COVID-19 News Updates for January 2022

Omicron, a new coronavirus variant that is circulating across the country, needs to be closely monitored and communities hardest hit may need to take new precautions. Older adults are at a much higher risk of complications from COVID-19 and so infectious disease experts are urging adults 50 and older to forgo large gatherings where not everyone is vaccinated. If an individual has other significant health conditions where they are more likely to have complications from a COVID infection, it is currently recommended they avoid attending any large gatherings.

“What is correct for any given family system will depend, to a certain extent, on what sort of risk individuals are willing to take.  In general, if all persons at a gathering are fully vaccinated, risks are relatively low, but it is possible to lower risks more by using masks unless eating or drinking and making sure gatherings are in well ventilated spaces,” said Dr. Andrew Duxbury, a geriatrician and professor within the Division of Gerontology, Geriatrics and Palliative Care at UAB, Birmingham, Alabama.

Some countries have banned all foreign travel due to the Omicron variant and the U.S. has imposed travel restrictions. The most important thing that all individuals, especially older adults, can do in light of the new Omicron variant is to become fully vaccinated, including a booster shot. This goes for Pfizer, Moderna and Johnson & Johnson vaccines.  “What we know at this time is that Omicron and other coronavirus variants can be contracted by fully immunized individuals, and that reinfections are possible in those who have had the disease. In general, in the fully vaccinated, clinical disease remains relatively mild with a low chance of serious complications unless the individual has significant underlying health conditions,” said Dr. Duxbury.

The Omicron variant of the novel coronavirus has only recently been identified and the World Health Organization (WHO) and the Centers for Disease Control (CDC) are concerned about the variant given the number of mutations on the spike protein. These mutations allow the virus to attach to human cells and replicate itself within a human host. “Our current vaccines are based on spike proteins so it's possible that new mutations may help the virus evade our immune systems.  There is also the possibility that these mutations may make the virus more transmissible or more virulent in some way,” said Dr. Duxbury.

In general, U.S. vaccination rates for adults over 65 are quite good and this is one of the reasons that the mortality for this age group has decreased significantly from 2020. Dr. William Petri, Chief of the Division of Infectious Diseases and International Health at the University of Virginia School of Medicine, Charlottesville, Virginia, said indoor gatherings with similarly vaccinated and boosted friends are fine. Adding another layer of security would be to have everyone do a rapid test for COVID-19 the day prior, and of course to tell everyone who has cold or flu symptoms not to attend.

“Omicron is more infectious than Delta, at least in South Africa,” said Dr. Petri. “Every adult should receive a booster shot of their COVID-19 vaccine, as this has been shown to raise protective antibody levels at least tenfold and importantly provides better protection in the real-world.”

AGE MATTERS 

Older adults may be at higher risk for developing more severe symptoms and are at higher risk of hospitalization and death because of a specific cell receptor called ACE2.  A group of Italian and American researchers are now reporting that the expression of the cell receptor for the virus (ACE2) is essential for mediating cell entry of the virus. The older a person is, the greater the risks for COVID-19 complications in terms of ACE2 expression. The findings provide one possible molecular explanation for the increased sensitivity of older adults to COVID-19.  

Older adults are also being cautioned about the COVID-19 virus because it is evolving toward a more efficient aerosol generation. Loosely fitting masks provide significant, but only modest source control. Infectious disease specialists say all adults 50 and older should know that until vaccination rates are very high, continued layered controls, including improved ventilation, increased filtration, UV air sanitation, and tightly fitting masks are critical to protect people in public-facing jobs and indoor spaces.

Results of a new study led by the University of Maryland School of Public Health show that people infected with the virus exhale COVID-19 infectious virus in their breath, and those infected with the Alpha variant (the dominant strain circulating at the time this study was conducted) put 43 to 100 times more virus into the air than people infected with the original strains of the virus. The researchers also found that loose-fitting cloth and surgical masks reduced the amount of virus that gets into the air around infected people by about half. The study was published in the journal Clinical Infectious Diseases.

"Our latest study provides further evidence of the importance of airborne transmission," said Dr. Don Milton, a professor of environmental health at the University of Maryland School of Public Health, Baltimore, Maryland. "We know that the Delta variant circulating now is even more contagious than the Alpha variant. Our research indicates that the variants just keep getting better at travelling through the air, so we must provide better ventilation and wear tight-fitting masks, in addition to vaccination, to help stop spread of the virus."

As the Omicron variant continues to spread, public health experts say it is important to see the whole picture and be aware of “long COVID”. It is not unusual for individuals to have problems with fatigue and a host of other health problems following infection. More than half of the 236 million people who have been diagnosed with COVID-19 worldwide since December 2019 have experienced post-COVID symptoms (more commonly known as long COVID) up to six months after recovering, according to researchers.

John Schieszer is an award-winning national journalist and radio and podcast broadcaster of The Medical Minute.  He can be reached at medicalminutes@gmail.com.