Position Statement No. 27: Omicron is a threat to each one of us

The risk of infection can be reduced with a booster dose of the mRNA vaccine, whose  protective effect begins after about two weeks. In a recent position statement, the interdisciplinary COVID-19 Advisory Team to the President of the Polish Academy of Sciences writes about the Omicron variant and reminds us that social distancing and masks limit transmission of all SARS-CoV-2 variants. “We urge the implementation of rigorous controls on compliance with these rules in public spaces,” the researchers emphasize.

Today, we are on the eve of another major escalation of the COVID-19 outbreak. A new variant of the SARS-CoV-2 virus, Omicron, emerged in the first half of November 2021. It has raised concern due to the numerous modifications present in its genome. In the past, alterations observed in these regions have been associated with increased transmissibility of the virus [1]. We now know that these fears have proven correct, with the Omicron variant transmitting more easily than Delta. The first European countries to report the emergence of Omicron are experiencing an unusually rapid increase in infections that overlap with the current wave of infections caused by the Delta variant. Even in highly vaccinated societies, we have recently seen an unusually steep curve of growth in infections (Figure 1), and mathematical models speak of a coming wave of unprecedented height. Across the European Union, the Omicron variant will be the dominant variant by the end of February 2022. [2]

Fig. 1. Number of daily new infections per million people in Denmark, the United Kingdom, and South Africa, cited after: Our World in Data, https://github.com/CSSEGISandData/COVID-19.

At the same time, studies have shown – initially laboratory and now epidemiological – that the virus is actually fairly successful in “evading” the response produced by our immune system [3] against earlier variants. Early reports indicate only 40% protection against disease after receiving two mRNA vaccines (Pfizer and Moderna) and virtually no protection after vector vaccines (Astra Zeneca, Johnson&Johnson) [4]. Similarly, the risk of reinfection when exposed to Omicron is very high in patients who have recovered [5].

Are we, then, back in the same place as we were at the beginning of our fight against the pandemic? No, we are not. Studies have shown that administering a booster dose of mRNA vaccine to vaccinated individuals reduces the risk of symptomatic disease by about 75% compared to unvaccinated persons, which is true for both mRNA and vector vaccines [6]. Currently, in selected countries, a vaccine booster can be given as early as three months after the date of the second vaccination with mRNA and Astra Zeneca vaccines, and Johnson&Johnson single-dose vaccine. This information is especially relevant for those vaccinated with vector vaccines. We cannot rule out the possibility that a similar recommendation will also appear at some point in Poland.

At present, we do not yet have a clear answer to what extent the reduced protection against the Omicron variant will translate into a risk of severe illness or death. Although preliminary data from South Africa seem optimistic, we should wait for data from countries of similar demographic structure to assess the risk to our society. Data from the UK and Denmark are still too sparse, and the time since the wave began in both countries is too short for the virus to penetrate risk groups and for people in those groups (elderly or diseased) to develop a more severe course of illness. The number of hospitalizations is already on the rise in some countries, and the number of deaths associated with this variant [7] is likely to increase soon.

Even assuming that Omicron is less harmful than Delta, a very high number of cases will strain the health care system to the maximum – both hospitals and primary health care centers. We should remember that in Poland the number of doctors and nurses per population is dramatically low, by far the lowest among European Union countries. Numerous quarantines may paralyze the health care system, and other infrastructure critical for society to function: the police, fire department, border services, army, education education, courts, public transport, power industry, and so on.

The main conclusion from the above information is that everyone is at significant risk. Getting a booster dose of the mRNA vaccine is the key to reducing this risk. Do not delay – remember that the protective effect of this vaccine begins after about two weeks.

Given Poland’s low level of primary vaccination coverage, it will be impossible to control the wave of infections caused by the Omicron variant with booster vaccines alone. It is important to remember that social distancing and masks limit transmission of all SARS-CoV-2 variants – we urge strict monitoring of compliance in public spaces. In addition, restrictions on social contact will need to be re-imposed to slow the spread of Omicron variant infections.

A year ago, we published a set of “Scenarios for 2021”. In the first scenario, the vaccination campaign went well and stopped the pandemic; spring 2021 was the last season where the threat still remained. The other four scenarios we assumed were less optimistic. In the second, the vaccination campaign was not universally successful. In the third scenario, immunity after vaccination decreased over time, making it necessary to administer further doses. In scenario four, the pandemic continued unabated, resulting in a variant that evaded the immune response. Number five involved the emergence of a new pathogen, and the pandemic caused by this pathogen overlapped with infections caused by SARS-CoV-2. Unfortunately, the second, third, and fourth scenarios we outlined are now playing out simultaneously in Poland.

Among the many statutory obligations of a physician is to inform the patient of the prognosis for their disease. Suppose we predict a very unfavorable further development of the disease. In such a case, information should be given to the patient in such a form and scope that the patient can cope with this difficult content and utilize still available remedies. The facts above make up a very pessimistic prognosis for the Polish public, although it is not yet the most gloomy of all possible scenarios. Let us take the looming threat very seriously, as it deserves to be treated.

About the team

The Interdisciplinary COVID-19 Advisory Team to the President of the Polish Academy of Sciences was set up on 30 June 2020. The team is chaired by Prof. Jerzy Duszyński, President of the PAS, with Prof. Krzysztof Pyrć (Jagiellonian University) as deputy chair and Dr. Anna Plater-Zyberk (Polish Academy of Sciences) as its secretary. Other members of the team are:

• Dr. Aneta Afelt (University of Warsaw)
• Prof. Małgorzata Kossowska (Jagiellonian University)
• Prof. Radosław Owczuk, MD (Medical University of Gdańsk)
• Dr. Anna Ochab-Marcinek (PAS Institute of Physical Chemistry)
• Dr. Wojciech Paczos (PAS Institute of Economics, Cardiff University)
• Dr. Magdalena Rosińska, MD (National Institute for Public Health – National Hygiene Institute, Warsaw)
• Prof. Andrzej Rychard (PAS Institute of Philosophy and Sociology),
• Dr. Tomasz Smiatacz, MD (Medical University of Gdańsk)

[1] https://covariants.org/variants/21K.Omicron 

[2] https://www.ecdc.europa.eu/sites/default/files/documents/covid-19-assessment-further-emergence-omicron-18th-risk-assessment-december-2021.pdf

[3] https://www.medrxiv.org/content/10.1101/2021.12.08.21267491v1

[4] https://khub.net/documents/135939561/430986542/Effectiveness+of+COVID-19+vaccines+against+Omicron+variant+of+concern.pdf/f423c9f4-91cb-0274-c8c5-70e8fad50074

[5] https://www.medrxiv.org/content/10.1101/2021.11.11.21266068v2.full.pdf https://www.medrxiv.org/content/10.1101/2021.12.08.21267491v1

[6] https://www.medrxiv.org/content/10.1101/2021.12.14.21267755v1https://khub.net/documents/135939561/430986542/Effectiveness+of+COVID-19+vaccines+against+Omicron+variant+of+concern.pdf/f423c9f4-91cb-0274-c8c5-70e8fad50074https://www.biorxiv.org/content/10.1101/2021.12.12.472252v1.full.pdfhttps://www.medrxiv.org/content/10.1101/2021.12.13.21267670v1https://www.medrxiv.org/content/10.1101/2021.12.15.21267805v1

[7] https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1042221/20211218_OS_Daily-Omicron-Overview.pdf