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Omicron is not the end of the COVID pandemic

With a new year, we find ourselves embarking on new variations of old tales. Last time we talked to Dr. Peter Hotez - dean of the National School of Tropical Medicine at Baylor College of Medicine and co-director of the Center for Vaccine Development at Texas Children's Hospital - he remained concerned about the delta variant of COVID-19 while the omicron variant began to make news.

Weeks later, the omicron shows signs of declining, but the death toll remains high, as does corona fatigue. A recent discussion point suggested that the rapid spread of omicron could accelerate the pace of COVID-19 from pandemic to endemic. Hotez is not entirely convinced that we are there yet. We asked him for an update along with a handful of reader questions.

Q: I think this is our first of these for the new year. But why change things? What are your thoughts on where we are now with delta, omicron, it all?

A: In some ways, we reproduced in 2022 what happened in 2021. There was a big wave over South and Texas in the summer followed by a national wave that went into the winter.

What happened in 2020? Exactly the same. Variants are different. Some details are different. But there is a pattern there.

At HoustonChronicle.com: It took Houston 21 months to hit 300,000 COVID cases. Thanks to omicron, we approach 400K a month later.

Q: There is a lot of talk about omicron, which creates herd immunity and the transition from pandemic to endemic. Your thoughts?

A: The big picture I'm still worried about. There is a lot of happy talk about omicron somehow acting as a weakened virus, herd immunity and the end of the pandemic. I do not think so yet. I think we're getting another wave this summer across Texas, and it could be like 2020 and 2021. Here's the reasons why.

One: I'm not convinced that the durability of omicron protection will be adequate. It may be reminiscent of the short-lived immunity you get from the upper respiratory tract virus. The population may still be vulnerable in the spring.

And vaccination rates are still not high in low- and middle-income countries where these variants occurred. I think we are still very vulnerable to another variant occurring in Africa or Asia.

Question: As you pointed out, this is contrary to many of the hopeful buzz about omicron that I encounter.

A: Yes, you hear it coming from the White House. And I hear it from many of my talking head colleagues. But to me, right now, it sounds hollow. I do not think it is wise. I think what we need most right now is a national strategy on how to prevent another major variation in the summer from hitting Texas and the southern United States. Here is what I think the strategy requires.

One: a global immunization strategy against COVID-19 that just does not exist now. The White House announced an additional 400 million doses, which is slightly more than what our Texas childhood vaccine has done. We are missing 9 billion doser.

Second: We need a greater understanding of the durability and protection against mRNA boosters. We get conflicting results about durability. It needs to be clarified. We need to understand that for a strategy to move forward. Whether we keep the unique focus on the mRNA vaccine or expand our COVID stocks to include additional technology.

And let me say, thirdly: What is our plan for global surveillance? So far, we have been surprised by all the major variants of concern. We need predictable monitoring models, but we do not have them. It is a need. What I would like to see come out of the White House is a national strategic task force that really needs to dive into these three components. We need a realistic plan for the country. And I just do not understand that we have it right now. Nationally, we are still in a reactive state every time.

Question: The degree of fatigue, even among those who have buy-in, feels like it is growing rapidly as we approach the two-year mark.

A: I understand fatigue among the population. I really do. What I do not understand is fatigue among our public health leaders at the national level. We can not have that. We need to have some fresh thoughts in if that is the case.

Question: We received an email from a reader who had a few questions that I would like to present if it is okay. First, are vaccinated people just as likely to spread COVID as non-vaccinated people?

Answer: The answer is, yes, if we are talking about people who have been vaccinated and boosted with a high level of virus-neutralizing antibodies, they may still experience breakthrough infection and excrete the virus. But it is in a shorter period of time and less of the virus is excreted. But it's not like a light switch. Still, you are much less likely to spread the virus.

Remember how this works: What we are talking about when we talk about transmission is to secrete the virus from the nasal secretions and into the saliva. What happens is when a large portion of the virus is neutralized by antibodies in the mucous membranes that reduce virus excretion. That was the great thing about the previous variants - there were almost no virus releases, even if you were exposed to the virus. There was virus replication.

At HoustonChronicle.com: Omicron sends vaccinated people to hospital, but unvaccinated people are more likely to end up in the intensive care unit

Question: Second: Is the virus level higher in vaccinated people?

A: They should be lower, for the reasons I just said. You have the virus-neutralizing antibodies. So there should be reduction.

Question: And thirdly: Is asymptomatic spread extremely unlikely?

A: It is certainly less likely for those who are partially or completely vaccinated. I'm glad people are asking these questions. There's a lot of bad information out there. Anyone who tuned in to Fox News (Tuesday) night could hear Alex Berenson say the vaccines are not working. There are other talking heads on Joe Rogan who say similar things that discredit the vaccines. There is a lot of misinformation and a lot of people tune in to it.

Q: I understand that there is frustration over so many breakthrough cases. People grew and increased with getting cases. Which feels like it could reduce the buy-in.

A: This is one of those problems where we do not adequately explain to the public what is going on. The Cliff's Notes version goes like this. The vaccines were designed to stop symptomatic disease. They were released for emergency use and approved. Later, there were data from Israel that showed that just after the second dose of Pfizer, the symptomatic and asymptomatic transmission stopped.

Around that time, the Centers for Disease Control and Prevention came out and said, "If you are waxed, you do not need masks." Then it turned out that the shelf life of stopping asymptomatic transmission was not long lasting. That was the need for the booster. The delta booster appeared to restore that function again. So we understood it was not one and done or two and done. It was three and done.

We wanted to increase the antibodies and create a more durable immune response. Then came the omicron. And it seemed that the effect of the boosters was not as good compared to omicron as alpha and delta and the original descent. The reason for that? We do not quite know. It may be that the boosters are not holding up so well. Or a unique quality of omicron. We do not know.

But it is these things that we need to keep track of. However, there is no doubt that compared to two vaccinations, three are better in terms of keeping people out of the emergency room and hospitals. Three doses, we see about 90 percent protection by keeping people out of the hospital versus six months after the second dose, which is about 57 percent.

Question: Any confusion speaks to your suggestion that there is a clearer national policy.

A: I am an MD and Ph.D. who has studied coronavirus all my life. And it still takes me a while to fix it all in my head. With omicron, I think I understand what's going on. But the problem is, when the CDC and the White House communicate and do not go into detail, people get confused, understandably. And the anti-vaxx groups are taking advantage of this and drawing a picture that seeks to discredit either the vaccines or the messengers. It is relatively easy to arm health-related communication.

Question: So clearer messages ...

A: What I see is that the White House and the CDC are trying to use simple messages to reach the entire population. And that's not how it works. There are many populations, but there are two populations in this case. One is all-in on medical intervention. They want to know the science to protect themselves and their family. They tolerate the levels of complexity because they feel that their family's health depends on it.

Another segment will not be vaccinated with mRNA no matter what you tell them. It requires another discussion. The White House and the CDC need to stop trying to create one message for the entire American people. It starts to come out as baby talk, which does not help with the second group, and does not convey key nuances that part of the first group wants to know about.

At HoustonChronicle.com: Houston's new vaccine jackpot offers 12 gift cards for $ 1,000, $ 38K in prizes to get COVID shots

Question: What has changed as we prepare for year three? What is the same? I suppose we know a lot about the latter ...

A: What has changed is that we are at a different time in the pandemic. Omicron is down nationwide. In many cases, it went down as fast as it went up. And much of it - not all of it - was among the unvaccinated. But we are at 2,000 deaths a day. I think that will continue. We'll soon be hitting 80,000 in Texas. The big question again is whether we can establish a global national strategy and really try to end this.

Question: And again, you think the suggestion that we're moving towards the end is premature.

A: Yes, I'm not convinced yet. I hear the message, "It's starting to look like the flu." For me, it all becomes an excuse for passivity. And it's frustrating because we still have a chance to end this pandemic by fully vaccinating the world.

Q: Where are the things with your vaccine? There was a great announcement about it in India. Will there be a broader global rollout soon?

A: We are now on about 250 million doses and producing about 140 million a month. We get there. We have worked with people in Indonesia, Bangladesh, Botswana. But both domestically and internationally, we need a US-based strategy. Maria Elena (Bottazzi, Hotez's colleague at Baylor College of Medicine and Texas Children's Hospital Center for Vaccine Development) still hears from people who for one reason or another will not take an mRNA but will take ours because the technology is well known due to of our recombinant hepatitis B vaccine.

Question: A little off topic, but I just saw "Station Eleven." Does all this give you time to watch a movie or TV or something like that?

A: A big part of my routine is waking up at 6 p.m. 6 calls from Indonesia and then I have calls at night with India. Then there's work, a little bit of "Morning Joe." So not much time for movies. I have not taken a whole day off in two years.

andrew.dansby@chron.com

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