As the Omicron variant rips through Canada and the world, this latest wave has left many people wondering when the COVID-19 pandemic may finally subside. Kim Parlee speaks with Dr. Vipan Nikore, Chief Medical Director, TD Bank, about what you need to know about this new variant.
- Yeah. Thanks again for having me back, Kim. And happy holidays to you too, and I can't believe we've been doing these talks for two years now. But with respect to the Omicron, we know it spreads much quicker than other variants, and that's pretty obvious by now. With vaccine escape, we do see more of that. Meaning with the vaccine, you still can get Omicron. If you have a booster, you're less likely to get it than if you have two shots.
But the big question is really around severity. So if you're vaccinated and you have a booster, you're generally going to do pretty well. It's unlikely that you're going to end up in the ICU. If you're vaccinated and you don't have a booster, you had a previous infection again, you'll probably do pretty well. But again, if you have a booster, you're going to feel better, not get hit as hard, and feel less like crap than if you actually do get it.
And then the next group is really the unvaccinated and those who've never had COVID-19. They're completely naive to the virus. A real possibility, they'll end up in the ICU. I did see this in the hospital just the other day as an example. So this is something we're really seeing. They lack T cell immunity that we know was preserved by initial vaccination or infection. So those are some of the key things.
And also, another key group is the immunocompromised. So the immunocompromised they even with the vaccine are at risk as well. So we do have to try to protect them. It doesn't appear that, or I should say, it does appear that Omicron is less severe at baseline than Delta for the unvaccinated. What I mean by that is if you took two people who are unvaccinated, it's going to be less severe. The question is how much less severe? And that has big implications on our system. Is it 60% less severe or 25% less severe? In that, obviously we've seen our ICU capacity and how tenuous it can be. So we're waiting on those numbers, of course and just have to wait and we have to obviously take measures because we don't know those exact numbers right now.
- I know a lot of people, and I think I know how you're going to answer this, have referred to this as somewhat of a mass inoculation event because it's not as severe even though it spreads much more rapidly. But it sounds like for the unvaccinated, it's still pretty scary stuff.
- Yeah. So technically there's a lot of people, a mass number of people getting inoculated. So by the term mass inoculation, sure you could say that. But I've seen the term natural vaccine thrown away. And that's a very dangerous way to look at things. If the virus caused no severe disease in those who are unvaccinated or immunocompromised, then maybe you could have a case to call it that.
But that's not the case with this disease. And what's happening is there's a lot of people who are vaccinated who are getting the virus. So it makes it seem like the virus is very mild. Because on a ratio basis, there's less people going to the ICU. But at its baseline, as I mentioned, people get sick from this. And plus we don't know about long COVID, we've seen long COVID in previous strains, we don't know how it's going to affect people who get Omicron as well.
- Do we have any sense, I mean, you and I have talked about this as you mentioned for a while. It's been a number of years. Is Omicron perhaps maybe the beginning of the end of the variants? I mean, I know even as we speak, I mean they're identifying more variants around the world constantly. But do you get a sense that we're closer to the end than we are to the beginning?
- Yeah. It's a good question. I mean, this upcoming wave that we have, and I know we talked about wavelets. This is not a wavelet. This is a big wave. We get through pandemics by having immunity in the population. So we eradicate diseases often through immunity by getting vaccination. But you can also get infection to get immunity. And it's just a terrible way to reach immunity because a lot of people die from that. And it fills up hospitals, and there's other implications from that.
But as we get through Omicron, I mean it is spreading so fast. If you're not vaccinated, there's a very good chance you're going to get immunity through the Omicron. So I definitely wouldn't call it the beginning of the end. We don't know what's in store, but there's a decent chance by spring we're going to have higher levels of normalcy because people will have some level of immunity and t-cell immunity. And there'll be an endemic nature to this and maybe we'll have an annual flu shot. Maybe it'll be every few years, some sort of vaccine. I say flu shot, a shot similar to the flu shot, of course.
Maybe we'll have better treatments to keep things under control better. Nobody really knows. Those are some of my predictions. But I think one of the biggest variables again are mutations that could cause a strain that's resistant and causes high mortality. And that's going to be a concern, but believe in human resilience and I think we'll find solutions. So overall, I am optimistic that after a couple of tough months, we're going to be in a situation that's better for the rest of the year.
- I've only got about 30 seconds, but if I was to say, and I think ahead you mentioned, we could have annual shots. I know there's antiviral pills coming endemic immunity. But we're year 3 in this pandemic, excuse me. When you look ahead, are there other things we should be thinking about? Things you're thinking about as we look ahead to how to manage this?
- Sure, so in 30 seconds that's tough. But maybe an hour, but I'll do a quick rapid fire. Bed capacity of course we're looking at closely those ICU numbers. Treatments are critical. We've seen Paxlovid have some positive effect we need to get that sort of approved quicker hopefully by Health Canada. That's shortening of five days from 10 days of isolation, an important concept. it's not a magic number of five days. People really need still mask up from days 5 to 10.
Workforce shortages we're seeing everywhere. Keeping an eye on long COVID. The likelihood of catching Omicron, looking at next generation of lower cost vaccinations so we can vaccinate the rest of the world. Again newer variants, thinking about how long your PCR is going to stay positive in light of the fact that we can't confirm a lot of these cases, those travel implications. So those are just a few of the things going through my mind and how it might affect us in the future.
- Well, I think we're going to be talking again. And I do look forward to it. Dr. Nikore, thank you.
- Thank you for having me, Kim.