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What we now know about omicron COVID-19 variant ahead of New Year's

Nicole Villalpando Heather Osbourne
Austin American-Statesman

The omicron COVID-19 wave is here. On Monday, the Texas Department of State Health Services announced that 90% of Texas' cases are this variant. 

When omicron hits communities, it's obvious, said Dr. Brian Metzger, medical director of infectious diseases at St. David's HeathCare.

"Some people are calling it the omicron signature," he said. "You know when it's hit your area, because the graph just fills up with cases."

On Wednesday, Austin Public Health moved Austin/Travis County to stage 4 after Austin's seven-day average of new hospitalizations was 36, up from 15 last week.

The community transmission rate is now 405, up from 36.5 at the beginning of December and up from 173 last week. Community transmission rate is the number of new cases per 100,000 people.

The Travis County positivity rate was 15.7%, up from 7.7% last week and 3.8% in November. The Centers for Disease Control and Prevention considers anything above 10% a high transmission rate. 

On Tuesday, Travis County had recorded almost 2,000 cases in the last week, but that is likely under reported with the number of people taking at-home tests instead of tests in a pharmacy or public health center. 

New hospitalizations wre 64 on Tuesday and there were 203 people hospitalized on Tuesday, which doubled in a week. 

Raising rates:On cusp of new year, omicron prompts Austin to adopt stricter Stage 4 pandemic guidelines

Medical assistant Less Cantrell tests covid tests outside The Long Center for the Performing Arts on Monday.

What do we know about omicron?

Omicron as a variant has multiple mutations that have been found in other strains. These mutations make it more transmissible and more antibody-resistant. It's like all the variants in one big package. 

Since it was named in late November, we have learned more about it. Omicron is believed to be anywhere from twice as transmissible as delta to five times as transmissible. 

Understanding omicron:What is the omicron COVID-19 variant, and should we be worried?

Health experts initially believed that omicron didn't cause as serious an infection as delta, but new data from the United Kingdom on Dec. 17 indicated that it was showing rates of death and hospitalizations among the unvaccinated similar to delta, Metzger said. 

How omicron is different than delta

Omicron, unlike other COVID-19 variants that show symptoms about a week or two after infection, takes just two to three days from exposure to start causing symptoms, Dr. Desmar Walkes, Austin-Travis County health authority, said on Wednesday.

As a result, those infected during Christmas gatherings should start showing signs of infection, along with a positive COVID-19 test, this week. 

Is it safe to gather for New Year's?

To dodge another round of the devastating effects delta caused over the summer, Walkes is now urging all residents, regardless of vaccination status, to skip New Year's Eve gatherings so more people don't get sick. 

"I would recommend that people limit their social interactions and social contact and, if they absolutely have to go and gather, that they (have tested) negative," Walkes said, again encouraging everyone in Austin to wear masks in public. 

Early anecdotes point to gatherings as superspreader events with this strain, and even people who are vaccinated or have previously had COVID-19 are getting infected from such events. 

"You need to protect yourself as much as you can with the same interventions we've talked about all along," Metzger said. 

Continue to do all the things we know help: masking, washing your hands, social distancing, getting vaccinated and improving ventilation by using an air filter, opening up windows or being outside.

What does it mean to be in Stage 4?

Austin Public Health's guidelines range from Stage 1 to Stage 5, each coming with varying levels of recommendations based on how severe COVID-19 transmission is at the time.

Stage 5 is the most severe level and was last triggered in early August after the highly contagious delta variant caused a deadly surge in the community. Increased vaccination efforts and mask wearing slowly helped bring the Austin area back to Stage 3 on Oct. 12.

Stage 4 recommendations 

Fully vaccinated individuals should wear masks when gathering with people outside of their household, traveling, dining and shopping. Get a booster shot once eligible.

Partially or unvaccinated individuals should wear masks, avoid gatherings with people outside of their household, only travel and shop if essential, and choose takeaway options for dining. Get fully vaccinated as soon as possible.

Diane Ginsburg, clinical professor and associate dean of the College of Pharmacy at the University of Texas, prepares Pfizer-BioNTech COVID-19 vaccine.

Are vaccines working against omicron?

Yes. Metzger sees hospitalizations of mainly unvaccinated people who are usually in their 40s and 50s. 

Breakthrough infections of people who are fully vaccinated and even boosted are happening, but those cases are not likely to end in hospitalization or death. 

The Pfizer and Moderna vaccines use mRNA to train your cells to make just the spike protein of COVID-19. Your body then makes antibodies — a blood protein that is developed to recognize the virus and know how to fight it — and T cells, which are found in the white blood cells and are a second response to recognizing and fighting the virus.

This variant is able to evade some of the antibodies that vaccines produce or that are produced from a previous infection, Metzger said. The spike protein is slightly different, which makes it require an even more robust immune response of both antibodies and T cells than delta required, Metzger said.

Having had a previous infection, though, is not as good as having been vaccinated. Because of the immune evasiveness of omicron, natural protection from an earlier strain doesn't provide as much protection against this strain, Metzger said. 

Read more:University of Texas sees 'alarming' spike in COVID-19 cases likely due to omicron variant

That's why getting a booster is important if it has been six months since the last mRNA vaccine or two months after the Johnson & Johnson vaccine.  

"Three doses provide significantly more protection both against breakthrough infection and against hospitalizations," Metzger said.

People who suffer breakthrough infections often are asymptomatic or have mild symptoms, but there is a spectrum, Metzger said. Some could be miserable for a few days or even need to be hospitalized.

Getting boosted:Ready for 16- to 17-year-olds to get a COVID-19 booster? What you need to know

How is omicron treated?

Unlike previous variants, omicron does not respond to some of the monoclonal antibody treatments. It does respond to the monoclonal antibody sotrovimab.

On Monday, the state health department announced that its regional infusion centers in Austin, El Paso, Fort Worth, San Antonio and the Woodlands have run out of the monoclonal antibody sotrovimab.

The state does not expect to receive another shipment of sotrovimab from the federal government until January. 

Last week the Food and Drug Administration gave emergency use authorization for two new oral antiviral drugs, the Pfizer COVID-19 pill and the Merck COVID-19 pill. The state expects that those will be available soon but in a limited supply from the federal government. 

Without these three early response treatments to COVID-19 available, the state is recommending that people take precautions against getting COVID-19, including getting a booster shot as soon as possible. Wearing a mask, avoiding gatherings, social distancing and hand washing are also recommended by the Centers for Disease Control and Prevention. 

Chris Cahalan holds a kit of COVID-19 tests he received at the Del Valle Community Center on Tuesday, Dec. 21.

What should I do if I think I have COVID-19?

Because of vaccination, people are reporting either no symptoms or mild symptoms such as feeling achy, a cough, a slight fever, or even symptoms that might be confused with allergies like cedar fever.

Get tested, either by calling your doctor or finding a testing center or an at-home test. If you are positive, call your doctor to see what treatments are available to you and what warning symptoms to look for, such as difficulty breathing, that would require hospitalization.

The CDC has changed the quarantine rules with this strain because the time from contact to first symptoms is shorter. Instead of needing to isolate for 10 days after testing positive, the CDC is recommending you isolate five days if you are asymptomatic. 

If you have symptoms, continue to quarantine until you test negative.

If you've been exposed and are vaccinated with a booster, you do not need to quarantine, but you should wear a mask for 10 days following the exposure.

If you are unvaccinated or are more than six months out from your last vaccine and have been exposed, you need to quarantine for five days and wear a mask for the five days following that. 

When in doubt, test. 

How can I find a COVID-19 test?

Austin Public Health will be closed Friday through Sunday (Dec. 31-Jan. 2), but does have these testing centers available on other days: 

George Morales Dove Springs Recreation Center for walk-ins,  5801 Ainez Drive, 8 a.m. to 2 p.m. Tuesday-Saturday, and Travis County Exposition Center for drive-thru testing, 7311 Decker Lane 8 a.m.-2 p.m. Monday–Friday.

We found appointments at Tarrytown pharmacy for rapid testing beginning on Thursday (Dec. 30). We tried CVS.com and found no available testing appointments in the next four days. Walgreens.com had a few appointments available, but not until Jan. 5. 

We could get at home kits delivered in two days at Walmart.com, but not until next week from Amazon.com. 

How bad will omicron be?

UT's COVID-19 Modeling Consortium on Dec. 16 released four scenarios of what this new variant could do nationally. In what it calls its pessimistic scenario — in which omicron is as transmissible as delta and more evasive of vaccine and naturally acquired immunity — it predicted: "Omicron could lead to the largest health care surge to date."

Under that scenario, the number of new infections would peak near Feb. 3, and cases, hospitalizations and deaths would be between 1.2 and 2.2 times higher than the January 2021 peak, which set pandemic records.

In its most optimistic scenario, in which omicron is 50% more transmissible than delta but less immune-evasive, the surge would peak about Jan. 18, and cases, hospitalizations and deaths would be 0.46 to 0.92 times the January 2021 peak. 

The consortium projects that only 57% of those eligible will get booster shots by March 1. But if 80% do, we could avert 1.3 million cases, 168,000 hospitalizations and 39,000 deaths by May 1. Under its different scenarios, deaths during this period would be between 342,000 (low booster rates) and 166,000 (high booster rates) and hospitalizations between 1.6 million (low booster rates) and 637,000 (high booster rates). 

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Is another variant on the way?

"We thought delta was transmissible enough and caused enough infections and got our immunity high enough," Metzger said, but then omicron came, with the additional feature of immune-evasiveness, and is even more transmissible than delta. 

"There's always a possibility of more evasive strains down the road," Metzger said. 

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