Expert virologist Dr Yong Poovorawan on Saturday posted a list of questions and answers related to the Omicron variant of Covid-19.
• Is it very transmissible?
Yes. For example, if one person infected by the original Covid-19 virus sits among seven people, one or two will be infected.
If a person infected by the Delta variant sits among 10 people, six or seven will be infected.
If one person infected by the Omicron variant sits among 11 people, 10 will be infected.
• Can Omicron skip the immunity provided by the vaccine?
Two doses of any Covid-19 vaccine provide little or no protection. People should get a third jab to protect themselves. Those who have received a booster a long while ago may be at risk because immunity provided by the vaccine can drop over time and people who have been infected before can be infected again.
Vaccines, however, reduce the severity of symptoms.
Studies show that the Omicron variant is far less severe than the Delta variant. The number of hospitalisations from the variant in South Africa, where it was discovered, is 70 per cent fewer than from the Delta variant.
However, hospitalised patients did develop symptoms as severe as with the Delta variant.
Studies in the UK revealed that the number of hospitalisations from Omicron was 15 to 20 per cent less than the Delta variant, while they were two-thirds less in Scotland.
Yong advised people to get their shots to build up their immunity to reduce the severity of the disease. He said people should get a booster three months after their last jab because Omicron will soon replace the Delta variant.
In a Facebook post on Thursday, expert virologist Dr Yong Poovorawan said people need at least three doses of the Covid-19 vaccine to protect themselves from the Omicron variant.
He said the booster dose should be AstraZeneca or the mRNA Pfizer or Moderna vaccines, as they will increase people’s immunity, especially if they have had two jabs of the inactivated Sinovac or Sinopharm vaccines.
He added that people who have received two Sinovac shots and followed up with an AstraZeneca, Pfizer or Moderna booster will have the same immunity as people who have received two jabs of AstraZeneca and then a third shot of either Pfizer or Moderna.
He added that even half a dose of Moderna provides enough immunity.
However, the virologist said this was a basic study and that we need to wait for the results of a study into neutralising antibodies that work against Omicron and Delta.
Yong added that people in the US and UK were being given half a dose of Moderna if their first two doses were AstraZeneca.
He added that the results of a study into the booster dose for people who received a combination of Sinovac and AstraZeneca will be available next year.
These studies are necessary to work out which vaccine formula is most effective, he added.
A third dose of AstraZenecas Covid-19 vaccine significantly boosted neutralizing antibodies against omicron, according to lab studies at the University of Oxford.
The vaccine, created by Astra and Oxford, saw antibodies increase to similar levels as those after two doses against the delta variant with a booster shot, the drug company said Thursday. A third dose also produced higher levels of neutralizing antibodies than those found in individuals who had recovered naturally from the alpha, beta and delta strains.
The results are largely good news for the vaccine, which has been sidelined in the West as a booster after messenger RNA vaccines were shown to be more effective in various trials. The study looked at 41 people who had been given a third dose.
Omicron’s rapid spread and its ability to initially reduce antibody protection in many vaccines led many countries to launch accelerated booster campaigns. The U.K. alone reported more than 100,000 new covid cases Wednesday for the first time, heaping pressure on Prime Minister Boris Johnson, who has resisted imposing further restrictions before Christmas.
However, early studies out of South Africa, Scotland and England show the highly mutated omicron variant appears less likely to land patients in the hospital than delta. The findings raise hopes there will be fewer cases of severe disease, yet omicron’s greater infectiousness means it could still severely affect health services, fueling the need for boosters.
“It is very encouraging to see that current vaccines have the potential to protect against omicron following a third dose booster,” said John Bell, a professor of medicine at Oxford and one of the study investigators. “These results support the use of third dose boosters as part of national vaccine strategies, especially to limit the spread of variants of concern, including omicron.”
Neutralizing antibodies against omicron were 3.6-fold lower 28 days after a booster Astra shot compared with the levels seen from three shots against delta, according to a preprint of the study. Exactly the same reduction was seen from the Pfizer Inc. vaccine compared with delta in the study.
The results come after Pfizer and Moderna released studies on how their vaccines stand up against omicron in recent weeks. Initial lab tests from Pfizer and partner BioNTech showed a third dose of their Covid-19 vaccine may be needed to neutralize omicron after researchers observed a 25-fold reduction in neutralizing antibodies that fight the variant from two doses.
Moderna also found a booster dose increased antibody levels against omicron.
Novavax said Wednesday that its vaccine generates an effective immune response against the variant, but added it could be necessary to develop an omicron-targeted vaccine.
Data from another lab study showed two doses Astra’s retained some protection against omicron, although a 36-fold decrease in antibody levels was observed from the original virus strain.
Separately, Astra published more results on the impact of omicron on its Covid-19 antibody drug Thursday after the company said last week the therapy retained neutralizing activity against the variant in lab testing.
Tests using a live version of the virus conducted by University College Oxford and Washington University School of Medicine in St. Louis found neutralizing antibody levels were similar to individuals who had been previously infected with Covid-19.
The omicron variant is heightening risks for this little-talked-about demographic: pregnant women.
Left out of early vaccine trials and faced with confusing messages and misinformation on the dangers to their unborn children, a disproportionately large number of pregnant women have steered clear of Covid shots. About 75% of expectant mothers in the U.K. and about 65% in the U.S. remain unvaccinated, making them among the groups most at risk of getting infected and being exposed to severe forms of the disease as the fast-spreading omicron strain sweeps across the globe.
At least 17 pregnant women and four babies have died from Covid-19 in England between May and October, figures published last week show. Over that period, 98% of pregnant women admitted to intensive care were unvaccinated. Also, since July, one in five Covid patients receiving treatment in England through a special lung-bypass machine was an unvaccinated expectant mother.
“The uptake of vaccination in pregnant women is depressingly low and significant numbers of women have come to serious harm as a result of this,” Chris Whitty, the U.K.’s chief medical adviser, told lawmakers Dec. 16. “Pregnancy’s a period of vulnerability. We really should have made that point even clearer earlier on.”
Information on this group remains sparse across much of Europe. While real-world data over the spring and summer showed the shots are safe and effective for them, the absence of pregnant women in early vaccine tests resulted in hesitancy that’s hard to shake off.
Take Antonia, for instance. The London lawyer, who’s seven months pregnant, got her first jab before she was pregnant but struggled over her second, post-pregnancy inoculation. Vaccine centers didn’t have reassuring answers to her questions, and she got the shot with a lot of trepidation.
“I was so nervous I booked the vaccination so many times and canceled it,” said Antonia, 38, who’s having her second child and didn’t want to reveal her last name. “I just thought ‘it’s not my life here, it’s somebody else’s life I’m making decisions about.'”
Vaccine hesitancy compounds the immuno-compromised state brought on in pregnant women by their bodies’ efforts to grow the foetus. The risk of severe Covid-19 is particularly acute in the third trimester and increases the prospect of premature and still birth. It also raises the possibility of long-term health issues for the expectant mother.
Many maternal-care specialists saw this coming, said Pat O’Brien, vice president of the Royal College of Obstetricians and Gynaecologists.
“We were worried from day one that it might be worse in pregnant women than other people because other respiratory viruses have been, like SARS and flu,” said O’Brien. “We must learn the lesson that pregnant women should be included when it’s safe to do so at an early stage in all new drug and vaccine trials.”
At least one drugmaker tried. In February, Pfizer initiated a mid-stage trial in pregnant women before moving to advanced-stage testing in June. But low enrollment and the ethical dilemma of giving placebos to expectant mothers when vaccines were already recommended saw the trial halted with less than 10% of its target 4,000 volunteers.
While the company still plans to publish the data, the low participation may limit any takeaways.
“I think this has opened the eyes and the potential for regulators and manufacturers to initiate pregnancy studies earlier,” said Alejandra Gurtman, vice president of vaccine research and development at Pfizer.
The problem is deciding when it’s alright to include pregnant women. Vaccines must be shown to be safe in the general population before authorities can expose unborn children.
“If we weren’t in such a pandemic ‘all-out’ mode, we probably could have started a trial early on in pregnant women,” Peter Marks, head of the U.S. Food and Drug Administration’s vaccine program, said in a Bloomberg interview. “If I were drawing this up from scratch again, probably within a few months after we had safety data flowing in from the phase 3 clinical trials we probably could have initiated a trial in pregnant women.”
Some of the reticence stems from history. Although not a vaccine, in the 1950s a drug called thalidomide was prescribed for early-pregnancy nausea. It severely impacted limb development in children and affected more than 10,000 babies, half of whom died.
A lack of information on the vaccine’s safety in the first trimester and a surfeit of misinformation on social media, especially on the impact vaccines could have on a growing baby and on fertility, haven’t helped. Over the summer, a “news” item went so far as to suggest vaccines provoked miscarriages.
Laura Magee, an obstetric physician in the U.K., said the similarity between a protein in placental development and the spike protein on the virus raised concerns antibodies from the vaccine could attack the placenta, though studies have shown this isn’t the case.
“There’s no basis whatsoever for any concern that the antibodies that you make as a result of accepting the vaccination will interfere with placental development,” she said.
Clinical trials have also shown that the shots had no impact on fertility. The same is true for birth outcomes, stillbirths or low birth-weights, data from the U.K. Health Security Agency showed.
Such assurances have failed to make a big difference, suggesting the need for better communication and an earlier involvement of expecting mothers.
The U.K. drugs regulator says it’s looking into “how developers of new medicines and vaccines could improve inclusion of pregnant women in studies.” One way would be to start trials when early tests have established safety and advanced trials are underway, as Pfizer did with adolescents.
For Ruth Faden, a bioethicist at Johns Hopkins who’s involved in the working group PREVENT — which drafted guidance on vaccines in epidemics and pregnant women in 2019 — Covid-19 shows why some serious rethinking is critical.
“The experience of this pandemic, which has gone so wrong for pregnant women, I’m hopeful is enough to at least in the epidemic-vaccine space result in some changes going forward,” she said.
Covid-19 is likely to spread quickly as the virus mutates, expert virologist Dr Yong Poovorawan wrote on his Facebook page on Thursday.
He said a factor proving the virus is spreading quickly is that most patients are young people who develop mild or no symptoms.
He went on to say that the death rate due to Covid-19 has dropped from 5 per cent to less than 2 per cent. The death rate in Thailand is about 0.9 per cent, he wrote.
“As Covid-19 patients develop mild or no symptoms, they can spread the virus quickly,” he said. “Foreign travellers [who are infected and] who enter the kingdom may not show any symptoms, so they are ready to spread the virus anytime,” he warned.
Yong wrote that temperature screening, tracking people who were in contact with Covid-19 patients and checking patients’ timelines are not enough to detect the virus.
He advised people to strictly comply with preventive measures as others close to them may be infected with Covid-19.
Three Sinovac Covid-19 vaccine jabs is another interesting option to deal with Omicron as it gives around 94 per cent protection against the virus, Public Health Commission vice chairman Dr Chalermchai Boonyaleephan claimed on Wednesday, citing a study.
He said Omicron has spread across 100 countries less than a month after the World Health Organisation’s variant of concern announcement on November 26, faster than the Delta variant by up to three months.
He also cited data from Pfizer, saying two Pfizer jabs provided just 33 per cent immunity against Omicron, but this immunity would increase to around 90 per cent after the third Pfizer jab.
“A recent study showed that two Sinovac jabs gave 35 per cent immunity against Omicron, but the immunity increases to around 94 per cent after receiving the third Sinovac jab. The immunity generated from three Sinovac jabs is equal to three Pfizer jabs,” he said.
“Therefore, the Sinovac vaccine is another interesting option to deal with Omicron when the development of new vaccines is not yet completed.”
Chalermchai said that apart from 1 billion Sinovac doses administered to people in China, another 800 million doses have been given to people in 44 countries, including 54 per cent of people in the Asia Pacific, 28 per cent in South America, 13 per cent in Europe and 5 per cent in Africa.
“Thailand should consider and follow studies on inactivated, viral vector and mRNA vaccines closely to be ready to deal with Omicron,” he advised.
Expert virologist Dr Yong Poovorawan took to Facebook on Wednesday to warn that the Covid-19 Omicron variant will spread in Thailand, but he would like it to be as slowly as possible.
Yong said he wants public health authorities to administer the third dose of vaccine to as many people as possible because two doses are just not enough to prevent Omicron.
He said Omicron came into Thailand quickly because foreign travellers, especially those under the Test & Go scheme, did not undergo quarantine. It was difficult to keep Omicron at bay because the variant could be in the incubation period or travellers might be infected mid-way.
Yong said Thailand must use quarantine for 7, 10, or 14 days again to prevent Omicron from spreading.
He advised the government to also suspend some activities or reduce the number of people travelling during the New Year.
He said the Omicron situation will affect the economy if it is widespread.
Yong also wrote that Thailand must realise, just like Europe and America, that it cannot fully control the variant and some countries have had to close.
The decision will be up to administrators to find a balance between safety and the economy, the virologist wrote. They must decide as quickly as possible before Omicron spreads across Thailand, he advised.
Covid-19 is not a weak virus as it has infected more than 200 million people and killed over 5 million, Assoc Prof Dr Thira Woratanarat from Chulalongkorn Universitys Faculty of Medicine said in a Facebook post on Saturday.
He added that the Omicron variant is particularly worrisome because it is easily transmissible, escapes immunity and resists treatment.
“Even though Omicron infections are less severe, the number of Covid-19 cases can be expected to surge quickly,” he said.
He said many countries, including those that had decided to “co-exist” with Covid-19, have launched strict measures to curb the spread of the disease.
He is advising people to wear two face masks (a surgical mask with a cloth mask on top), maintain social distancing, avoid gatherings especially in poorly ventilated places and celebrate Christmas and New Year at home.
Thailand’s expert virologist Dr Yong Poovorawan explained the administration of vaccine combos in a Facebook post on Saturday.
He said there is scientific evidence proving the effectiveness of combined vaccines and it will soon be published in international medical journals.
He said he was worried that Thais were wasting their time arguing while researchers in the rest of the world are working on setting a standard.
He cited the World Health Organisation (WHO)’s paper “Interim recommendations for heterologous COVID-19 vaccine schedules” published as an “Interim guidance” on Thursday.
In the paper, WHO recommends the administration of combined vaccines and cites the inactivated-viral vector or inactivated-mRNA vaccine combinations used in Thailand.
WHO has recommended that countries adjust their vaccine rollout based on the availability of vaccines.
Yong said the Public Health Ministry has studied the efficacy of the Sinovac-AstraZeneca combination and has learned that this mixture offers as much protection against Covid-19 as two doses of AstraZeneca.
Consuming turmeric, ginger, leafy vegetables and grains can help ease the side-effects of Covid-19 vaccines, the Department of Health suggested on Thursday.
Dr Suwanchai Wattana Yingcharoenchai, the department’s director-general, said the most common side effects include soreness at the vaccination site, headache, fever, body ache or fatigue.
He said the symptoms can last for up to three days and suggested that consumption of the following herbs and plants can help ease symptoms. They are:
Turmeric: Contains anti-inflammatory properties and can help ease the pain.
Ginger: Helps reduce inflammation.
Leafy vegetables and fruit: Contain vitamins that can boost immunity, dietary fibre to help flush toxins and high water content, which helps refresh the body.
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