Dr. Daniel Kuritzkes

Local docs: More time needed to fully assess Omicron variant



Local docs: More time needed to fully assess Omicron variant

Dr. Daniel Kuritzkes

BOSTON – With cases of the new omicron variant of the novel coronavirus rising worldwide, and at least one case reported in Middlesex County, Greater Boston infectious disease experts say it’s still too early for a full assessment.

“I think we are waiting to hear more about it. We are waiting to hear what the level of protection will be from prior vaccination, prior infection. It looks to be highly transmissible. There’s an uptick of disease in South Africa,” said Dr. Camille Kotton, the clinical director of transplant and immunocompromised host infectious diseases at Massachusetts General Hospital.

“We’ll just have to see what level of threat it represents,” said Dr. Mark Poznansky, director of the Vaccine and Immunotherapy Center at Massachusetts Gen­eral Hospital and a professor at Harvard Medical School. “Do people have uniformly mild disease or, like the delta case, which remains a threat here in Massachusetts, will there be a period of severe disease, with some moderate and some mild [as well]? Time will really tell.”

Experts said that it’s important to pin down several main aspects of omicron.

In separate interviews, two doctors mentioned wanting to know more about both the transmissibility and virulence of the new variant – Dr. Shira Doron, the hospital epidemiologist and antimicrobial steward at Tufts Medical Center, where she is an attending physician as well as an associate professor at Tufts University School of Medicine; and Daniel Kuritzkes, the chief of the Division of Infectious Diseases at Brigham & Women’s Hospital, who is also the Harriet Ryan Albee Professor of Medicine at Harvard Medical School.

Additionally, Kuritzkes wanted to know how different omicron is from earlier variants, including delta, while Doron wondered to what extent the new variant evades immunity conferred from prior vaccination or infection, or from treatments such as antibodies.

The Biden Administration has responded to the new variant with a partial ban on travelers entering the U.S. from countries in southern Africa, exempting American citizens from the ban. Some doctors have supported the policy, others oppose it.

Kotton described it as “sort of putting the pause onto the situation, just so we can figure out how to proceed, which seems reasonable.”

“It’s better to be cautious,” Poznansky said. “Cases of omicron are being detected all across the U.S.” He said that if and when things change, the U.S. could reduce its ban, as Israel previously did. “They pretty rapidly introduced a travel ban, then prepared to modify it based on data,” he said.

However, Doron and Kuritzkes criticized the U.S. ban.

“We assume because [omicron] was identified in South Africa, southern Africa, that it originated there,” Doron said. “We know it’s in 20 other countries. We did not impose a travel ban on those countries.”

“It’s kind of punishing South Africa for doing the right thing, detecting a level of the novel variant,” Kuritzkes said. He asked rhetorically, “Why didn’t [the U.S.] shut down Texas, Alabama, Missouri for exposing the virus to the rest of the country?”

Meanwhile, last Monday, the Centers for Disease Control and Prevention recommended boosters for everyone over the age of 18 years old who was vaccinated more than six months ago.

“To protect ourselves, our loved ones, our communities, I would encourage everyone to [get] either a primary vaccine series or get a booster,” said Kotton, who is a member of the Advisory Committee on Immunization Practices, which advises the CDC.

Doron questioned the recommendation of boosters for everyone after reading a Nov. 29 op-ed in The Washington Post titled, “We don’t need universal booster shots. We need to reach the unvaccinated.” It was co-written by three vaccine experts: Philip R. Krause, Marion F. Gruber and Paul A. Offit.

“Their view, looking at the data, is that there are still populations where we don’t see any cases of serious infection and death, young and healthy populations,” Doron said. “Telling an 18-year-old if there are no comorbidities, ‘you should get the booster,’ I guess I’m not sure I understand why you should, particularly now there’s a possibility there could be an omicron-specific vaccine in the future.”

Doctors were more in agreement on vaccination for children age 5 and older.

“Those of us on the CDC’s Advisory Committee on Immu­nization Practices have looked at the data,” Kotton said. “We find it to be safe. We said we would vaccinate our own children. We have actually vaccinated our own children.”

As she explained, “serious [COVID-19] disease is rare but not unheard-of for children.”

“It is important for children, just as everybody else, to be vaccinated,” Kuritzkes said. “Young children are a major vector of the spread of infection. They pick up infection in schools and playgrounds and bring it back. Many children have parents or grandparents in the home who may be vulnerable.”

In Massachusetts, overall cases are on the rise. For Dec. 7, the state Department of Public Health reported 3,720 new cases, with 1,151 hospitalizations and 51 deaths.

“Cases are going up quickly,” Doron said. “Deaths are not. It’s not the lowest they’ve ever been, but not much higher than the lowest [point]. Hospitalizations are up, but much less, a much lower rate, than cases.” She cited this as evidence of vaccines working.

Yet she is concerned about hospitalization data, including breakthrough cases, which were addressed during a video call with chief medical officers at Tufts last Monday.

“Everyone reported a lot of fully vaccinated patients getting an additional diagnosis of COVID,” she said. “They were in the hospital due to something other than COVID and happened to be diagnosed with COVID when they were admitted or at some [other] point.”

In this moment, doctors urged the public to stay on guard.

“Personally, myself, I wear a mask when I go out,” Kotton said. “I’m avoiding crowded locations. I think it’s a good time to avoid problems. I’m definitely seeing an increase in hospitalized patients. Now is not the time to stop being cautious.”

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