Status: 07.12.2021 6:55 p.m.
Little data, many imponderables: based on the first figures, virologist Christian Drosten assumes that the new Coronavirus variant Omikron could mark the transition from a pandemic to an endemic situation – at least in southern Africa.
“We are dealing here with a perfect post-pandemic virus, with a perfect first endemic virus,” says Drosten in the new episode of the NDR info podcast Coronavirus Update. In any case, where the mutant originated, Covid-19 could soon become a disease that occurs regularly and frequently, but no longer reaches the proportions of an epidemic. In the southern African countries, vaccination rates are low, but population immunity is still extremely high because a large number of people have been infected. The first, as yet incomplete, data indicate that Omikron is spreading extremely quickly. So far, relatively mild courses have mostly been observed in South Africa.
Germany not ready for the endemic phase
The bad news for Germany: “We are not yet ready for a re-infection, we are not yet so far with our immunity,” says the head of virology at the Berlin Charité. It is not responsible that one obtains the necessary immunity to enter an endemic phase through infections. “That would cause too many serious deaths.” In order to achieve population immunity, above all the vaccination gaps would have to be closed. Boosters alone do not help on this point. However, it increases protection, also against the new mutant: “The boosted vaccination is the new double vaccination. What Omikron does to immunodeficiency is perhaps the difference between two doses and three doses.”
Difficult data situation
Drosten describes the interpretation of the first data from South Africa as difficult, because less than two weeks after the variant was classified as “worrying” it is of course still incomplete. In addition, the country has experienced a completely different infection dynamic: In the southern hemisphere there was a severe winter wave during the European summer, after which the pandemic almost came to a standstill, and the immunization, mainly due to infections, was almost complete with the approaching summer. And now a virus is emerging that is apparently taking advantage of the remaining weaknesses in the population’s immunity at breakneck speed.
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Growth rate of 25 percent – Drosten: speed is terrifying
A growth rate of 25 percent per day can be calculated from the number of infections, especially from the Gauteng province, which is badly affected by Omikron. That would be equivalent to a doubling about every four days. The R-value (infection rate) in Gauteng is estimated at 2.2, for the delta variant the number of reproductions there is 0.8. In England, too, with currently more than 300 confirmed Omicron cases, daily growth rates of 25 percent are indicated. “The speed of reproduction is terrifying,” says Drosten.
Antibodies – Drosten expects a high loss of neutralization
At the same time, a preprint suggests that the reinfection rate in South Africa has increased 2.5 times with the appearance of Omikron. This reinforces assumptions that the variant with more than 50 mutations could not only have a fitness advantage, but could also evade the immune response more effectively than previous variants. Our own laboratory data on the activity of antibodies in contact with B.1.1.529 are still missing, says Drosten. “But my firm expectation is that there will be a loss of neutralization like no other variant before.” That would mean: The immune response in vaccinated and convalescent people would be significantly reduced, vaccines would have to be adapted.
“The boosted vaccination is the new double vaccination. What Omikron does to immunodeficiency is perhaps the difference between two doses and three doses.”
Christian Drosten
According to their own information, Biontech and Moderna are already working on an update for their mRNA vaccines. Drosten assumes that it will be possible to vaccinate with the new generation from the second quarter of next year.
No lifelong vaccination subscription – “Virus evolution has biological limits”
Fears that the development of Sars-CoV-2 is synonymous with a “lifelong vaccination subscription”, the virologist dispels. “We are on the way to an endemic state, the transition process will take place here too.” He does not want to rule out that the entire population will have to be boosted for a few more years towards winter. But: “Virus evolution has biological limits. Coronaviruses are, in a certain way, more stable than influenza viruses, we may come out of this obligation at some point and be able to deal with the virus in a similar way to the flu.”
Does Omikron make milder gradients?
So far, there is also only incomplete data on the question of how sick the new variant makes. A hospital group from Pretoria has documented that of the first patients infected with Omikron and hospitalized, only 21 percent needed an oxygen supply. That is little in the case of hospital-compulsory Covid-19 diseases. The death rate fell from 17 to 6.6 percent and the length of stay was shortened from 8.5 to three days. Drosten restricts: On the one hand, these are preliminary data, on the other hand, they apply to a country in which almost everyone has already gone through a Sars-CoV-2 infection.
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More children in the hospital – no harmless virus for the unvaccinated
According to Drosten, the most striking thing about the hospital study is the age of the patients: 80 percent were younger than 50 years, 19 percent children up to nine years. In South Africa, too, children under the age of twelve are currently not vaccinated. For all smears that have to be taken on these initial dates, the information on affected children attracts particular attention from the virologist. So far, small children have been less affected by the infection, so the Omikron variant in children could now catch up with the initial infections that had previously failed. “I take away from this that this does not mean anything good for the immunologically naive group, that Omikron is not a harmless virus for those who have not been vaccinated,” says Drosten. A virus variant that has a combination of effective immune escape and very rapid reproduction has so far always been associated with an increase in the severity of the disease.
The new virus variant must be taken very seriously, because it is not yet known how B.1.1529 behaves in Germany. There are currently between 25 and 30 confirmed cases known, Drosten assumes that the week after next it could be between 200 and 300: “I don’t want to paint a devil on the wall, but out of responsibility I have to say that when in doubt, we always take precautions should exercise. “
Omikron could keep us busy until summer
If Omikron should, for example, double the number of infections every three days in Germany, “then this is a development that is faster than any political decision-making option”. Since Germany drives with the handbrake on compared to other countries, i.e. maintains numerous corona protective measures, the rate of increase could also be lower, but it will certainly not be zero. Drosten’s assessment for the next few months: “Delta will be our problem until January, Omikron into summer.”
Note: On this Friday, NDR Info is sending a special episode of the coronavirus update with general practitioner Marc Hanefeld from Bremervörde with basic information about vaccinations.
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