Omicron largely evades immunity from past infection or two vaccine doses | Hacker News Reader

Omicron largely evades immunity from past infection or two vaccine doses

imperial.ac.uk

88 pointsdoener148 comments

It's worth clarifying: un-boosted vaccination or past infection seem to have greatly reduced ability to prevent infection with Omicron. There is still substantial (lessened, but not as drastically lessened) protection against serious illness / death.

My understanding is that protection-against-infection and protection-against-death rely on different aspects of the immune system. The primary protection against initial infection comes from antibodies, which are narrowly targeted. Other systems are more flexible, but don't kick in quickly enough to ward off a mild infection.

And the takeaway is still: get vaccinated, get boosted.

What you’re saying sounds correct, but is there any evidence that shows omicron is resulting in less serious illness/death because of the vaccines? The reports seem to indicate that the overall risk profile of omicron is lower including for unvaccinated people. Are we just parroting the same fact as for the alpha/delta variants without any substantial evidence here when we say vaccination helps avoid serious illness for omicron? Why would a variant which has apparently evolved to evade the vaccine continue to react to prior vaccination? We see the opposite with flu vaccines sometimes when vaccinations prime against the wrong strain.

give it a month or two and we'll see who's right or wrong

Hard information regarding serious illness / death from Omicron is scanty; it's still early. I've read indications that the vaccines (and/or previous infection with another variant, such as Delta) do seem to provide substantial protection against serious illness/death, but I don't have a link handy. IIRC at least some of the data we're working with is based on lab experiments of how various immune system components react to Omicron, which of course is less definitive than clinical outcomes, but is worth something.

> Why would a variant which has apparently evolved to evade the vaccine continue to react to prior vaccination?

This is over-simplified. In particular, "react to prior vaccination" is conflating a bunch of different things, involving antibodies, B cells, T cells, etc. My understanding is that (1) such data as we have seems to generally point toward protection-from-infection being badly eroded but protection-from-illness/death being only moderately eroded, (2) if you're boosted, protection is less badly eroded, (3) all of this seems to fit with our general understanding of how the immune system works. I don't have the domain knowledge to unpack that further.

Your argument boils down to “well the body learns what it looks like and so discriminates against similar looking viruses with more exposure allowing more targeted responses.” Under this theory, shouldn’t a natural immunity (as obtained from prior infection with alpha/delta) result in better immune response because it has learned “more” way to discriminate than the spike protein? Boosters seem inappropriate if the theory is to provide a wide database against which the immune system can check for similarities and associated response because they are targeted at the spike protein.

It might, but you don't want to get natural immunity because that would mean getting sick first.

Getting booster shots doesn't simply give you more antibodies, it gives you better ones; each round finds new ways to match the spike protein.

Can you provide a reference for this, as I thought the boosters were just the original vaccines, hence exactly the same antibodies.

Yesterday I read that the customised omicron specific boosters being developed by pfizer and moderna are not going ahead as the existing boosters are deemed good enough, though I can't find the link for that now.

They are the original vaccines. I suppose it works by giving your body another chance to study them.

Natural immunity followed by a single dose is the strongest immunity available supposedly. Many of us likely have cross reactive immunity from a previous Coronavirus infection from before the pandemic.

Regarding "better antibodies", that doesn't make any sense to me. More in number perhaps, but better? It's the exact same formula being given as boosters.

We train neural nets on the same training sets for multiple iterations and expect it to come up with new/better connections. When learning a new skill we may meditate on previously solved problems and discover better solutions. Why would the immune system not have the capability to continue experimenting and learning from the same stimulus?

Omicron does escape natural immunity + no booster though.

https://www.tandfonline.com/doi/full/10.1080/22221751.2021.2...

Similarly, immunity to omicron might not be good at the other variants (which are worse for you), which is why reusing the existing boosters instead of making new ones isn't that bad an idea.

I think your first sentence is a bit premature considering the study. Its forgivable to post this because it's so early but seriously, this was done in test tubes.

"One major caveat of the current study is that we used an in vitro assay system and the pseudotyped viruses but not the real viruses were used in the assay."

Two doses of Pfizer's vaccine reduce hospitalization risk from Omicron by ~70% based on data from South Africa, with similar reductions across all age cohorts from 18 to 79. https://www.linkedin.com/pulse/discovery-health-releases-cri...

I think it's more like, after a vaccination or infection you're now producing 20 different antibodies targeting different sites on the Covid spike. You start out producing high levels of the antibodies and less over time, but when you encounter the same virus you ramp up production of all 20 if your levels weren't high enough to prevent infection in the first place.

With Omicron maybe only few of those antibodies still work and not as well. That won't be enough to prevent infection. But you can still ramp up production of the ones that work after infection and your body has a good blue print, though the wonders of memory B cells and somatic hypermutation, to start work on more effective Omicron specific antibodies that makes the process easier than developing covid antibodies from scratch.

You're missing T-cells.

There's something on the order of 1,000 T-cell epitopes against spike, not just 20, and some of them are densely packed in areas of the spike protein that are highly conserved.

The spike is cleaved by proteosomes into small segments and those segments are attached to MHC-I in the ER and then shipped off to be expressed on the cell-surface to be identified by T-cell receptors. Those segments are long enough to be recgonized, but small enough that there's a ton of them (and since they're cleaved an no longer attached to the rest of the protein there's no steric hindering or conformation changes or any of that to worry about). And there's still about 80% overlap between Omicron and Delta/Wuhan-hu-1. That number will probably never get down to zero due to the highly conserved areas.

CD4+/CD8+ T-cells will therefore still be able to identify infected cells and lyse them or drag them back to have a discussion with some memory B-cells. That is where somatic hypermutation might be important since some of those antibodies will match Omicron's spike and those B-cells can then be amplified and you can get Omicron-specific antibodies being produced -- all without having to start entirely from scratch.

But its the CTLs that already identify the Omicron-infected cells which will do the bulk of responding to the virus and clearing the infection. This is also why we don't need to rush to update vaccines to be Omicron-specific or why neutralizing abs really matters that much at all (and if there's Original Antigenic Sin it really may not matter much at all since there may not be much Omicron-specific B-cell or Nabs response to an infection or variant-specific vaccination at all).

> SARS-CoV-2 human T cell epitopes: Adaptive immune response against COVID-19

> Over the past year, numerous studies in the peer reviewed and preprint literature have reported on the virological, epidemiological and clinical characteristics of the coronavirus, SARS-CoV-2. To date, 25 studies have investigated and identified SARS-CoV-2-derived T cell epitopes in humans. Here, we review these recent studies, how they were performed, and their findings. We review how epitopes identified throughout the SARS-CoV2 proteome reveal significant correlation between number of epitopes defined and size of the antigen provenance. We also report additional analysis of SARS-CoV-2 human CD4 and CD8 T cell epitope data compiled from these studies, identifying 1,400 different reported SARS-CoV-2 epitopes and revealing discrete immunodominant regions of the virus and epitopes that are more prevalently recognized. This remarkable breadth of epitope repertoire has implications for vaccine design, cross-reactivity, and immune escape by SARS-CoV-2 variants.

https://www.sciencedirect.com/science/article/pii/S193131282...

> There is still substantial (lessened, but not as drastically lessened) protection against serious illness / death.

My understanding so far is that the vaccine is much better at blunting the effects than preventing infection generally, even with "classic" COVID and delta.

In Ohio where I live the statistic so far has been that >90% of all hospitalized cases are unvaccinated, and of the ~10% who are vaccinated the majority have other conditions that boost risk of severe COVID such as being immunocompromised, diabetes, obesity, etc. There are very very few healthy vaccinated people in the hospital.

This, a million times.

Over here 80-90% of Covid patients in ICUs are either never vaccinated or in need of a boost because of too much time past since their 2nd shot. So, yes, vaccination may not prevent being infected, but for sure it helps immensely in avoiding being hospitalized and shortening the infection, which does actually translate in less people being infected. And believe me, having both lived and seen this with my own eyes, there's a world of difference between staying home 2-3 weeks with a strong cough and living 2 months in an ICU with chances of being carried out from there in a brown bag.

>So, yes, vaccination may not prevent being infected, but for sure it helps immensely in avoiding being hospitalized and shortening the infection, which does actually translate in less people being infected.

On the flip side, infections in the vaccinated who are asymptomatic are more likely to leave the house, simply because they have no idea that they're sick. Perhaps they end up at a restaurant with their mask off and turn into a literal super spreaders (if we're to believe Omicron is 4X more transmissable). This was always a potential problem with vaccines that only reduce symptoms and don't prevent transmission. If Omicron is indeed mild and highly contagious as officials in South Africa claim, this could be a huge issue with anyone vaccinated.

Transmissions and symptoms are roughly correlated through viral load.

The household attack rate of ultimately asymptomatic infections is much lower than ultimately symptomatic. The window for vaccinated people is also shorter since mRNA loads peak at about the same levels (where the entry criteria for the study was the same level of symptomology) but they decline faster and have less culturable, infectious virus for the same level of mRNA load.

And delta already spikes viral loads much, much higher in the presymptomatic phase of an infection (doesn't matter if its naive, breakthrough or reinfection) so that people are walking around spreading it before they know they have it. That ship already sailed.

Once someone is infected, then its better that they get less symptoms and less viral load / less shedding and that they're vaccinated.

Is there data about infection + two doses of vaccines against omicron? Scientists/Doctors in India have been claiming that's the best combination of protection one could have and if true that would cover significant chunk of our population.

There seems to be data from UK that two doses of type-X vaccine followed by a booster of type-Y vaccine being more effective against Omicron.

Different types of vaccines platforms being mRNA vaccines(Pfizer, Moderna etc.), Inactivated whole virus vaccines(CoVaxin,CoronaVac etc.), Pure DNA Vaccine(Zydus), DNA vector vaccines(Astrazenica/Covishield etc.) and upcoming protein subunit vaccines.

Does anyone understand why a third dose of the same vaccine improves immunity to Omicron?

I'm willing to believe the empirical evidence that boosters make a meaningful difference, but I can't figure out intuitively why the same mRNA a third time helps to address this new spike.

Maybe it is less about it being the 2nd or 3rd shot and more about how recently you received your last shot? I got my 2nd shot 7 months ago and we've already heard that protection fades over time, so maybe the booster just works because it boosts, not because it is really any different than my 2nd shot.

> Maybe is ... about how recently you received your last shot .. not because it is really any different than my 2nd shot.

No. That appears not be the situation. Immunity shortly after the thirds shot is substantially higher than shortly after the second

https://twitter.com/PaulMainwood/status/1460191035531878405

https://twitter.com/PaulMainwood/status/1458026852249919490

I have seen speculation that the second dose was given too quickly.

I wonder if that's a factor in the Pfizer/BioNTech vs Moderna performance. Moderna had a higher dosage, but it was also 4 weeks between doses instead of 3.

> but it was also 4 weeks between doses instead of 3.

YMMV. The UK gave out AZ and Pfizer. First at a 12 week interval, then shortened to 8 weeks.

Firstly, YMMV, different people got different separations of different vaccines. The US doing Pfizer 3 weeks apart was the fastest. The UK gave out AZ and Pfizer. First at a 12 week interval, then shortened to 8 weeks

The question is: too quickly for what? My understanding is that

a) If the goal was optimal immunity in the longer term then yes, it might be overly quick.

b) But if the goal was fighting the raging pandemic that needed urgent actions right now as "the house is on fire", and you have a lot of vaccine doses, then no, maybe not too fast.

Finally, a lot of vaccine courses require more than 2 doses, separated by more than a couple of months. UK standard childhood vaccination schedule for instance. "Polio" is in there 5 times. Polio is a memory, but only because because to this day they don't mess around with vaccinating against it

Agreed, I was only referencing a.

If you assume an unlimited supply of vaccine then the shorter dose interval gets everybody to good level of sterilizing immunity as quickly as possible.

Yep. if you need to fight against a raging pandemic, then quickly as possible (as quickly as is tested to be safe, quickly as makes a significant difference) is the over-riding concern.

That implies we thought about it in the US, but we didn't really, and our public health people seem to be completely inflexible about everything. The schedule we used for vaccines is just what was done for their trials.

> The schedule we used for vaccines is just what was done for their trials.

There is a reason for that - what's being deployed is what has been tested. You could work out an optimal schedule, but that might take years of trials, and meanwhile people are dying.

Other countries stretched them out and saw positive results.

Given how quickly the virus mutates, giving it less frequently makes even less sense.

My response was with respect to maximizing immuno response following vaccination. There is some evidence that larger spacing between doses increases response.

I am not an immunologist, but I imagine repeated infection is a signal to the body to build and expand immunity to the virus.

Is it not just timing? I thought the effectiveness of the vaccines only lasted around 6 months. In the US 18+ were able to get it 7 or 8 months ago.

Vaccines can last your entire lifetime, but their effectiveness decays over time it largely depends on the disease and your risk of infection. Booster shots for various vaccines have been common for example, it’s recommended people take a Tdap booster every 10 years, Tetanus every 4-6 etc.

The flu vaccine is a special case as it’s changed every year.

The 'T' in Tdap stands for tetanus

Yes, though to be clear your supposed to get a both.

“It is recommended that adults get a Tdap shot for one of their tetanus boosters.” https://www.verywellhealth.com/booster-shots-1298291

It simply reduces the number of injections when you get multiple vaccines at the same time.

In the original use of the vaccina virus against variola (smallpox) infection, symptomatic smallpox could present after vaccina exposoure of at least five years past.

https://en.wikipedia.org/wiki/Smallpox#Prevention

"Smallpox vaccination provides a high level of immunity for three to five years and decreasing immunity thereafter. If a person is vaccinated again later, the immunity lasts even longer. Studies of smallpox cases in Europe in the 1950s and 1960s demonstrated that the fatality rate among persons vaccinated less than 10 years before exposure was 1.3 percent; it was 7 percent among those vaccinated 11 to 20 years prior, and 11 percent among those vaccinated 20 or more years before infection. By contrast, 52 percent of unvaccinated persons died."

My understanding is that they've studied people with 2 vs. 3 shots, both groups having received their most recent shot in a similar timeframe to account for that.

> Is it not just timing? I thought the effectiveness of the vaccines only lasted around 6 months

No, it is not (just) timing.

"Three doses gives better protection than two doses ever did" (1)

Immune response is very complex (2) and we're not experts; but we should not measure it in just 1 number: that gives the impression that the response is a range from "high alert for this recent threat" through to "threat forgotten" - effectiveness did not last that long.

There are there are other states as well when the threat is "on file" in the immune memory. Another exposure months later influences this process. My guess is that the evolved heuristic is that "a threat that recurs more is worth remembering better".

1) https://twitter.com/PaulMainwood/status/1460191035531878405

2) https://www.theatlantic.com/health/archive/2020/08/covid-19-...

3) https://www.theatlantic.com/science/archive/2021/09/waning-i...

One of the theories is that the booster raises the levels of neutralizing antibodies. While the antibodies against the original strain don't work as well against Omicron, having more of them does help.

Mutations in spike proteins don’t completely change it’s shape so they render a percentage of antibodies infective vs that specific strain. A boosted immune response can therefore be less efficient but still useful.

To simplify, Vaccines provide long term protection because the immune system builds infrastructure to rapidly create antibodies after infection cutting days off of the immune response. That’s huge because the virus has less time to replicate in your body. Vaccines use multiple injections to increase how much infrastructure is built and the number of types of antibodies being produced. Also this infrastructure decays over time if you never see the strain again.

However, in the short term your body reacts like it’s infected actually flooding the body with the appropriate antibodies. This isn’t sustainable but can crush most infections before they go anywhere. Kind of a bonus turbo mode which can be really helpful if your say going to treat people infected with the disease.

Because of the way your immune system works. Vaccines aren't medicine, they work by provoking an immune response. What happens after that immune response is triggered is way more complicated than just "molecule X get response Y", there are multiple stages of responses, and the deeper, longer span ones create a resilience against mutations as well.

It is extremely common for a proper vaccination regimen to require multiple doses, and it has entirely to do with how the immune system works.

> Does anyone understand why a third dose of the same vaccine improves immunity to Omicron?

From what I've read, 2 doses in 8-12 weeks is a small separation, as these things go.

A third dose 6 months after the second is not just a third revision of the lesson (metaphorically), but a more appropriate spacing to re-enforce it.

From what I understand it is about affinity maturation. Basically, when you get an initial vaccine (or infection) your immune system learns how to recognize the antigen (the virus spike protein) and produces a bunch of antibodies to recognize it. But your immune system also preserves the spike protein in antigen presenting cells so it can continue to produce antibodies to recognize more features of the spike protein. Over time, your immune system learns how to produce a broader range of antibodies that are (in aggregate) more likely to recognize partially mutated versions of the antigen. That's the affinity maturation part.

So when you get a booster (or a breakthrough infection) your immune system kicks into gear again but now it produces a broader range of antibodies. In addition the number of antibodies produced from the booster is quantitatively much larger than from the first vaccine. So with a booster you end up with more antibodies but also a larger variety of antibodies that can recognize different features of the spike protein (including features that are consistent between variants).

That's my understand at least but I am not an immunologist.

> So when you get a booster (or a breakthrough infection) your immune system kicks into gear again but now it produces a broader range of antibodies.

Would/could it not also be the case for exposure to the virus that doesn't result in a breakthrough infection i.e. the body detects it and fights it off successfully? (I daresay you didn't mean to imply that, just checking.)

I would assume so but it probably depends on the "level" of exposure and such.

From what I understand, the immune system has some capacity to anticipate mutations. The most basic function of antibodies is to stick to and neutralize the target, in this case the spike protein that the mRNA vaccine presents to the immune system via producing some copies in muscle cells. But the immune system doesn't just produce exact form-fitting duplicate antibodies, it also has something like a biological "fuzzer" that also produces antibodies to target anticipated mutations to its main target, the spike protein. Each time this system gets stimulated, it not only makes more antibodies and more memory cells to produce them, it also runs some more anticipatory mutations. So in aggregate, hopefully the increased quantity plus maturation of these various antibody tweaks produce enough antibodies that stick well enough to the virus to incapacitate or slow it down so that the other aspects of the immune system have time to react instead of getting overwhelmed. And it makes sense to have an antibody arms race like this since viruses mutate so fast. Obviously, this doesn't always work and viruses frequently out-mutate the immune memory, but the immune system is pretty smart.

By the way, if there are any actual scientists here that spot some atrocious mistake I've made describing this, please let me know. I find it really interesting to learn about but I'm certainly no expert.

Unfortunately as a result of original antigenic sin, the fact that the immune system has been trained for by a vaccine for a certain strain means that the body will respond to that strain, likely unable to mount a new defence for the different strain.

https://pubmed.ncbi.nlm.nih.gov/33692194/

Virologist are aware of this but I seen no indication that it applies to the CoVi variants we are currently dealing with.

After exposure to a pathogen the levels your body starts evolving antibodies against it. It also quickly ramps up antibody production, but ramps that down over time without additional exposure.

Having had a more recent jab will mean a higher quantities of antibodies. But more vaccinations also means your body has done more cycles of evolving better targeted antibodies against the threat. I assume that there's a certain level of diminishing return to the second factor, as well as questions about how much the extra work translates against a new variant. But the second effect exists alongside the first.

The CEO of BioNTech said they don't know for sure but speculated that memory B cells may keep hypermutating after a third shot which could result in the improved effectiveness against Omicron. Or that's what I understood with my very rudimentary knowledge of biology.

And no one is talking about whether we will be expected to take a fourth and subsequent

No-one really knows that yet. Novel virus is new.

If I had to guess, I would expect another anti-COVID jab in 2022. I expect 1 injection in 2022, maybe in autumn, of a mRNA vaccine, against a strain such as Omicron, that is not original COVID-19-alpha. Not a firm prediction, just a guess at what's IMHO most likely.

From the article: this translates into vaccine effectiveness estimates against symptomatic Omicron infection of between 0% and 20% after two doses, and between 55% and 80% after a booster dose

What I'm wondering is: Is this due to the timing of a booster, since most boosters have been given in the last few months? Or is there some kind of cumulative impact on the immune system?

Eg, If I got a booster early, am I still as protected as they state above?

Another question would be, what if someone got their first dose 6 weeks ago and their second one 2 weeks ago?

Maybe recency is not the sole factor: https://i.imgur.com/OzznuBa.png

edit: source: https://www.medrxiv.org/content/10.1101/2021.12.14.21267769v...

No one is going to trust a random imgur link. Source or it didn't happen

Or, another hypothesis, your immune system is busy dealing with the vaccine and just ignores the omicron virus in your noes and this stops the spread?

The booster dose increases antibody titers significantly above what they were after the second dose (or first in the case of J&J) so someone who is boosted should be more protected than someone who got their second dose at the same time. Additionally, through the process of affinity maturation, the antibodies you have after a booster will be more likely to recognize Omicron because your immune system has learned to recognize more features of the virus spike protein and is more robust to mutations.

This news came out shortly after the UK mandated proof of two vaccine doses (or a negative test, though there's some suspicion this option will be removed like in many other European countries) for access to nightclubs and other large events. It is also not surprising and was expected when the decision was taken. Between this and other recent news I don't think trust in the establishment is exactly high right now.

The sooner they mandate a third does the better. Not sure why this news would lower trust in the government, can you elaborate on that?

Because the promises aren't panning out, and with each stutter step comes another heavy handed proposal (e.g., tracking, vax passports, etc.)

In desperation the public has abandoned "trust but verify." Put another way, given the lessons of history, governments should be trusted less, not more. The default shouldn't not be, "Sure, whatever you say."

Governments are adapting to new information. If you expect government policy to be based on an all-knowing oracle, of course you are going to be disappointed.

If I said that. If I implied that. Please point it out to me.

It's implied by "government promises". What has your government promised wrt covid? Were such failed promises made in bad faith, or due to the fact that covid is a complex and changing global pandemic without clear answers to anyone?

It's not what's said, but what's also said.

https://apnews.com/article/coronavirus-pandemic-science-heal...

The current cycle smells like insanity among other things. There are plenty of questions. "What questions?" is not one of them.

Governments are not known to relinquish control once a new baseline of normal is established... so it does seem that they are adapting to new information only when it serves a certain agenda.

Mask and other mandates from the Spanish flu era were relinquished once they were no longer needed. Interestingly, paranoia about such things was as common (and wrong) back then at it is now.

I can only talk for my own country but politicians seem to have been really careful to either couple the laws to an state of emergency which is justified by the pandemic situation or do laws which have a certain due date and need to be renewed by Parlament every 6 monthish.

Unlike national security against an invisible threat the absence of CoViD can be shown in which case government even if showing the behaviour you suggest can be more easily pressured into doing the right thing.

So they "mandate" a third dose, nothing happens long term, so they do a fourth lockdown, close some businesses again, do some travel bans, tell people to put things on their faces, nothing happens long term, so they "mandate" a fourth dose, do a fourth lockdown...

And then the virus is still everywhere, it's still significantly more dangerous to be outside than it was in February 2020, and now it's a tremendous administrative pain in the arse to do everything, everyone is terrified due to your big marketing campaign, and we all get it anyway repeatedly.

But this time, of course, it'll be different.

> everyone is terrified due to your big marketing campaign

Yeah, a lot of people dying tends to terrify people.

The data has only trended in one direction since the beginning. The response continues to trend in exactly the opposite direction.

This is increasing apparent with Omicron.

It's suspicious when "the science" suddenly aligns with long standing political dictates. That doesn't mean that it is wrong but certainly is justification for a heavy dose of additional skepticism. Governments have been especially flustered by naturally acquired immunity and now "the science" gives them what they have long desired to be able to dismiss natural immunity. That doesn't mean that "the science" is wrong but it sure is suspicious how often politics proceeds science when throughout most of history, it has reacted to it instead.

Omicron will do what it is going to do regardless of what "the science" or politicians have to say on the matter but politicians and those involved with "the science" have no one to blame but themselves for the public skepticism after they've indulged in many "noble" lies and misleading statements throughout the pandemic. The gaslighting after they're called out on previous lies or poorly thought out promises and predictions don't help either. Maybe they can try out "I was wrong" for once and get some of the credibility back instead of constructing even more elaborate excuses for their failures.

Anecdotal but I currently have Omicron. I had COVID in March 2021 and got vaccinated in September. I have no symptom except back pain.

Get well soon! <3

While anecdotal data isn’t very useful, it is good to remember that people actually do get this disease. It seems like it’s always at arms length in online discussions; that someone else will get it surely, probably due to some implied moral failing, but not OP. Thanks for sharing and I hope you get better soon.

> good to remember that people actually do get this disease.

Why does it continue to be significantly important to call this out when the trajectory places Omicron and possible future variants within the realms of cold/flu ?

To remember that normal people from our own social circles get infected and usually survive just fine. Rather than pretending that every infection is an overweight, anti-vaxxer, etc. who dies immediately after destroying the local medical facilities. I think both sides of the severity discussion would benefit from keeping the human consequences in mind, whether they are more or less severe than imagined.

Agreed, yet at some point society has to be productive again. Living in constant anxiety will ultimately be more destructive than the disease everyone fears if it has not already.

I actually completely agree. COVID is endemic so now we’re just prolonging the inevitable getting-on-with-it and the only question is how much damage we do pretending otherwise.

> and possible future variants within the realms of cold/flu ?

Delta was already "within the realms of" the flu. Omicron so far appears to have shot past that and is on its way to a cold.

I'm not sure it's really considered a moral failing here in the UK, everyone gets it unless they're barricaded inside.

The official Government stats claim that over 15% have had a confirmed positive test at this point[1], I'd be surprised if the reality weren't over half.

Half of my friendship group currently have it (no idea whether it's Omicron or not, but, well, probably).

[1] https://coronavirus.data.gov.uk 11.2M positive tests/67M population makes 16.7%

Keep us posted, and hope you feel better soon xoxo

I'm fighting it right now myself. Have my initial vaccines and got my booster about a month and a half ago. First two days were terrible, but now it just feels like a cold. What I can't handle is the brain fog. I've been awake enough to do some last minute code reviews for people before we start the Christmas shutdown and they have taken me double/triple the amount of time they usually take me. Answers to questions don't come as fast, etc. I really hope the fog clears up soon, it's pretty demoralizing for me right now.

Both me and my wife are fighting it right now, confirmed via PCR testing. Started as cold like symptoms, but a cold I've never experienced before. Unless I keep up the paracetamol it's unbearable... Not much of a cough for me, but my head is spinning and it's hard to focus on anything.

Lost all sense of taste and smell too.

It's not fun people. We are both fully vaccinated.

I know I'll catch grief for this but ivermectin will clear it up very quickly and is your best bet against letting it morph into long covid.

We experienced a 100% infection rate super-spreader event in our circle of four close friends last weekend. A husband in our group traveled for work last week and by end of the week was sick and clearly showing symptoms. His wife felt fine and the rest of our wives still decided to go out for the long-ago planed dinner/drinks Saturday night. To make matters worse they decided to car pool into one SUV. These are all fully vaccinated and boosted adults. My son also went into car (vaccinated) for short ride to babysitter. By Monday my wife and another one of the wives was feeling symptoms. Tuesday my son stayed home from school with sore throat and by bedtime we were rushing him to the hospital with a 103 fever. He tested positive while at the hospital. Since then every single person in that car has also tested positive through PCR.

I thought I escaped it by isolating from my wife/son in our home but I started to show early symptoms Wednesday morning waking up with splitting headache. I went and got tested that afternoon. By Thursday night I was having itchy throat, chills, fatigue and body aches. Feeling pretty crappy and a crazy symptom I also have been having is uncontrollable hiccups past 24 hours that come and go.

The test I took Wednesday came back negative but the OTC Rapid I did today was positive. I am going for another PCR tomorrow to confirm as the first one was done possibly too early after exposure with no symptoms.

IF this is the Omicron that went through our vaccinated group like butter, we are going to be in a very bad spot by mid-january.

Here's some numbers from 15 December in Denmark, relating to Omicron infections:

76,93% of the poulation are vaccinated.

Of Omicron positive cases 89,59% were either double or triple vaccinated. 8,49% were unvaccinated.

Why are the unvaccinated underrepresented?

Source: https://www.dr.dk/nyheder/indland/status-paa-coronavirus-lig...

Realistically we are probably going to be exposed to Omicron in the next 3 weeks here in the UK, is there much point in having a booster right now? Are we sure that it will actually be providing protection if I got a booster today and got COVID in, say, the next 7 days?

Probably some, if not the full amount.

Sure. The effectiveness of the vaccine rises over time, which means you will have some protection even after a few days. And the vaccine also protects against serious illness, so if you get covid in 7 days you might be wishing for lighter symptoms about a week after that. Basically, getting your immune system any amount of head start would be great.

I’m sure if you got COVID a few days after you’d be protected you’d be kicking yourself. I got mine yesterday after booking on Monday so you might be able to get it sooner than you think. I didn’t even take the first day available due to a conflict.

I took the Moderna booster.

In my case, I had fatigue and cramps within 24 hours (not as bad as the 2nd dose, but felt worse than the 1st dose). Clearly, my immune system was responding immediately.

The stats say I'm not fully protected until 2-weeks later. But I know for a fact that my body was reacting within a day.

Yes, get it ASAP. You should not assume that you'll get it that soon and therefore it's pointless even if many many people will. The booster also triggers a secondary immune response which rises faster and bigger than the primary response. Get your boosters ASAP!

You want to go into this crisis with shields up, weapons online.

I was going to get my UK booster yesterday, but came down with COVID on Tuesday :(

Yeah feeling pretty ill right now.

Rescheduled booster for early Jan, so hopefully that'll mean my immune system will be ready for any future infections.

Get well soon! I'm sorry that happened to you! <3

For other people reading, make sure you wear an N95 to your vaccination appointment! If there are long lines or people not following the rules, it can make sure you get your shot safely. <3

Past spikes in infection have played out over many weeks, so you'd probably still be fully boosted for most of the wave. From the article: "this translates into vaccine effectiveness estimates against symptomatic Omicron infection of between 0% and 20% after two doses, and between 55% and 80% after a booster dose."

Also important to note:

The study finds no evidence of Omicron having lower severity than Delta, judged by either the proportion of people testing positive who report symptoms, or by the proportion of cases seeking hospital care after infection.

With the qualification:

However, hospitalisation data remains very limited at this time.

So, hopefully this proves to not be the case. Given the speed at which this variant appears to be ripping through the UK—with cases doubling every ~48 hours—it could quickly cause quite a lot of pressure on the healthcare system – not to mention the knock-on effects of so many people isolating.

Not really a new finding. Norway's curve gives a decent hint at where we're heading to.

What about both? I have both past infection and I'm double vaxxed. Based on the data, should I get boosted?

From what I'm reading the answer is yes but does anybody have an estimation of my protection right now?

It is called hybrid immunity and it is much longer lasting

https://www.news-medical.net/news/20211202/Hybrid-immunity-p...

"The overall protection provided by two doses of ChAdOX1 was considerably lower than that given by BNT162b2. However, infection-acquired immunity boosted with vaccination-induced immunity remained high over a year after infection. Based on these observations, the authors recommend the strategic use of booster vaccines to prevent SARS-CoV-2 infection and transmission in the population."

Is there any indication if double-vax + exposure carries similar benefit?

My wife had 2x Pfizer and then she and our kids got delta. I had 2x Moderna and never had symptoms and tested negative 3 times. No quarantining whatsoever -- slept in the same bed as my wife, the kids still crawled all over me. I still got boosted a few weeks ago, but I've been curious if living in a sick-house with 100% certainty of exposure would carry its own booster effect.

What do you have to loose?

Well I had a pretty bad second dose response. I was bedridden for a week. That said, my COVID infection was far worse and I'm still struggling with long COVID today.

I guess I'm going to have trouble taking a shot (active decision) I know I'll respond badly, albeit temporarily, to. As opposed to waiting around (passive decision) and trying my chances with COVID a second time.

Now that I'm writing this all out, I think I'll get my booster, maybe a fourth if I can weasel my way in.

You might not have a strong reaction this time. Hard to tell.

I would still go for it and just make some arrangements just in case it’s a tough ride.

Omg I have this garbage right now and I'm doubly vaccinated. I recommend anyone visiting vulnerable family get tested before heading out. It's going to be a very weird NYE, again.

I didn't download the full report (pdf) but this news (?) article and the link to source (in the first line) don't mention sample size.

What happens when it mutates again? Do we need to keep society shut down and enforce a booster for each variant?

Possibly. It depends on how it mutates.

It's either that or everyone openly accepts the ensuing suffering and death as an acceptable tradeoff.

Neither are particularly great options, but nobody said life was guaranteed to be easy or simple.

Has there been any studies if switching vaccines for the booster is more effective or less effective?

When the CDC released the statement that you could mix, my dad (a physician) was a bit upset. I remember him telling me that they seem to have based that on a single paper that had a sample size far too small to generalize for the different combinations of vaccines, age groups, genders, and races.

So like a common cold?

for vaccinated people yes. unless you're really compromised or unlucky. then its near death or a death experience.

If it evades immunity from past infection isn’t it a different virus in the practical sense?

Note that the same vaccines are still effective against omicron, just less than against delta.

It's also still a coronavirus that binds to ACE2, it's the same mechanism with several new mutations.

Well, since the booster seems to protect, no?

I am hoping that Omicron will boost immunity versus delta while being more mild. This makes me suspect that this will be the case: https://abcnews.go.com/Health/wireStory/omicron-dominant-was...

"Even though there have been practically no cases of clinical infection, wastewater samples show that the new omicron variant is now the dominant strain of COVID-19 in the Florida county that is home to the nation's largest theme park resorts, officials said this week."

> Well, since the booster seems to protect, no?

That hasn't been proven, as far as I know. Pfizer did some in vitro study but we still have no idea if that translates to real world results.

That is an accurate statement I believe. However, given it is the only available evidence we have, it is probably the most accurate prediction that we have, so let's call it our prior.

From the article this thread is about (italics emphasis added by me):

> The researchers found a significantly increased risk of developing a symptomatic Omicron case compared to Delta for those who were two or more weeks past their second vaccine dose, and two or more weeks past their booster dose (for AstraZeneca and Pfizer vaccines).

> Depending on the estimates used for vaccine effectiveness against symptomatic infection from the Delta variant, this translates into vaccine effectiveness estimates against symptomatic Omicron infection of between 0% and 20% after two doses, and between 55% and 80% after a booster dose. Similar estimates were obtained using genotype data, albeit with greater uncertainty.

I wonder if they saw more traces from the theme park wastewater...

Business idea: device that you plug to your home wastewater output, scans it, and reports to you anything interesting.

Of course it'd need to be connected to the cloud and have a stupid subscription fee. /s . At least then "Internet of Shit" will apply to the name non-sarcastically.

You’re late to the party. Smart toilet, identifies you by looking at your butthole https://www.vice.com/en/article/jge377/stanford-smart-toilet...

Unfortunately, the mutation differences between Delta and Omicron are more significant than from the early Alpha/Beta which it appears to be more related.

https://nextstrain.org/ncov/gisaid/global (see B1.1.529)

It's fitness is driven (in South Africa) largely by the ability to avoid Delta immunity, where a majority of the population has already had that.

Whether Omicron is more mild or not seems still up in the air. Saying that it is more mild in Southern Africa (or a theme park?) where the average age is in the mid 20s (rather than 38 for the whole US) isn't all that relevant since we know symptomatic illness falls more than an order of magnitude between those two.

That said, I've been expecting COVID immunity in the US to look something like Pfizer-Pfizer-Delta-Omicron-Omega since it was clear that we couldn't get more that 60% vaccination. The goal should be keeping the hospitals available for actual catastrophic accidents (heart attacks, car accidents, ladders) rather than complex suicide lottery attempts.

Frankly, at this point it's a choice. You can be a rude nudist/antimasker, a filthy contagion/antivaxer who will spread disease or you can be a regular human who goes about their life. Other than the old/infirm we don't need to protect people from their (bad) decisions any more. I'm glad I'm not immune compromised, 80 years old, or caring for a very young child... it would suck!

Biological taxonomy is largely arbitrary. From a practical perspective it has very similar characteristics, so not much is gained from distinguishing it.

Not really, evasion is a continuum rather than a binary distinction. So Omicron seems like it evades immunity acquired from infection with previous variants or vaccines to a certain degree, but from what I have read with vaccine + booster you are still ~60-80% protected from symptomatic infection and almost entirely protected from severe outcomes.

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