Covid: ‘Those who don’t have immunity to vaccination become a variant factory’

The discovery of the omicron variant in South Africa in late November raised new questions about the pandemic around the world.

Its emergence also comes at a time when half the world is vaccinated, even with booster doses, and the other half has low or very low inoculation rates.

Dr. John Swartzberg, professor emeritus in the chair of infectious diseases and vaccination at the University of California at Berkeley, in the United States, argues that he has not been able to obtain massive vaccination worldwide, either due to lack of access to doses in some countries, in addition to rejection of immunization in others generates millions of viral factories, one for each of these individuals.

They will be the ones who produce the next variant of the coronavirus, says Swartzberg.

The specialist believes that, in addition, the Northern hemisphere could suffer in the coming weeks what he calls “tridemia”, that is, three pandemics at the same time, and he believes that the variant that will appear in the world after the omicron will be one that will transform the Sars-CoV-2 from a pandemic to an endemic.
Below are the main excerpts from Swartzberg’s interview with BBC News Mundo, the BBC’s Spanish-language news service.

How do you analyze the course of the pandemic three weeks after the detection of omicron in South Africa? I have a very clear picture of the possibilities for the next six to eight weeks, and I’m very concerned about potentially tough times, tougher than what we’re going through right now.

In the United States and much of the world, we are seeing a resurgence of the (variant) delta now. The delta pandemic is not over, even though the news talks a lot about omicron. We’re still in the middle of a delta variant pandemic that’s causing significant morbidity and mortality, and so superimposed on that is the omicron.

A week ago, in the United States, 0.7% of cases were related to omicron; now that rate is 2.8%, four times more. If this continues, we’ll see omicron as the dominant variant in the US in early January, while we’re still dealing with delta. This is called a double pandemic.

But my concern is that not only will we have a double pandemic, but we will have a tridemic: omicron plus delta plus influenza.

Last year, we had little flu contagion, both in the Northern and Southern Hemispheres, but this year it could be average. In an average year, we have a few hundred thousand hospitalizations and between 25,000 and 35,000 excess deaths (overdeaths) in the United States.

If we have omicron, delta and influenza at the same time in these months of December, January and February, we could really be in a very difficult position in the next eight or ten weeks in the United States.

Do you believe that people are now more relaxed about the non-pharmacological measures against Covid-19 and that’s why the flu will return? If you had asked me before the omicron, the answer would have been “yes”. There was a big flu outbreak last month at the University of Michigan and also at the University of Wisconsin. This was because people were more relaxed and the flu spreads the same way as Covid-19.

But if you ask me now, when people are worried about omicron and are going to take the booster or get vaccinated for the first time because of that fear, I hope that it will also lead people to get the flu shot and to be more careful.

So I’m not sure I can say that people are more relaxed now. I will say that, without a doubt, the omicron arrived at a bad time of year, because the cold (in winter) makes people stay indoors and that is dangerous. Also, it is the holiday season when people often travel and gather to celebrate. It’s the perfect time for omicron scattering, but it’s too bad for us.

Almost half of the planet’s population completed the vaccination schedule. What is the risk for people who have not yet been vaccinated? When people who have no immunity to this virus become infected, they become virus factories; they produce billions of viral particles. And if people are virus factories, they become variant factories, because some of these billions of viral particles will be a variant.

Most variants are unsuccessful, but some will. This is clearly our problem. We don’t have enough people with immunity, which allows the virus to continue to find a home in humans who function as viral factories to make more viral particles, and that means more variants.

The only way to break this cycle is to vaccinate humans at a much higher rate than we have around the world today. It is useless for the US to vaccinate its entire population if the rest of the world is not vaccinated. The virus does not recognize nationalities. He will simply search and find humans to infect. Wherever you are, he will be there; in the United States, South America, Africa or elsewhere.

What do you expect from a future variant? Should it be less harmful than omicron? A respiratory virus usually makes me sneeze and cough, but it doesn’t make me feel too bad, because if I have a high fever, terrible body aches, and can’t get out of bed, I won’t infect other people. If the symptoms are minimal, but it only produces coughing and sneezing, I will still work and do things with other people. This spreads the virus and is your ideal scenario.

If with omicron the coronavirus evolved into a less serious virus, this evolution may continue and become more benign. It would be a very good thing.

Could the omicron then be the prelude to transforming the pandemic into an endemic one? It might be. It will depend on how benign the disease it causes. It is not possible to predict what its behavior will be beyond two months, but one possibility is that the omicron is so transmissible that it infects almost the entire planet. And if it doesn’t become a really serious disease, it can become endemic.

But my guess is that omicron will first be replaced by another variant, which will be more likely to become an endemic infection. In any case, this virus, Sars-CoV-2, has many tricks up its sleeve, continues to show those tricks and continues to amaze us. I have no idea how long it will take, but I know we’ll get there.

Until when do you believe that cases, hospitalizations and deaths due to Covid-19 should be accounted for? As long as it is a serious disease and threatens the capacity of our health systems, we must closely monitor it against these three parameters. Once it becomes a much more benign disease, doesn’t threaten the capacity of our hospitals, and we have a lot fewer deaths, we can relax.

​Some antivaccines claim that vaccination is useless because people who are vaccinated also get sick and pass on the disease. What is your opinion on this? Go to any hospital now or to an ICU (Intensive Care Unit) and see who is hospitalized with covid. There are between 10 and 15 unvaccinated patients for each vaccinate. It’s true that people can get the infection even though they’ve been vaccinated and yes, we’re seeing more omicron infections in the vaccinated, more than we’ve seen with delta (and, in turn, more than with alpha). This is all very true. But these infections in vaccinated people are much less serious and usually don’t take people to the hospital.

13 or 14 months ago, we were talking about the fact that vaccines would need 50% effectiveness against contagion to be approved by the WHO (World Health Organization). Some were 95% effective, which far exceeded our expectations. And not only that. They were also preventing transmission, so they were doing a lot more than we expected, and everyone was thinking, “Wow, this is great! This is what we can expect from vaccines.”

Frankly, this was an unrealistic expectation and it has been disappointing that vaccines do not prevent infections as we would have liked. Fortunately, however, they protect us from hospitalization and death.

Some people have received two doses but don’t want another third. This is an evolving pandemic, and our understanding of how vaccines work best and how best to use them is still evolving. The fact that we now need a third dose is a reality. And we may need another in six months or a year, two or 10. No one has the answer right now.

Anyway, I think there’s a good chance we won’t need another dose for long after the third. But that’s the reality. This is what we need to understand.

After all, after some time after receiving both doses, immunity diminishes and we need a third one to stay alive and keep our loved ones alive. So get vaccinated. We may not need a fourth dose, but it’s a possibility, and if we do, we’ll have to get a fourth dose. That’s what we’re supposed to do when we’re in the middle of a pandemic.