Now is a very important time for myeloma patients in particular, but for everyone else as well, to stay safe. There is a major surge of the Delta variant across the U.S. and an emerging threat from the Omicron variant. Making sense of the avalanche of new information is definitely a challenge. The fact that the Omicron variant originated in South Africa has brought into sharp focus the global nature of the COVID-19 pandemic.
What’s going on in South Africa?
The world should be very grateful for the excellent sequencing detective work conducted in South Africa. Dr. Tulio de Oliveira, Principal Investigator for the National Genetic Monitoring Network, has been tracking COVID-19 mutations since the start of the pandemic, the New York Times reports. Last year, he sequenced a COVID-19 sample from a 36-year-old woman with HIV. The sample revealed 32 different mutations. He realized that the woman had been on ineffective treatment for HIV and it took 216 days (over 7 months) to clear COVID from her system.
In November, Dr. de Oliveira tracked another sample with many, many mutations to another patient who was on inadequate treatment for HIV and had been fighting COVID for many months. By this point, there were more reports of the same phenomenon: poor immunity of HIV patients allowing COVID-19 to grow and mutate month after month.
In South Africa, there are 8 million people with HIV, of which maybe half are on adequate therapy. Importantly, the risk of severe disease or death from COVID is only increased by 1.7 times versus 30 times for diabetes or obesity or advanced age. This means that as the patients with HIV fight off COVID, especially when adequate treatment is resumed, there is an enormous opportunity for the development of mutations, including among those who have been vaccinated. The end result is heavily mutated COVID-19 variants that may also evade vaccination.
Clearly, helping vulnerable and immune-compromised communities globally must be a top priority. It is a humanitarian must, as well as an essential step in containing the global pandemic.
Implications for myeloma patients and the global community
The heavily mutated COVID-19 variants emerge selectively in patients fighting less severe disease (not life-threatening lung disease, etc.) over a period of months, then recovering. The dramatic increase in Omicron cases in South Africa and now elsewhere has established that the variant is highly transmissible — estimates are two times more transmissible than the notorious Delta variant.
The extremely rapid global spread of Omicron has triggered alarms around the world. But how do we react to this new virus, which does not seem to have the dire consequences of the Delta variant?
Laurie Garrett, the Pulitzer Prize-winning author of "The Coming Plague," notes that vaccinating and caring for the vulnerable on a global basis is mandatory to prevent an inevitable ongoing emergence of new mutated strains.
Difficulties in tracking Omicron
Because the symptoms of Omicron appear to be mild or non-existent, tracking is difficult. Interest is focused on symptomatic or hospitalized patients, who are predominantly infected with the Delta variant. In South Africa, COVID testing of children hospitalized for other reasons has revealed a very high level of positivity for the Omicron variant. Fortunately, only one child (so far) with pneumonia has required oxygen treatment.
In the U.S., since testing is really focused on those who are symptomatic, it is hard to know the true spread of Omicron. However, Omicron testing of wastewater in the Central Valley of California has revealed significant Omicron in several counties, including Sacramento and Merced Counties. The real concern is that a majority of initial Omicron-positive cases have been in younger, healthy individuals versus older or vulnerable groups in whom more severe disease could develop.
As I have mentioned before, the good news is that vaccination boosters really do help in raising anti-COVID antibodies to an active and effective range. Pfizer has just announced that the booster does provide added protection against Omicron. There is even talk now of a fourth dose to better combat the Omicron variant. (The initial recommendation is a fourth dose 12 months after the third dose but may be recommended even sooner.) There is also good news that boosters have been approved for 16- to 17-year-olds, which both protects them and those around them.
So, recommendations for myeloma patients remain the same:
- Get a booster shot
- Continue to wear a mask in all situations of risk
- Be especially cautious about both travel and any types of group gatherings, even if individuals have tested negative in recent days
Looking for joy
As we approach the holiday season, we all need to look for joy in our lives. After reading about the release of the new version of “West Side Story,” I wanted to download the soundtrack to hear wonderful songs like “Somewhere (There’s a Place for Us).” But what popped up first was “Somewhere (Over the Rainbow)” and I vividly remembered “The Wizard of Oz” and the wonderful rendition by Israel Kamakawiwo’ole, the Hawaiian singer.
We all need to be focused on our own personal rainbows and positive expectations for the holidays and for 2022. There is so much to be grateful for and so much we can do to support those truly in need.
Wishing everyone the very best as we stay informed and safe in the weeks and months ahead!
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