International data agrees

well a warm welcome to today's talk it's wednesday the 12th of january now today i want to look at reduction in hospitalizations amongst people infected with omicron and we've got some rather nice data that's starting to come out of the united states now particularly from california and we also want to look at natural immunity because there's some new evidence now that when people have been exposed to the natural corona viruses that cause common cold then that's going to give them greater levels of protection against sars coronavirus ii so quite interesting really now just before we plow into the american data i just want to show you something from um netherlands first of all now here's data from the netherlands and this is quite an amazing graphic this so what what we have here is we have the reduction in the uh delta variant here and just it's almost like a mathematical opposite the increase in the omicron and now of course omicron is is a predominant so the crossover point was what just just uh well that's december that's january just sort of the end of december so just really quite amazing the way that the omicron has essentially taken over from the delta in that dutch data now moving on to the theme of uh hospitalizations i just want to show you some more dutch data here now these were projections that were made in uh i think it was early december for the netherlands for the virologists that uh consulted with the uh inform the dutch parliament and these are various scenarios of hospitalizations with omicron infection so this is the most optimistic scenario here then the actual cases are way better than the most optimistic scenario now it's just from uh from a twitter thing there so it's not that good but we can see it's uh it's about what 1373 i think that is hospitalizations but the point is it's way better than the worst scenario the middle case scenario and the best case scenario it's even way better under the error bars of the best case scenario so i thought that was that was uh pretty interesting and pretty good news really now moving on to this californian study clinical outcomes amongst patients affected with omicron uh sas coronavirus 2 very in southern california so the background of course is omicron is sweeping the world accounting for most infections in the united states by december 2021 i suppose roughly the crossover time in the states was similar to that one we've just seen from the um from the from the netherlands um but not but now we know that omicron is at least 95 of the cases in the united states probably higher than that omicron has just taken over and omicron is has essentially now replaced delta which is is good news as we've looked at many times uh so this data is from november the 30th 2021 uh until the end of the beginning of january so this is basically data for december isn't it delta v omicron now the thing about this period of time is this is when um omicron was taking over from delta so we had a time when there was delta hospitalizations and omicron hospitalizations together so the two could be compared which of course makes perfect sense a unique opportunity to do that so you couldn't repeat this study now because there's not enough delta cases around to be able to um to be able to do it anymore right so using s gene target failure to identify omicron and they found out when they did genomic analysis that that was accurate 99.7 percent of the time so this this s gene uh target failure or this s gene deletion at least in the california situation is a very accurate way to assess whether the infection was omicron or delta and if it had the s gene target failure it was omicron and of course they were looking at hospital admissions they were looking at length of hospital stay hospital admissions associated with new onset respiratory symptoms intensive care unit emissions mechanical ventilation and of course deaths they were looking at all those things now the first group they looked at was the omicron group and of course as time went on the omicron group got bigger and as time went on the delta group got smaller as you would expect but they're able to get pretty good data so omicron cases um over 52 000 cases with omicron variant infections now hospital admissions from the 52 000 cases that were diagnosed now remember these are cases of course the actual number of infections in this collect section area will be way higher than that so hospital admissions were at 0.5 percent of those uh diagnosed uh so only like 0.1 or something of infections but but um or 0.2 percent of infections anyway there's 235 cases 0.5 percent now these were followed up for 5.5 days now they couldn't follow them up for the for as long because the omicron cases weren't hospitalized for as long they were they were in hospital for about 70 less time on average with omicron which in itself is encouraging um so um 88 were actually admitted so there was 235 that went to emergency rooms and things like that but 88 actually admitted to hospital seven were admitted to itu zero went on mechanical ventilation and in the whole omicron group there was one death and the length of hospital stay was typically 3.4 days as we said 70 percent less than delta so quite a lot turning up for hospitalization but not that many actually being uh admitted now if we compare this with group two which was the nun on the clock the non-omicron which we know is the delta of course uh there was 16 000 say 17 000 cases of there hospital admissions there were 222 so that's 1.3 percent whereas the omicron had been 0.5 mean follow-up days were 15.5 so they're hanging around for much longer and could be followed up as opposed to a mean follow-up of 5.5 days from this group there was 189 actually admitted into hospital 23 were actually admitted into intensive care were ventilated and 14 died and if we look at the uh omicron equivalence there it was seven in intensive care as opposed to uh 23. uh zero ventilated with omicron 11 ventilated with delta one death with omicron 14 deaths with delta so really pretty stark differences and consistent with what we've been thinking and saying for quite some time now this study went on to do some more thinking omicron variant infections reduce risk of hospitalization so cross-aging co-morbidity categories so this is pretty important so we were worried about this but what this is saying is that if you're infected with omicron regardless of your age you're less likely to be admitted so a two-year-old infected with omicron less likely to be admitted than a two-year-old infected with delta an 80 year old infected with omicron less likely to be admitted than an 80 year old infected with delta so the reason that if this data is correct if this pans out to be generally true it's looking true so far what this means is the increase in pediatric admissions that has been seen in the united states is due to the simply massive amount of omicron cases that have been presenting all at once for any given age group you're less likely to be admitted with omicron than you are with delta and the same with comorbidities so if you're diabetic and you get omicron you're less likely to be admitted and if you're diabetic with delta so it was true uh monochromatic infections reduce risk of hospitals across age and co-morbidity categories so that he really is pretty good news risk of symptomatic hospitalizations remarkably reduced amongst cases of testing for positive sars coronavirus 2 greater than so that's greater than um greater than more than 90 days prior for three months so even if someone had had the natural infection um more than three months ago and of course some of them would have had the natural infection of well over a year ago now then they were still less likely to be uh hospitalized so risk of symptomatic hospitalization was markedly reduced among cases who tested positive for sarcoidosis in other words they had natural immunity because they've been exposed to the actual virus in this case the sars coronavirus ii so we're seeing that this natural exposure to size coronavirus ii and as we'll see in a minute other coronaviruses is protective and it's looking like it's protective longer term so natural immunity seems to be giving longer term good quality protection against symptomatic hospitalization as this data shows us they conclude that the illness is intrinsically less severe the infection is less severe again consistent with other data that we have been seeing so initially we didn't know whether it was people had immunity or the infection was intrinsically less severe we now know both is true the the infection is intrinsically less severe so if someone's never been vaccinated and they get omicron they're much less likely to be hospitalized than someone who's never been vaccinated who gets delta so the natural immunity is having an effect but we also know it's intrinsically less pathogenic less severe and vaccinated and unvaccinated so if you're vaccinated or unvaccinated again less likely to have severe diseases in omicron compared to delta now that's not saying that people who were vaccinated didn't have more protection they did they did they they didn't did and the authors were keen to point this out so direct quote evidence for a reduction in severe outcomes among vaccinated cases with both delta anomalocon variants infections suggests our in our studies suggest substantial public benefit from continued covered-19 vaccination so what they're saying was whatever your age whatever your co-morbidities whatever your vaccine status compared to other people of your age with your comorbidity or other people with your vaccine status you're always less likely to be admitted with omicron compared to delta so that's really pretty good uh news now that was the dutch data we looked at there obviously it's in dutch so it's a bit difficult that's a i've given you my understanding of it now moving on to this next paper we wanted to look at common cold protection this is cross reactivity memory t cells so the memory t cells we know are the ones that give longer lasting immunity and cross reactivity means that these people have been exposed to one of the four coronaviruses that caused the common cold but they found that they also had enhanced immunity to um sas coronavirus ii now of course this is one of the things we've been wondering about since the start of the pandemic we had some people in the same age and with the same core comorbidities at the start some had minimally symptomatic disease who sadly died or admitted to intensive care so it turns out that one of these variables that we couldn't see if they'd been exposed to a coronavirus common cold in the six months year possibly even 18 months probably not more than two years before so another reason to sort of get out there and mix with viruses and get this natural immunity cross-reactive immune response to sars coronavirus two from the four common cold corona viruses yes there is here they tested 52 uh covered 19 household contacts so people who who would definitely uh definitely be exposed to the virus we enumerated the frequency of specific t cells and they looked at the the way the t cells responded to the pipe spike protein the nucleocapsid proteins that's the ones right inside associated with the um the rna membrane protein envelope protein and orf1 which is a functional protein that's basically an enzyme that the cross react with human endemic corona viruses so there's these four endemic human corona viruses and these are giving cross protection so it really makes you wonder why we didn't have a vaccine much earlier on based on these common cold corona viruses which we now know are giving protection but we have we have actually suspected that they gave protection right since january uh 2010 but we haven't known till now so it's taken two years basically um to be speculated on it in january 2020 now january 2022 we know that there is cross-immunity so infection with the sars infection with the um the coronavirus that causes common cold will give cross-immunity to sars coronavirus ii and one that was particularly effective was the nucleocapsid protein so you might remember that we have the um we have the virus and of course we have the spikes and the spike proteins as we know with these spike proteins then we have um we have the rna inside like that well the the nuclear the the um the nuclear capsid protein antigen is is the one that's actually associated with these uh the rna right inside uh but but but also there's envelope ones as well but the one that was specifically good was the nuclear capsid t cells but of course none of the vaccines that we have generate immunity against this so that so the natural immunity is generating t cells that are able to respond against the sars coronavirus 2 nuclear capsid program protein and therefore eradicate the whole virus because it's seeing that as the foreign material the epitope or the the antigen but none of the vaccines went for that but the natural infection does of course because the natural infection and natural infection were exposed to all parts of the all parts of the virus not just the spike proteins um they found limited protective function of spike across reactive t cells so in other words when you're exposed to the spike protein of a common cold coronavirus that didn't give you much cross-immunity against the spike protein of the sars coronavirus 2. but with the internal proteins if you're exposed to the internal proteins of the uh the natural common cold corona virus that did give you across immunity to these natural internal proteins of the sars coronavirus ii causing the covered 19. so again really showing what you could argue to be the superiority of natural infection and exposure and the reason i'm sort of emphasizing this now is of course that even though having a difficult time now with omicron millions of us are being exposed so i'm really hopeful about the long-term immunity and the quality of that longer-term immunity that we're getting from this natural exposure because we know we get good immunity from exposure to the four common cold corona devices we already have therefore it also seems very likely that we'll get good natural immunity to the um omicron variant and we already know that exposure to the omicron variant gives good antibody neutralizing protection against delta variant so it's looking very encouraging for the memory t cells which is going to give us our long term immunity of course um i was also this consistent with pre-existing non-spike cross-reactivity memory t cells so pre-existing non-spike so not the spike cross-reactivity of the memory t cells in other words it's the internal proteins that are generating most of the t cell response not the spike proteins protection against sars coronavirus two naive contacts from infection so if you've never come in contact with size coronavirus ii but if in the past year or so or 18 months you've come into contact with one or two presumably three or four would be even better of these of these natural common core corona viruses you get a good degree of protection so it will i think we can say will be the same i get with omicron because the omicron of course is even more similar to size coronavirus ii because it is a sars corona virus too it's not a common cold corona virus obviously thereby supporting inclusion of non-spike antigens in second generation vaccines now that's not being done at the moment so none spike antigen so why did all the vaccines go for the spike protein presumably because it gave the neutralizing antibodies but that's not what's having the effect really the long-term effect is the t cells and of course every immunologist in the world knows that but for some strange reason the vaccine developers didn't go for it so strange um i really can't not quite quite sure why they wouldn't go for it of course the chinese vaccine did and some other some of the vaccines that went for the whole virus the whole attenuated virus because that would give you uh immunity to all of the um um all all of the antigens all of the epitopes in the in the sars corona virus too because it is a sas coronavirus too it's the whole virus but that's not stimulating the t cells as well as we would like it to so there we go um pretty good news on hospitalizations with omicron the risk is down in all ages and categories and comorbidities therefore if there is more of a particular age group admitted that is um just because of the sheer volume of numbers the risk to any individual is less and we have this cross-immunity which is absolutely brilliant between different corona viruses making me very optimistic about the um immunity that's going to be generated by this omicron wave now just to finish um i've just got an email from some doctor friends in india now i haven't got permission to say who they are yet so so i'm not gonna say but they are they are respected physicians uh known to know to friends of mine who are doctors in india i'm just gonna read just some of the things that they have come out with and it's very reassuring because these doctors have been doing their own research in india and they're coming to the same conclusions as people working in the united states people have been working in south africa but these doctors have been working independently so that is very reassuring and the doctors that have sent this email have actually treated twenty thousand patients between them so uh omega uh omicron delta alpha but the whole range of sustainability patients all through the outbreak and this is what they say omicron is the most infectious respiratory virus the world has ever seen now i was a bit taken aback by that because now what we had looked at before here we have this now this is when delta first came out so here we have a faster spread and there we have more deadly so um this was the ancestral form here which didn't spread as well and then the delta form spread more uh measles of course is the most transmissible disease i've known of personally um but um so so what we find out is that um omicron is is maybe down here somewhere about here because it's uh it's less virulent but it's much more uh transmissible so it's probably around about there somewhere and these doctors are actually saying omicron is the most infectious respiratory virus the world has ever seen so are they saying it's more infectious than measles wow it looks like they are i mean just just wow i mean measles is so transmissible if someone's in a room breathing out measles anyway everyone in that room's got a 90 chance of being exposed to it um so they're actually saying that we know it's less pathogenic so it's down here intrinsically less pathogenic uh it's the most infectious viral respiratory virus apparently according to these doctors so it's it's up there with measles now um if you know if you know of a more infectious respiratory virus if you're a virologist or something do let me know but that that's direct from these physicians in india um three to five times more infectious than delta which of course was already more infectious than the original b11 strain and indeed was more effective than the alpha strain that it replaced we can safely say 90 of the current infections in india are omicron and of course infections in india are really scooting up just now the milder symptoms seem mainly due to upper respiratory tract infection um so again they're saying it's affecting the upper airways intrinsically less infectious but also due to the immunity and there is a lot of immunity in india as well but they're agreeing that it's the upper airways rather than the lungs that are being infected vaccine does not prevent omicron infection but does seem to protect severe again severe disease and hospitalization so same thing as we're finding here omicron is not preventing symptoms the vaccines are not preventing symptomatic infection certainly not completely but do seem to protect against severe disease so again the indian doctors having exactly the same findings as as the south african united states and british scientists omicron does not affect the lung and therefore 70 less chance of admission they're saying 70 less chance of being admitted rather consistent with the california data so it's all it's always reassuring when different uh data is derived from completely different countries using different methodologies and that data agrees that's very reassuring in only ten percent without was oxygen required all these uh all the patients are required oxygen so all the patients are admitted the few that were admitted relative to their omitted only 10 required oxygen wears before it was about 90 percent of people required oxygen all of the people that required oxygen and this is about 20 000 well that they've treated several thousand patients lately about 20 000 altogether all the patients that required oxygen recently were over 70 years old or had co-morbidities the doctors are recommending boost of vaccines if possible try and get a different vaccine then the primary one is what they're saying um this is not what we're advising this is just reporting what these indian doctors are saying obviously they're looking for the polyclonal exp uh response uh the available antibody cocktail is useless in omicron so this is the monoclonal antibodies the avenue is just not working at all it's become a fad amongst the rich please stop asking for it they say mixed opinions on mulnu pirivia if recommended at all to be given on day four or five of fever or cough not coming down or increasing uh or in elderly patients with comorbidities so more nor purify not going down particularly well in india so there we are a few interesting things to think about um difficult time now but uh encouraging for immunity uh soon um [Music] cases of um omicron probably peaked now in the uk united states got a couple of weeks to go after that the numbers will start going down i believe but hospitalizations are going to be an ongoing problem in the united states due to the sheer number of people and due to the co-morbidities in the united states which is also going to be a factor and the older age group demographic which is probably why hospitals in the states are under such a lot of strain now compared to somewhere like netherlands for example okay thank you for watching

Channel: Dr. John Campbell

Views: 1,353,423

Keywords: physiology, nursing, NCLEX, health, disease, biology, medicine, nurse education, medical education, pathophysiology, campbell, human biology, human body

Id: TrVGymR-jFU

Length: 24min 33sec (1473 seconds)

Published: Wed Jan 12 2022

Reddit Comments

[u/WeaknessSea490]

BIGGEST DIFFERENCE BETWEEN USA AND TURKEY, NO ONE IN USA EVER HEAD OF RVV OR THE DRUG. WHY SIGN UP ? NOT ENOUGH CASH FOR RICH AMERICANS TO SIGN UP. IN TURKEY, THE PRINCIPAL INVESTIGATOR OF TRIAL KNOWS OUR DRUG AND WILL PUSH IT < NO ONE IN USA DID THAT> PLUS PEOPLE IN TURKEY WILL WANT TO SIGN UP FOR THE $$$

[u/DeepSkyAstronaut]

84.3% had at least one shot though, so most likely every high risk patient + most normal risk patient got at least a single dose.

[u/DeepSkyAstronaut]

Appreciate the perspective. Hospilization of Delta (1.3%) -> Omicron (0.5%) which equals ~60% reduction is actually not that much as media want to make us think. However, the drop in ventilation and death is significant. Be aware though, this data probably includes vaccinated patients so it has limited implications for our trial.

[u/Spare-Property-8731]

These were pretty surprising results to me. Especially how low the rate of hospitalization was for Omicron cases. Also, the rate of 2 dose vaccination in California during the time frame was a little over 60% (like someone pointed is Turkey's rate)