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In the war against COVID-19, is the virus is winning?

At Northwestern Medicine, it takes Dr Ramon Lorenzo-Redondo about a week to sequence viral specimens from patients who have tested positive for SARS-CoV-2. Delta still reigns as the most common variant in circulation. But omicron, the more transmissible and seemingly smarter variant, is on a steep rise.

“From the beginning of December, it looks like 7% or 8% of the cases we detected (were omicron) but I suspect now it’s going to be worse,” Lorenzo-Redondo said.

The more cases, the more opportunity a virus has to change, making it a moving target. Omicron is a perfect example.

“If we have big numbers, they are going to keep spreading, keep evolving,” Lorenzo-Redondo said. “Delta might diversify even more. Others may diversify even more. This is a never ending race. … The concerning thing about omicron is how many mutations it has acquired.”

With omicron, the most critical change is on the spike protein. Northshore University HealthSystem pathologist Dr Karen Kaul said the variant has figured out a way to get back into our cells.

“As that protein is changed, it becomes more effective at getting into the cells,” she said. “And it also reduces the capacity for our own antibodies and the vaccine-induced antibodies to fight off and block that infection.”

Still, she said, vaccines and boosters offer the best protection against severe disease.

“I think the thing I want to stress is that those people who are vaccinated are not getting as sick and are not going to the hospital,” she said. “We also have very significant data showing if one is double vaccinated and boosted that shows a great deal of protection against the virus. So those boosters are very important.”

Not just locally, but around the globe. In countries with low vaccination rates or limited access, Lorenzo-Redondo said they can become a niche of new viruses.

“If we don’t protect other places in the world, this will keep happening,” he said. “It happened with delta. It happened with this one.”

“We really need to address what is causing these and that is replication of the virus and that is a worldwide problem,” Kaul said.

Standard mitigations – masks, social distancing, hand washing, staying home when sick and vaccines — are the best protections we have at the moment.

“Right now the amount of transmissibility is still like a new virus,” Lorenzo-Redondo said. “We shouldn’t relax. … We might jeopardize our efforts with the vaccine if we keep this way. And then we have to reset the system and do it all over again.”

“It’s depressing to be back in this situation again,” Kaul said. “It does feel like we are going through this all again. But what we want to do is keep everyone out of the hospital.”

Omicron is also threatening the impact of some COVID-19 medications. Monoclonal antibodies and convalescent plasma may not be as effective against the variant. And testing is in short supply due to holiday demand.