Omicron variant detected in Oregon

Oregon joins a growing list of states reporting cases of the Omicron variant. Scientists at Oregon Health & Science University have detected three cases of the new variant of concern. All three cases occurred in people who had been fully vaccinated. Patrick Allen, Director of the Oregon Health Authority, joins us with the details.

The following transcript was created by a computer and edited by a volunteer:

Dave Miller: The Omicron variant has been identified in Oregon. The news came yesterday afternoon but it was hardly a surprise. Omicron has now been found in at least 33 states and 77 countries. Patrick Allen is the Director of the Oregon Health Authority. He joins us once again with more details. Patrick Allen, welcome back.

Patrick Allen: Thanks for having me.

Miller: We all knew it was just a matter of time before Omicron was detected here. Now that time is upon us, does that fact actually change anything?

Allen: Well, as we sit today, Dave, I would say no. I think our guidance to people remains the same which is if you haven’t yet gotten vaccinated, please do. If you have kids who are now eligible to get vaccinated, get them vaccinated. And if it’s been long enough since you were first vaccinated to be eligible for a booster, do that.  We also continue to ask people to wear masks when they’re gathered indoors. All these things, masks and vaccinations are really helpful. I think if we need to do other things, we need to know a little bit more about the Omicron virus. We need to know if it is more contagious. Early data out of South Africa and the UK seem to indicate it’s potentially a lot more contagious. Does it evade vaccines? There’s a little bit of data beginning to come out that indicates maybe at least in terms of people coming down with a case with symptoms. We still don’t know how the vaccines hold up for serious illness, hospitalizations and deaths. And then we need to know if the Omicron version is actually a more serious illness. There’s been some talk coming up particularly out of South Africa, that it’s less serious, but we have to be really careful with that data because South Africa is a really different place with a much younger, healthier population than in the United States, much lower vaccination rates, much higher exposure rates. And so I think we need a lot more information before we can answer that question. If those things line up, they can line up either good or bad and we’ll have to adjust our strategy based on what we find out.

Miller: There’s a lot to dig into everything you just said. So I want to turn to some of those big global questions that tons of scientists are trying to answer. We’ll come back to those in a few minutes. But I’m curious closer to home, there’s been sequencing data from the University of Washington showing a big rise in Omicron cases in the last two weeks there and they’ve actually done a lot of work. So maybe that is the case where they’re more able to track it and more aware of the case there than the fact that there is more there than here for example. But I’m curious what Oregon modeling or maybe modeling from Peter Graven at OHSU, what it tells you about what we should expect in the coming weeks.

Allen: It’s a little too early to tell. Last week’s model from Doctor Graven began to introduce some themes about Omicron and what we would need to be looking for but we need to be able to actually put some numbers to those factors that we just talked about in terms of immune escape through vaccines, severity of disease and those kinds of things before we can really before he’d be able to model changes in hospitalizations or case rates or those kinds of things. I think we’re probably two weeks out from being able to do that.

Miller: Are you expecting Omicron to become the dominant strain in Oregon to beat out Delta?

Allen: Yeah, that has certainly happened very quickly in South Africa and in the UK they expected that to happen sometime later this week which is also very, very fast. I don’t see a reason to think that wouldn’t happen here.

Miller: So let’s turn to this data and as you noted and we probably can’t say it enough, this is all really preliminary but so far it’s also been consistent in reports out of South Africa, out of UK, out of Denmark. It does seem that so far the variant is about three times more transmissible than Delta, which itself was at least twice as transmissible as the coronavirus 1.0 but also potentially less virulent meaning in this early data less likely to cause serious illness not just in South Africa, if I recall correctly, but also in the UK, which maybe is a better comparison. How hopeful should we be about this early data?

Allen: Well, hopeful and yet cautious. If the disease is considerably more contagious and if it’s mild, that’s actually a good development. However, if it’s as much more contagious as it seems to be emerging than it is, it doesn’t need to be very serious to still generate a lot of cases in the hospital. And our hospital capacity is still a critical problem right now. Although the percentage of cases for instance in intensive care units has dropped significantly from our peak, those ICUs are still full because of catching up on all the procedures and surgeries and things that they didn’t do during the peak. So we still have a pretty fragile hospital system and it doesn’t take very many cases–even if there are a really small percentage of new infections–to put a lot of stress on that system.

Miller: In other words, this is a case where the different numbers and comparisons really do matter. If it’s three times more transmissible than Delta, even if it’s say only 70% as virulent, that could still be really serious and we just don’t know. What’s your best understanding now for when we’ll have a much clearer picture for what this means?

Allen: As I indicated with Dr. Graven’s modeling, I think two or three weeks is probably a pretty good target to have a good sense. We’re beginning to see for instance lab data on vaccine effectiveness. That’s not as good as real world data but as this virus becomes the dominant strain, especially in the UK which is a lot more comparable to the US, we will know more. We will know more real world data about hospitalizations once we get two or three weeks down the road from it becoming dominant in the UK because that’s typically how long it takes for those more severe serious illnesses to manifest themselves.

Miller: Given those uncertainties the next two weeks include some of the most concentrated holiday times of the year where a lot of people maybe want to get together with families in a way that they haven’t for a while. What does that mean to you?

Allen: Well, it means that the advice that we’ve been giving continues to be the right thing to do: To get vaccinated; to wear masks; if you’re going to have a gathering, try to keep it small; if you’re able to do parts of it or do it outdoors even though we all know what that means in winter in Oregon do that; if you’re able to increase airflow in spaces that you’re going to occupy, that’s a good thing to do. It’s all the same precautions we’ve been asking people to take that continue to be really effective. Before the arrival of Omicron, it now looks cautiously like we got through Thanksgiving without there being a big spike in cases and I think all of those steps have helped.

Miller: It’s possible, as you noted though, that the best case scenario is that we’re not going to see a surge in hospitalizations because Omicron may be the more transmissible but is less virulent. It’s possible that’s not going to be the case as you noted. You just said that hospitalizations rates have gone down, but it’s still precarious. Just yesterday, the governor demobilized Oregon National Guard troops that had been called in to support completely-overwhelmed hospitals because of the Delta surge. What will happen if there’s another hospital surge?

Allen: We’ll need to take a look at the tools that are available to us and go ahead and deploy those tools. We’ve been making extensive use of contracted traveling staff from around the country.  We’ve worked to try to increase access to things like monoclonal antibody treatments that have the ability to drive down hospitalizations. There are potentially some new therapeutics coming online that similarly could drive down those hospitalizations and we’ll need to basically pull those levers that we have available to us if we get into that kind of circumstance.

Miller: One of the big bits of news that we just saw today for therapeutics came from Pfizer saying that their treatment for people who have been diagnosed with COVID-19 is highly effective at preventing hospitalization. What happens at the Oregon Health Authority (at the state level) when you see news like that?

Allen: We were responsible for the initial distribution of those treatments. We don’t literally get them in our possession, but we direct where they go from the manufacturer because they started out being in very limited supply. The new Pfizer drug as well as the one that’s a little further along in the approval process, Molnupiravir, both have some real challenges because they have to be given very quickly after someone discovers that they’ve got COVID. And so we’re working with the network of potential providers to make sure that we’ve got testing lined up with the ability to issue a prescription and the ability to fill that prescription. But as we see effective treatments and we work through the logistics of how to get them out in an equitable fashion, they really have a lot of promise because that’s one of those are one of the developments that are really the key towards getting out of an emergency kind of a pandemic circumstance into a more normal life of living longer term with COVID-19 out in the world.

Miller: Those National Guard troops that I mentioned, they were justly celebrated for their work, but I don’t think they’re anyone’s first choice for staffing hospitals. That’s not what they’re trained to do. Does the state have a role to play right now in preventing healthcare workers from leaving their jobs?

Allen: Well sure. And what we’ve done is work across different sectors of the larger healthcare system to try to provide resources for retention payments and try to provide additional staff  resources so that the existing staff and facilities don’t burn out as quickly although I think at this point of the pandemic about everybody has burned out. Longer term, we’ve had programs for a number of years and the Legislature has provided significantly more resources around training and developing new healthcare professionals. On a variety of fronts we are trying to preserve and protect the existing capacity while being able to add to it.

Miller: All three of the cases announced yesterday were in people who had been vaccinated. How significant is that fact to you?

Allen: It’s interesting, particularly when you combine it with the fact that two of the three cases had been foreign travelers, we don’t actually know yet about the third case and it appears that that’s been a common theme in initial cases in a number of states. And so part of what may be going on is we’re over-selecting for travelers who are more likely to have been exposed elsewhere  where the disease was just a little bit more prevalent. And basically to be an international traveler today you have to be vaccinated so we may be over sampling vaccinated people right now. It’s a little too early to tell. But lab studies from Pfizer and other emerging data seem to indicate that the first two doses of vaccine are less effective at preventing symptomatic disease and that would be consistent with that.

Miller: Do you know if these three individuals had also gotten booster shots?

Allen: I don’t know that.

Miller: Let’s turn to the question of the challenges that Oregonians are facing right now in getting booster shots in arms. Can you give us your big picture sense for where we stand right now?

Allen: The big picture sense is we have a lot of people who are eligible for shots of one sort or another. We’ve got kids aged 5-11 for their first doses. We’re now a little bit more than a month out from them becoming eligible. So we have kids eligible for their second doses.  We’re still working hard to get first doses in places that have had lower vaccine uptake and now we’re actually just at the last eligibility date back in the spring for people to become eligible for first doses and so we’ve gone through all kinds of significant waves of people becoming eligible. We’re seeing the demand maybe begin to taper off just a little tiny bit. That’s a little bit of a mixed bag. It helps reduce pressure on vaccinators, but we really want to have people get vaccinated. We’ve tried to provide a number of locations around the state that are walk-ups, I would call them kind of mid-sized vaccination sites that aren’t the huge number that we could do at the convention center but are in the 1000 or 1500 shots a day capacity. We provide financial resources to  pharmacies to enable them to add more staff and add to their capacity for vaccination. But the big challenge right now we have is that between the Guard and the health systems, they are really still fully– the Guard is just now demobilized but until yesterday–engaged in dealing with the cases resulting from the surge and so there’s a big chunk of capacity that’s not available today that was previously.

Miller: So is it the case that right now the bigger issue is that there aren’t enough health care workers to administer doses or that Oregon isn’t getting enough doses in the first place?

Allen: We have plenty of plenty of doses available. There have been little glitches in supply along the way, but they’ve been fairly minor in the big picture of things. The access to vaccines is not the problem. Really the problem is the human infrastructure to get shots in arms.

Miller: Has Omicron actually convinced more Oregonians to get vaccinated who were not convinced by approximately one trillion other reasons?

Allen: I haven’t seen evidence of that yet but I would expect that we would. If you look at the total number of vaccinations and you go back in time to  the beginning of the Delta surge, back in late July/early August, we had really bottomed down in terms of the volume of vaccines being given and that volume really increased pretty significantly as people especially in under vaccinated communities, saw more and more people that they actually know gets sick or potentially die and that that really did cause an increase in vaccination. So if we see negative outcomes from Omicron, I would expect you to have a similar effect.

Miller: So just to go back to my first question, health officials might as well have get vaccinated, wear a mask, social distance tattooed on your foreheads at this point?

Allen:  Who says we don’t?

Miller.  Haha. All of that is obviously still in place. Are you asking people to do anything differently for the holidays because of Omicron?

Allen: I would say generally no but I think perhaps the intensity of the task gets a little bit more important because of what we don’t know. And in particular, I would say if you have vulnerable people in your family and by that I would mean especially seniors  with serious underlying conditions, those kinds of things. I think you should take what we are asking you to do just that much more seriously. I think that’s especially true about simple things like opening a couple of windows. If you’re going to have people inside, if you’re going to have a christmas party, 10 people is a lot better than 20 people. If you can do some things that you want to do outdoors in a covered space or something like that. I think people taking those kinds of things just a little bit more seriously. And again, it’s a little too late obviously for the holidays but get vaccinated. This is another reason for you, as you observed a minute ago, to choose to get you, your family members, your kids vaccinated because that does continue to help.

Miller:  Patrick Allen, thanks very much.

Allen: Thanks for having me.

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