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SARS-CoV-2 was allowed to propagate everywhere. It was allowed it to do what viruses do best, random and uncorrected mutations resulting in their adaptive survival. This virus is in search of its new home and will not stop until it finds it. The lack of equitable access and distribution of vaccines continues to promote viral propagation resulting in the continuous appearance of new variants.
Thus far, we have recorded at least three dozen variants with considerable changes when compared to the "alleged" Wuhan original strain. Without a confirmatory sequencing data on the virus obtained from patient zero in China, we are left with no strong reference as a base to monitor viral evolution as it continues to propagate all over the world, either through human travel or via migratory birds.
Many of these variants were identified in healthy people meaning that at a best estimate, we would see some controlled mutagenesis as the immune system will be activated and limit accumulation of mutants. Our immune surveillance will keep the mutation frequency at its lowest level.
However, in the case of immuno-compromised people, such as those infected with either or both the HIV virus and the Mycobacterium tuberculosis, their immune system is not working with total absence of immuno-surveillance; thus, allowing all the possible combinations of pro-survival mutations to occur reaching a cumulative viral load, which will make them sick and even kill them.
The evolutionary pressure on viruses tends to focus on the regions involved in cellular attachment and entry, allowing the virus to replicate and make more copies. Some mutations are deadly and inadvertently kill the mutated virus; others are neutral with no consequence on the virus, while some tend to enhance the infectivity of the virus causing the infected cell to make more of this mutated form of the virus.
With time, this new "variant" becomes dominant as it has the advantage of making more copies than the other mutants; the best example being the Delta variant and how quickly it became the most dominant variant around the world.
The samples used in the sequencing efforts leading to the identification of Omicron seem to have been obtained from immuno-compromised people. Scientifically sound as the frequency of Omicron in normal people would have been relatively low and not dominant enough to have been detected during routine sequencing; but, it was found in high enough quantities to have been able to be detected and sequenced in these unhealthy people. Now that we know it exists, it has been causing hysteria in every country with media frenzy on the possible end of the world.
At this stage of the pandemic, travel bans, special measures, and confinements are counterproductive as they have no effect on public health. The contribution of migratory birds as free carriers of the virus abrogates all these travel bans rendering them futile.
Public health efforts should concentrate on educating the population on how to live with the virus, educating them on the added value protection from vaccines, and maintaining a balanced and apolitical transparency on the state of affairs of the pandemic.
Omicron presents 35 changes at the protein level, 14 of which are common with other variants such as Alpha, Beta, Delta, and Mu. The remaining 21 changes are specific to the spike protein and have not been detected before, except that individual mutations were found in both in immuno-compromised people and some samples obtained from animal sources.
The time scale to achieve all of these changes in Omicron is three to six months. It is no surprise that Omicron will be detected in many countries, as we are witnessing on a daily basis. It has been in circulation at least since September 2021. So if you don't look for it, you are not going to detect it.
With the exception of vaccines based on the Pasteurian method using whole inactivated viruses as polyvalent vaccines, the rest are based on the spike viral protein as monovalent vaccines. It is easy to see where fear and panic may arise from, it is to do with monovalent vaccine efficacy against Omicron with 21 unique changes in the spike protein sequence that is up to a 2 percent change in the primary sequence of the spike protein.
Neutralizing antibodies are designed to recognize small and specific protein sequences of the virus called epitopes. The concern of many governments has to do with the potential loss of these critical epitopes in Omicron rendering these monovalent vaccines obsolete, especially in the unforeseen scenario where Omicron could become the dominant variant.
Similarly, the fate of the monoclonal antibody based therapies for COVID-19 is up in the air since the loss of these epitopes upon which these monoclonal antibodies were designed would render them obsolete too. Do these concerns justify panic, hysteria, and punishing African countries? No they do not justify such behavior from many leaders and their advisors; especially when they tell us to accept and believe in science, while they ignore it when it suits their political agendas.
Almost two weeks since the onset of this Omicron Armageddon, we are hearing only speculations with more of the same. The reported increase in cases in South Africa is by no means the Omicron "smoking gun"; cases are on the rise in many countries independent of Omicron and as a result of how the pandemic is managed in these countries.
Our immune system is at the same time fascinating and intricate; it is very fast at learning and keeps good memory of what it learned. When we get vaccinated, it gets to work producing several thousand of these epitopes upon which neutralizing antibodies are produced, with the activation of another facet of protection to do with these specialized killing cells called cytotoxic T cells.
Even if with Omicron we lose hundreds of epitopes, there will be thousands more to help with the surveillance and protection against it. No clinical data was presented confirming the ineffectiveness of current vaccines, whether mono or polyvalent in nature, against Omicron infections to warrant a present and immediate danger concerns.
The Omicron infected cases presented with mild symptoms of the COVID-19 disease in those who were vaccinated with no reported deaths yet, and supporting the concept that vaccines remain efficacious. Unfortunately, these vaccines do not protect you from being infected as they offer no mucosal immunity since the virus infects you through the nose and mouth.
We have known this weakness in the vaccines for many months now and even named these events "breakthrough" infections. It appears that Omicron is facing a steep hill to climb in order to become dominant as the expectation would be that it will disappear as quickly as the Lambda and Mu variants.
It is of interest to note that the U.S. FDA approved an antiviral drug, Molnupiravir, which was found to cause mutations similar to those identified in the Alpha, Mu, and Omicron variants. This was an unexpected result for a therapeutic. It is plausible to assume that if the treatment duration were to be longer than five days, they would have identified Omicron-like variants in this population. Though this drug has the potential of generating mutations and harms us, it was approved for human use with no hysteria or concerns about its safety.
Omicron is hardly a cause for concern and the last variant to fear as many more will appear soon enough. Even therapeutics like Molnupiravir can create new variants, so remain calm, get vaccinated, wear your mask, and continue with your daily activities. Viruses have no political agenda; they adhere to no political party, they are not on Twitter or any other social media platform, and for sure, they are not active advocates for any conspiracy theory.
They are simply opportunistic microscopic pathogens, if allowed to circulate, they will mutate and keep mutating; they can potentially infect you, make you sick and even kill you. Instead of fearing them, we should concentrate on prepping our defenses up against them as they are here to stay with us for a very long time.
There is no immediate need to adjust the current vaccines. The focus should be on equitable distribution of current vaccines to every country that needs it, in the hope to just reach equilibrium with the SARS-CoV-2 virus.
Dr. Hakim Djaballah is an Algerian-born American molecular pharmacologist and technologist with expertise in virology and oncology. He is a thought leader on drug discovery and development and sits on several advisory boards. He is the co-founder, president and CEO of Keren Therapeutics, a startup company dedicated to the science of aging.
