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Treat Omicron Like a Bad Cold? It’s More Complicated

The severity of each case is often based on a person’s vaccination status, their age and overall health. But even then there are unknowns.

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(TNS) - The COVID-19 patients continue to stream into Holy Name, just as they have for the past month.

They’re not as sick on average as they were in earlier waves of the pandemic. But they keep coming, some struggling to breathe and further straining an already exhausted health care workforce.

The Teaneck hospital is among many New Jersey medical facilities managing the large and steady flow of coronavirus patients since Thanksgiving. It isn’t overwhelmed. But the flood of sick people has kept workers in a constant state of vigilance for weeks, said Dr. Suraj Saggar, Holy Name’s chief of infectious disease.

“We don’t see as many patients with the same acuity that we saw in the first phases of COVID,” he said. “And we’re not seeing as much ICU admissions. But we’re certainly seeing hospital admissions.”

But what about all those people whose bouts with the omicron variant amounted to nothing more than a bad cold? What about those who didn’t get sick at all?

The variant is presenting differing realities in the latest wave of the pandemic.

On one hand, the highly contagious strain is driving a record number of infections and stressing hospitals as well as doctors and nurses.

On the other, the new variant causes milder illness in general, with plenty of those infected having cold-like symptoms or none at all.

So why don’t we treat omicron like a cold? How much do people really need to worry?

There is no simple answer, experts say.

The severity of each case is often based on a person’s vaccination status, their age and overall health. But even then, there are unknowns. Although many intensive care patients — and those who succumb to the virus — are older or have underlying health conditions, that’s not always the case.

“On average, yes, omicron seems to be milder. That’s not true for everyone,” said Stephanie Silvera, an infectious disease expert and professor at Montclair State University. “And so I think the message that, ‘Well, it would just be a bad cold,’ can be dangerous.”

Many in the state still have not been immunized. For them, omicron is just as threatening as other variants and can result in severe illness.

“It’s more than a bad cold for the unvaccinated,” said Dr. Reynold Panettieri, vice chancellor for translational medicine and science at Rutgers University.

New Jersey has reported 679 confirmed COVID-19 deaths just this month. While officials stress that fatalities are sometimes delayed for days or weeks as deaths are investigated and certified, the large majority of January’s deceased were likely infected with omicron.

Meanwhile, 5,933 patients across the state are hospitalized with the coronavirus — the most since the spring of 2020 — including 907 in intensive care and 547 on ventilators as of Wednesday night.

“They’re experiencing respiratory failure. And that’s quite severe,” Panettieri said. “The chance for death there is high.”

Yet for others — especially the vaccinated and boosted — omicron can show up as something akin to a bad cold.

We could be catching a glimpse of how the virus is expected to shift and eventually become endemic in the state and country, just like influenza, experts say.

Even with the nation gradually moving toward handling COVID-19 in that fashion, Panettieri and other experts believe it’s dangerous to equate omicron with those illnesses.

“It’s real important that we’re not complacent with regard to recognizing that omicron, while (it) may result in less severe illnesses that result in less hospitalizations and less deaths in comparison to other variants, we have to still maintain our high level of vaccination to try to keep up protection in the community,” said state epidemiologist Dr. Tina Tan on Monday at Gov. Phil Murphy’s weekly coronavirus briefing.

“We know that also, now, that omicron has some level of evasion of immunity, particularly related to more severe illnesses. That’s why, again, it gets back to us just taking all of our preventive measures.”

Public health officials are more aware than ever of the importance of clear and honest messaging. But public health and nuance have never mixed well, as the pandemic once again has illustrated. While omicron has produced milder illness in general — especially among the vaccinated and the young compared with other variants — the strain remains a perilous threat to the unvaccinated and other vulnerable groups.

And experts say they are not ready to compare the coronavirus — responsible for nearly 30,000 deaths in just 22 months in New Jersey — to a mere nuisance illness.

Silvera said it’s important to look at the situation from a perspective of subpopulations, not averages.

“We’re seeing people who are being hospitalized, so we have to sort of stratify the risk by: Are you vaccinated? Are you partially vaccinated? Are you fully vaccinated? Are you boosted? That has a big impact on how you experience omicron.”

The variant is highly transmissible, driving up the number of infections — regardless of severity — and stretching the hospital system to its limits, which along with fatalities has been the biggest concern from the start.

While omicron may present as a cold for many, the nearly 1,000 New Jersey residents in intensive care, with more than half on ventilators, show the variant remains very much a threat.

“So the idea of, ‘Well, it’s mild for everybody’ is not holding up,” Silvera said. “And so I think we need to be really careful about what the message is in terms of: It’s mild for who?”

To call omicron merely a bad cold lacks important distinctions — and those distinctions can mean life or death for many people, experts say.

Health officials worry that equating omicron to a bad cold will suddenly make the virus nothing more than that in the eyes of the public. So people won’t get vaccinated or boosted. And more will fall ill and end up in the ICU.

“It ignores the nuance of who is more likely to get sick,” Silvera said. “And so if you say, on average this is milder, well then people who are not vaccinated are going to say, ‘Well then why should I get vaccinated?’”

Meanwhile, breakthrough infections among the vaccinated are far from rare, Panettieri pointed out. And so much remains unknown about the impact of breakthrough cases — and how the virus impacts people in the long term.

“The vaccinated people are having breakthrough infections, there’s no doubt about it,” Panettieri said. “So what we don’t know — and this is the important point — is what’s the consequence of a breakthrough infection?”

There also have been reports of children who contract the virus developing diabetes, he said.

“And we don’t know whether breakthrough infections will lead to long-hauler syndrome,” Panettieri said.

While it’s expected that the state will get past the current surge in a few weeks, there is no single metric that will tell us when the virus will become endemic. It’s going to be a gradual process.

“I don’t know that there’s a specific number,” Silvera said.

That said, the transmission rate has always been critical.

“I tend to think of it as when the rate of transmission is consistently below 1.0. Then we can think that this is something that is under control,” she said. “It needs to stay that way.”

When we finally get past this surge, what happens then? How will we know when the pandemic has taken a turn permanently (provided yet another variant does not emerge)?

“The question is, how bad does it get during those peaks, and how can we keep the hospitalization rates lower?” Silvera said.

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Spencer Kent may be reached at skent@njadvancemedia.com.

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Resilience