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Healthful Hints: Omicron's COVID compromise

From the Collection: Recent Healthful Hints columns by Dr. Frank Bures series
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So, where are we now on this microbial merry-go-round of mutating, mystifying viruses that we have been living and riding with the past two and a half years? The first ride was a death defying and death riddled roller coaster dive into medical mayhem and terror. That slowed down. Then came the various new Greek named variants’ variations, beginning with alpha. Each one took us on its version of spins on the not-so-merry-go-round. Delta dealt dastardly blows to a world weary and leery of the newest tricks up those viral sleeves.

This winter in November the first omicron variant B.1.1.529 was detected in a South African province. The next phase has been kind of like jumping off the merry-go-round on to the Tilt-A-Whirl. But this partner on the carnival ride in its several successive mutations has proven to be not as vicious as its progenitors. Its 30 plus mutations use different cells higher up in human respiratory tissue to call home.

An excellent Scientific American article on these virus’s biology outlined that this descendant used a different cell membrane receptor from the two the others have used, to gain entrance into our airway lining cells. Skipping a lot of scientific details, this let the omicron gang infect cells more in upper airways, and not so much down farther into lungs. This has led to a sort of biologic standoff between “us and them.” An article in the April 7, 2022, New England Journal of Medicine from South Africa summarizing the experience with that omicron variant and an accompanying editorial from the U.S. discussed the “Decoupling of Infection from Severe Disease.”

The omicron viruses have pretty much come to dominate COVID infections in most areas of the world since last November. And the overall experience seems to parallel that of South Africa. An article from the June 6, 2022, Minneapolis Star Tribune reports on the level and variant of virus found in the wastewater at the Metropolitan Wastewater Treatment Plant. “The fast spreading BA.4 and BA.5 Coronavirus subvariants made up 55% of the viral load identified in Twin Cities wastewater in the past week.” After tracking a real decline in viral load, this showed a 13% increase. In the past, these increases or decreases have forecast the trend of infections. It is too soon to tell now.

“The spring COVID-19 wave in Minnesota has produced a lower rate of severe illness than previous waves.” The ICU admittance rate is around 8% of cases, compared to the peak of 30% earlier in the pandemic, which squares with the April South African report. Personal communications with neighbors and friends who have recently gotten sick from COVID, mainly confirmed via the home test, (and likely not routinely reported to health authorities) report their level of disease was milder, though not without some misery. In these 6 or so folks none has reported any residual symptoms.

The South African report ends, “We think that the decoupling of the incidence of COVID-19 cases from the incidences of hospitalization and death during the omicron dominant wave in South Africa heralds a turning point in the pandemic, if the primary goal is protection against severe disease and death rather than prevention of infection.” It doesn’t seem that we can figure out how to eradicate these vermin. So, if we could come to a less threatening co-existence with mostly mild disease from infection, it could be perhaps a reasonable compromise — perhaps. Even Dr. Anthony Fauci was reported on June 15 to have gotten COVID. His case, too, showed only “mild” symptoms.

The virus has evolved to a form that is less virulent and more infective, seemingly to sustain its own existence better. And our immunity overall in the herd has increased from being infected and vaccinated (which compliment each other’s defense mechanisms). Whether the pandemic has become contained enough to change the term to endemic, we’ll leave to the experts. For now, we can go along with omicron’s COVID compromise of not generating sheer terror at being around anyone, to allowing a lot of communal activities. Unless a new subvariant sprouts up, just maybe we can take the summer off, so to speak, from deep concerns. But the virus is still teaching us. Most kids have vacation from school now. If we could somehow ask our teacher for a summer viral vacation as well, that would great. May the Fourth (of July) be with you.

Dr. Bures, a semi-retired dermatologist, since 1978 has worked Winona, La Crosse, Viroqua and Red Wing. He also plays clarinet in the Winona Municipal Band and a couple dixieland groups. And he does enjoy a good pun.


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