COVID-19 Omicron Variant: Symptoms and Treatment?

COVID-19 Omicron Variant Symptoms

South Africa’s National Institute for Communicable Diseases (NICD) has said that “currently no unusual symptoms have been reported following infection with the B.1.1.529 variant.”

NICD also said that as with other infectious variants such as Delta, some of those infected with the omicron variant of the coronavirus are asymptomatic.

Chair of South African Medical Association says Omicron cases are mild so far, but it's too soon to the determine risk of severe disease.

"It may be it's highly transmissible, but so far the cases we are seeing are extremely mild," Angelique Coetzee, chair of the South African Medical Association, told The Guardian on 26 Nov 2021. "Maybe two weeks from now I will have a different opinion, but this is what we are seeing."

Individuals are reminded to seek immediate medical attention (go to a hospital’s emergency department) if they develop emergency warning signs of COVID-19 such as:

• Difficulty breathing
• Persistent pain or pressure in the chest
• Bluish lips or face
• New confusion or inability to arouse

Related: 

• Best Early Combination Treatment Studies for COVID-19

How Is the COVID-19 Omicron Variant Diagnosed?

According to the WHO, current SARS-CoV-2 PCR diagnostics continue to detect this variant. Several labs have indicated that for one widely used PCR test, one of the three target genes is not detected (called S gene dropout or S gene target failure) and this test can therefore be used as marker for this variant, pending sequencing confirmation. Using this approach, this variant has been detected at faster rates than previous surges in infection, suggesting that this variant may have a growth advantage.

All variants of COVID-19 are diagnosed with a medical history which includes any recent known exposure to COVID-19, and a physical exam to check for symptoms of COVID-19.If COVID-19 is suspected, tests used to diagnose the virus include:

 

PCR tests (genetic or molecular test)

Results can take hours to up to one week

More accurate than an antigen test

Antigen test

Results are available in less than one hour

Less accurate than a PCR test

An antibody test may be used to determine if a person had a past COVID-19 infection, but it is not used to diagnose current infections because it takes up to 3 weeks following infection for the body to produce antibodies to the virus. 

Regular COVID tests do not test for variants. Testing for variants requires genomic sequencing, which not all labs can do and it can be expensive. State health departments may run tests to help determine prevalence of a particular variant in that state, but it is unlikely individual patients would learn which variant they are infected with.

COVID-19 Omicron Variant Treatment?

The World Health Organization said it is tracking a few dozen cases of two new sub-variants of the highly transmissible Omicron strain of the coronavirus to assess whether they are more infectious or dangerous.

It has added BA.4 and BA.5, sister variants of the original BA.1 Omicron variant, to its list for monitoring. It is already tracking BA.1 and BA.2 - now globally dominant - as well as BA.1.1 and BA.3.

The WHO said it had begun tracking them because of their "additional mutations that need to be further studied to understand their impact on immune escape potential".

Viruses mutate all the time but only some mutations affect their ability to spread or evade prior immunity from vaccination or infection, or the severity of disease they cause.

For instance, BA.2 now represents nearly 94% of all sequenced cases and is more transmissible than its siblings, but the evidence so far suggests it is no more likely to cause severe disease.

Only a few dozen cases of BA.4 and BA.5 have been reported to the global GISAID database, according to WHO. (Source)

The World Health Organisation (WHO) said that evolving evidence suggests that an Omicron BA.1 infection offers only limited protection against symptomatic disease caused by the emerging sub-lineages of Omicron. The WHO, with the support of the Strategic Advisory Group of Experts (SAGE) on Immunization and its Covid-19 Vaccines Working Group, is reviewing the emerging evidence on the increasing seroprevalence rates against SARS-CoV-2 globally.

The health watchdog is also keeping a watch on the characteristics and potential benefits of hybrid immunity. Hybrid immunity is defined as immune protection in individuals who have had one or more doses of a Covid-19 vaccine and experienced at least one SARS-CoV-2 infection before or after the initiation of vaccination.

This statement from WHO reflects the current understanding of hybrid immunity and highlights the gaps in evidence and potential implications for vaccination schedules and strategies.
As per WHO, current evidence suggests that immune protection against severe outcomes due to infection and vaccination is more robust than that due to infection, or vaccination alone. This is based on infections with the ancestral SARS-CoV-2 or pre-Omicron VOCs (Variant of Concerns).

WHO said, "The duration of protection from hybrid immunity has not been fully characterized yet and it is unclear whether hybrid immunity will continue to provide strong protection against new variants. Emerging evidence suggests that Omicron infection offers limited protection against re-infection with Omicron sub-lineages. Irrespective of infection history, achieving high primary vaccine series coverage remains the foremost priority." (Source)

Experimental antiviral pills - such as Pfizer Inc's (PFE.N) Paxlovid and Merck & Co Inc's (MRK.N) molnupiravir - target parts of the virus that are not changed in Omicron. They will work as effectively against the new variant because these drugs do not target the spike protein – they work by stopping the virus from replicating. However, there is a bigger risk that monoclonal antibodies, such as Regeneron’s treatment, could fail or partially fail because they target parts of the virus that will have mutated. 

Ivermectin and Omicron Variant 

Since the Omicron variant is newly discovered, there's little evidence to prove whether any treatment is effective against this variant.

Theoretically, drugs that target parts of the virus that are not changed in Omicron such as antivirals like Molnupiravir and Paxlovid might still work. As mentioned above, they will work as effectively against the new variant because these drugs do not target the spike protein – they work by stopping the virus from replicating. 

Ivermectin, has multiple mode of actions against the COVID-19 virus in general (not Omicron variant) as listed and explained in this review paper.

A schematic of the key cellular and biomolecular interactions between Ivermectin, host cell, and SARS-CoV-2 in COVID-19 pathogenesis and prevention of complications.

According to Dr John Campbell,

With ivermectin, because it’s working on so many different levels, it is improbable, to put it mildly, that a virus would mutate in a dozen different ways to avoid all those different mechanisms. We’ve talked about six mechanisms today. It’s very unlikely that we get six mutations that could dodge all of those all at the same time.

The I-MASK protocol and Omicron variant

The Front Line COVID-19 Critical Care Working Group (FLCCC) recommends hydroxychloroquine and ivermectin as part of their I-MASK+ protocol for prevention and early outpatient treatment of COVID-19 (Jan 19, 2022 version). 

Specifically, they recommend hydroxychloroquine (preferred for Omicron) and ivermectin as first line anti-viral agents:

• Ivermectin: 0.4–0.6 mg/kg per dose (take with or after meals) — one dose daily, take for 5 days or until recovered. (Find a Doctor). Use upper dose range if:  1) in regions with more aggressive variants (e.g. Delta); 2) treatment started on or after day 5 of symptoms or in pulmonary phase; or 3) multiple comorbidities/risk factors. (Ref)
• Hydroxychloroquine (preferred for Omicron): 200mg PO twice daily; take for 5 days or until recovered. (Find a Doctor)

Key Takeaways

As soon as you have symptoms, consult your healthcare provider and start treatment as early as possible. If treatment is delayed i.e. after 5 days of symptoms, your chances of severe COVID are higher.

For early out-patient treatment protocol, check out FLCCC (Front Line COVID-19 Critical Care) Alliance I-MASK+ Protocol.

For post-covid or long covid syndrome, check out FLCCC I-Recover Post-COVID Protocol.