An Omicron update: I have spent the week preparing our manuscript on COVID-19 infection vs vaccination, and keeping up with Omicron literature. Some thoughts to inform and hopefully reassure you.

Peter Morawski, PhD Peter Morawski, PhD

Currently, the data from multiple groups (a-e) has shown clear scientific evidence that Omicron is much more highly mutated than previous variants (attached image), which leads to significant but incomplete antibody escape (a). The antibody evasion is striking, but it is also largely reversed by additional vaccine doses (b-d). Future vaccines updated accounting for these mutations should be employed, but in the meantime our vaccines, especially third doses, look to be doing a great job!! Well, why?

What is important is that third vaccine doses not only bring antibody levels back up, but should likely also increase the breadth of our immune response and induce robust helper T cell responses. Remember, that even though all this noise is being made about B cells and antibody, T cells are a very important part of the response that protects us against disease and that several groups have reported on (e,f, & pending data my own work with collaborators at the UW). Don’t forget about your cool T cells!

Despite all the mutations in Omicron 80% of the virus that T cells “see” and respond to is unchanged. This is great news. Based on data I’m seeing including our unpublished findings, I predict that T cell responses will be generally better maintained long-term than antibodies and less impacted by this and future variants. That said, we still need the data to make these conclusions and inform our future public health decisions and vaccine design. Despite the work left to be done, this has me feeling optimistic!

What’s the future have in store?: With ~80% of the US having some kind of immunity to the virus, we are moving towards what it will look like when this is no longer a pandemic virus, but an endemic virus, which is to say, one that we live with on a yearly basis like the flu. We have so many more tools now than before, particularly the vaccines, and the future rollout of anti-viral pills (i.e Pfizer). We will not be rid of the burden of COVID, it’s here to stay, but with all our tools, the severity and overall impact of COVID on our lives is going to start looking a lot more like flu than a pandemic that kills half a million people in a year.

We’re all tired. The messaging has been at times sub par and we’re all struggling at times to keep up. But put into perspective, we have so much more capacity to help ourselves now than last year. As vaccines roll out to the youngest approaches (<5 years old, early 2022-ish?), and with boosters available, and new drugs coming imminently, we are actually doing quite well.

A final thought: Please remember that most of all, unvaccinated, even with prior exposure to COVID, the data clearly show that you are at much higher risk. Severe disease, hospitalization and death is ~30-50x more likely in unvaccinated individuals. This is not politics or government manufactured craze. It’s a crappy hand we were dealt, but we are persevering, and we have lots of science and data to back up the best course of action. Please get vaccinated. Please get boosted.

If you have any questions, as always, I will make time. I have published multiple articles and kept up with the COVID literature. If I can help, I will.

(a) Balazs/Cambridge…/10.1101/2021.12.14.21267755v1

(b) Sigal/SA…/10.1101/2021.12.08.21267417v1

(c) Ciesek/Frankfurt…/10.1101/2021.12.07.21267432v4

(d) Pfizer

(e) Wherry/Upenn

(f) Iwasaki/Yale

Useful summary by T. Bedford/Fred Hutch