panic.

We have taken time to give context here because we are now at a point where as a society, we have to come together, move forward and challenge those that seek to maintain a constant fear cycle. It is unhelpful on so many levels, and as more and more people experience pandemic fatigue, all it does is deplete our collective mental health.

It is well established from neuroscience that a constant state of fear does not just harm us physically, mentally and emotionally; it has much wider repercussions for society too.

When the brain is experiencing constant uncertainty, two physiological changes occur in the brain.

First, the prefrontal cortex (PFC) is inhibited. The PFC is central to creativity, critical thinking, effective decision-making, compassion, empathy and connection. We all agree that these are essential qualities in life for any progress.

Second, the amygdala goes into overdrive. The amygdala is part of the ancient limbic system deep within the brain. The amygdala looks for “stranger and danger”, has a default negativity bias, and turns us into the “horse with blinkers on”.

The amygdala has served an essential purpose in keeping us alive over many millennia. However, in the past, it was activated briefly in response to a threat to life and then disengaged.

In present times, our environment is such that this amygdala is constantly sent into action. We go online and immediately see more bad news. We go on social media, and it quickly becomes a doom scrolling affair. We go outside, and it is “stranger and danger” everywhere we look. People have learned to look at others as disease vectors rather than fellow human beings.

The constant fear cycle has created a neurological tripwire that causes many people to stop thinking creatively, productively and critically. This inhibition to the PFC and overactivation of the amygdala is why we see so much hate, division and loss of empathy on social media.

The current fear is a race to the bottom where no one wins.

So, when there is good news to be shared, let’s share it. And to date, Omicron represents good news. Let’s look at how and why.

Because Omicron is new to the literature, scientists are using pre-print medical studies from servers such as MedRxiv, which you can access here should you be interested: https://connect.medrxiv.org/relate/content/181.

Why is the Omicron variant generally less severe compared to previous SARS-CoV-2 variants? Let’s look at emerging evidence.

The first answer in understanding why Omicron is less severe is the capability of T cells to prevent serious disease. It has been known for some time that T cells are important in ensuring milder disease against Covid.

T cells form part of the adaptive immune system, alongside B cells. The adaptive immune system helps your body remember previous exposures to various mutations of SARS-CoV-2 and other coronaviruses and then kill it. Together, T cells and B cells help you maintain a strong line of defence.

Understanding T cells is essential. Antibodies get all the glory, but T cells are vital in helping us live with Covid for the long term with a lower risk of illness. For example, a brand new paper published in Nature has found that cross-reactive T cell immunity from exposure to other coronaviruses offers protection for the individual and surrounding people.

Research suggests that T cell responses are robust against Omicron and protect you against severe disease, whether the T cell immunity is induced by Covid-19 vaccination or previous infection.

The authors of this pre-print state:

“Cross-reactive T cell responses acquired through vaccination or infection may contribute to these apparent milder outcomes for Omicron. The resilience of the T cell response demonstrated here also bodes well in the event that more highly mutated variants emerge in the future.”

Yes, positive news! Protection, not just now, but for the future too.

We hear a lot about antibody waning in the news. However, this can lead to more fear because it ignores other parts of the immune system that work brilliantly to protect you.

For example, the first line of defence, even before antibodies, is led by the innate immune system. It is central to preventing infection and disease. Cross-reactive T cells work in the background as well and are pivotal in our ability to ward off different variants successfully.

You can look at T cell immunity from vaccination and non-vaccinated recovered participants in response to Omicron infection below. Look at the CD4 and CD8 T Cell responses generated by different vaccines (such as Pfizer BNT). You can also see the immune response generated by those who are unvaccinated and have immunity due to prior infection (convalescent):

This research paper is not the only study pointing to T cells as a key player in preventing us from experiencing serious illness with Omicron. Other pre-prints offer the same insight:

> Long-lasting cellular immunity to SARS-CoV-2 following infection or vaccination and implications for booster strategies

> Vaccines Elicit Highly Cross-Reactive Cellular Immunity to the SARS-CoV-2 Omicron Variant

> Homologous and Heterologous Vaccine Boost Strategies for Humoral and Cellular Immunologic Coverage of the SARS-CoV-2 Omicron Variant

As you read about Covid in the future, please remember T cells. They are important!

There is another reason we should be optimistic: immunity in response to Omicron infection also confer protection against Delta.

A new observational study in South Africa found that neutralisation against Omicron in vaccinated and unvaccinated participants increased 14-fold over two weeks. Significantly, neutralisation against Delta also went up 4.4 fold.

This finding is very positive. Suppose a less damaging variant like Omicron can replace Delta whilst also creating immunity against severe disease from Delta. In that case, it may well be feasible for us to get to a place of dynamic equilibrium in the population that keeps SARS-CoV-2 from causing the level of damage it has done before.

This dynamic equilibrium is often called herd immunity and represents a point where the virus becomes endemic, like the flu and common cold. As we stated earlier in this post, 97% of people in the U.K have antibodies against SARS-CoV-2, which is quite incredible.

To quote the authors:

Along with emerging data indicating that Omicron, at this time in the pandemic, is less pathogenic than Delta, such an outcome may have positive implications in terms of decreasing the Covid-19 burden of severe disease.

In interviews throughout November and December 2021, Dr Angelique Coetzee noted that Omicron did not appear to create the same frequency of cytokine storm in those hospitalised compared to previous variants.

The cytokine storm is a central factor in determining Covid severity. The cytokine storm represents an excessive pro-inflammatory response by the immune system in response to infection and was one main reason for extended hospital stays and worse outcomes.

In December, researchers from Hong Kong found that Omicron replicated much more slowly in the lungs compared to previous variants. In other words, it did not induce the same cytokine response, which explains why Omicron does not lead to the same length of hospital stays, oxygenation needs and worse outcomes.

A study using mice brings more light to Omicron in this respect. It found the same effect:

In contrast to mice infected with Pango B and Delta variant viruses, those infected with the Omicron variant had less severe clinical signs, showed recovery and had a lower virus load in both the lower and upper respiratory tract. This is also reflected by less extensive inflammatory processes in the lungs.

Humans are not mice, so it is always important to look at animal studies in context.

But, when you have a confluence of data suggesting Omicron does not create the same cytokine storm as previous variants, this should be discussed and shared widely in the news.

Understanding pathophysiology is also essential in guiding public health policy.

Models guiding public policy in December assumed that Omiron was just as lethal as Delta. As you can see, though, this assumption ignored real-life clinical data from South Africa. Such assumptions are likely why the models were wrong with Omicron.

We wanted to share this post to update you on the research on Omicron as it stands. Because our mission is to empower people in their health and wellness, we also want to make some simple recommendations below. These tips can help you and others, and collectively we hope that life can move forward more peacefully:

1 – Be Proactive In Your Wellbeing

At no point during the pandemic have authorities guided us on broader lifestyle changes that can be protective against SARS-CoV-2. For example, optimising Vitamin D can significantly improve immune resilience. Similarly, cardiovascular fitness is protective against severe Covid. Getting leaner by reducing body fat will also help to reduce the risk of infection and illness with Covid significantly.

2 – Avoid Media That Perpetuates Fear

As you learned earlier, the doom scrolling and clickbait articles do nothing for individual and collective mental health. If we stop rewarding these news outlets by not engaging the headline, we have a chance to force media outlets to change their business model and begin to offer more balanced and evidence-based news.

3 – Demand That Policies Are Driven By Evidence-Based Medicine:

As a society, we need to ensure impartial, high-quality, peer-reviewed studies lead public health policy. Whether that topic is lockdowns, mask-wearing or vaccine mandates, the weight of objective data from evidence-based medicine should guide the way.

For example, vaccine mandates have zero credibility from an evidence-based medicine perspective. Being vaccinated does not mean someone cannot transmit SARS-CoV-2. This objective truth has been evident in clinical research since early 2021, and with Omicron, the picture is becoming more explicit still.

For example, a pre-print study from the Faroe Islands in December 2021 found that out of 33 people at a private gathering, 21 tested positive for SARS-CoV-2. All infected were triple-vaccinated within the last eight weeks. Vaccines do not prevent transmission. This fact does not mean vaccines are not excellent in saving many lives. It simply acknowledges the limitations of medication, as we would expect in many other instances.

This tiny study is indicative of what is happening on a population level. A large pre-print study from Israel analysed the protective effect of vaccination versus natural immunity over time. You can see the results below:

As you can see, there are three types of population groups studied here:

1. Unvaccinated with natural immunity
2. Vaccinated with booster
3. Hybrid immunity (natural immunity plus vaccination)

As the results show, vaccination alone offers a level of protection. However, a vaccine mandate would make no sense. The infection rate per 100,000 people is highest amongst those vaccinated within 6-8 months.

In other words, a stadium, shop or hospital could be full of vaccinated individuals, but their likelihood of getting infected goes up rapidly from the first couple of months onwards. You could lock down the unvaccinated, but irrespective of medical ethics, this ignores the fact that many people have natural immunity, which, as you can see, confers longer-lasting protection against infection than vaccination.

Look at how natural immunity confers a level of protection compared to vaccination alone. It is far more robust. Also, look at how natural immunity and vaccination combined confers the most significant protection.

In this context, vaccine mandates are nonscientific. It assumes that if you are vaccinated, you have immunity against SARS-CoV-2, and if you are unvaccinated, you do not. This position is a false dichotomy. You can be vaccinated, and get Covid, and transmit Covid. Similarly, you can be unvaccinated but, through prior infection, have immunity and reduced likelihood of getting or transmitting Covid.

It is time for us to come together, work together and build a better future.