Alfred Dawes | The Omicron ex machina

The panic started the moment the news broke that a new strain of SARS-COV2 had been identified in South Africa. The markets sold off worldwide, wiping out months of gains. The knee-jerk reaction of many countries was to ban travel from Africa. The ‘I told you So-ers’ were out in full force lambasting the vaccine hesitant and vaccine hoarders for “creating” another variant in the unvaxed population.

The evidence that the Omicron strain was less deadly than the Delta strain, which it is rapidly replacing worldwide, was swept under the carpet in the ensuing hysteria. Mathematical models as to how a far more contagious but less virulent strain would lead to greater deaths were used to forecast Omicron as the mother of all spikes. The doctors on the front line in South Africa cautioned against overreacting to what they knew firsthand was a much milder disease.

Nonetheless, more conjecture as to why the disease would be milder only in South Africa consumed the narrative more so than the facts. South Africa, which has had one of the highest death rates per capita from COVID-19, suddenly had a younger population that would not be affected as severely as other countries with older populations. The data should, therefore, be taken with a grain of salt and vaccination programmes and lockdowns pursued with extreme haste.

Omicron is without a doubt far more contagious than any other strain of SARS-COV2. It is now the dominant strain in the United States and the United Kingdom merely weeks after being confirmed in those countries. Record case counts have been the norm even with undertesting biases. Despite the record numbers, the hospitalisation rates are not maintaining the same trajectory. Even more disconcerting is that vaccination status has extraordinarily little correlation with the likelihood of contracting the disease. This realisation is spelled out in the recent recommendations that both vaxed and unvaxed persons should avoid cruises.

Omicron is already here in Jamaica. We need not wait on official confirmation. The case counts are rising rapidly, and we will soon reach levels that we have never seen. Our hospital capacity will not be able to cope with a surge the likes of what was seen in the Delta wave. Our vaccination levels are woefully inadequate even as we prepare for another major vaccine dump. Our population is older than that in African countries. Yet I am not worried.

EXPECTING A MIRACLE

A deus ex machina is a plot twist in which a seemingly hopeless situation, when all seems lost, is unexpectedly resolved by the sudden appearance of an implausible character or event. We have seen it time and time again in Hollywood where the hero is saved at the moment of imminent defeat. Every superhero movie ever made ends in almost the exact ex machina moment. And now, the torment of the last two years, I believe, will be over in what some may call a miracle.

A weaker virus with greater infectivity is almost as good as a mass vaccination campaign with a traditional attenuated virus vaccine. This is due to the fact that the antibodies are formed against most if not all of the antigenic sites on the viral surface. This contrasts with most of the current crop of vaccines that stimulate antibodies to the spike protein only, one out of at least 15 sites that can induce antibody formation against the virus. Every mutation of the spike protein decreases the effectiveness of the original vaccines, and Omicron has the greatest number of mutations of any variant of the original Wuhan virus. As a result, it escapes the protection offered by the vaccines significantly.

If one is infected with a weakened virus, the immunity will render future infections less severe, as with vaccination. This natural immunity that is increasing so rapidly is what we need when so many variants are surfacing and vaccination programmes are lacking in vulnerable societies. If enough people rapidly get infected with Omicron and develop immunity to SARS-COV2, then this may be the last global spike, the end of the pandemic, and the beginning of the endemic COVID-19 era.

The virus itself is not the ex machina we would love to see. It is the emergence of the management of COVID-19 infections that will enable the dramatic turn of events predicted. For far too long we have been promoting vaccines as the be all and end all of the pandemic. The divisions stoked by such rhetoric will last at least a generation. Doctors like me have been hesitant to proffer early treatment of COVID-19 using repurposed drugs and natural supplements that have been demonstrated to work in decreasing hospitalisations and deaths because of the stigma attached.

With the big pharmaceutical companies now promoting oral drugs for the treatment of COVID-19, and the decreased effectiveness of their vaccines in preventing symptomatic disease, the world will finally open up its eyes to early treatment options. The approach should have always been (i) vaccination to decrease the chances of getting the disease and reducing the likelihood of hospitalisation and death; and (ii) the early treatment of mild disease and early identification of the development of severe disease in order to escalate treatment and thus decrease hospitalisations and deaths. The latter has largely been ignored by public health authorities to the detriment of the populations which they serve.

We have been handed a deus ex machina in the form of the Omicron strain and the available tools to successfully treat those with mild disease and decrease the progression to severe disease. I am willing to bet my career that this is the “hand of God”.

- Dr Alfred Dawes is a fellow of the American College of Surgeons, CEO of Windsor Wellness Centre, and medical spokesman for Lifespan Spring Water. Follow him on Twitter @dr_aldawes. Send feedback to columns@gleanerjm.com and adawes@ilapmedical.com.