Just when we all became eligible for Covid booster shots, in strolls Omicron. 

The variant du jour is still largely a mystery as global public health experts furiously analyze Covid hospitalizations and case counts in the sprint to learn more. As of this writing, there have been confirmed cases in more than 20 countries, including the United States. On December 4, the Washington State Department of Health announced three cases of the variant in the state, including one in King County.

Any new SARS-CoV-2 mutation inevitably means a prolonging of this pandemic—and that just straight-up sucks. But if there ever were a sliver of a silver lining, it's that Omicron's arrival seems to have convinced some previously reluctant individuals to go all in on boosters.

Still, many questions remain about those booster shots, the future of Covid vaccines, and the hand grenade that Omicron seems to have tossed onto the whole situation.

What do we know about the Omicron variant?

Some, but not much. Public health experts need more time to track hospitalizations and case counts to understand how transmissible is is (aka easy to spread), whether it causes severe illness, and how easily it can evade vaccine immunity. Either way, it's all been enough for the World Health Organization to dub Omicron a "variant of concern."

Are vaccines effective against Omicron?

As many unknowns as there are, health experts do know Omicron has some 50 mutations, 30 of which are on the ever-important spike proteins—you know, the things that antibodies are supposed to thwart—which doesn't exactly bode well for vaccine protection.

Unfortunately, the anecdotal evidence seems to support this theory: That case in King County was in a fully vaccinated (although not fully boosted) individual. And an office Christmas party in Oslo, Norway, where everyone was fully vaccinated and had tested negative prior to the event, resulted in the largest current outbreak of Omicron outside of South Africa.

Should we be worried?

Maybe. Early reports indicate that Omicron is highly transmissible, even among fully vaccinated individuals, like attendees of that Christmas gathering. Again, though, experts just don't know enough yet to say for sure.

Take a recent tweet from Fred Hutch data superstar and literal genius Trevor Bedford, who notes Omicron likely has an intrinsic transmissibility of anywhere between three and six. In non-genius speak that means without any immunity from a vaccine or otherwise, someone infected with Omicron would spread it to between three and six other people on average. By comparison, the novel coronavirus that started this all is around a three, while the highly contagious Delta variant is at a six. 

Early reports from nine provinces in South Africa note that Omicron has spread twice as quickly as Delta, but that could be because this variant is highly transmissible or because it can evade vaccination—or even both.

If Omicron does wind up being that double nightmare combo, you might feel like cueing that disaster cascade. One glimmer of hope, though, is that many of the reported Omicron cases seem to cause only mild symptoms, although whether that's because those cases were in low-risk, vaccinated individuals or because that's how this particular variant works is still unclear.

Wait. Why aren't we just modifying vaccines to protect against new variants like Omicron?

Well, you can't make a vaccine for something you don't know exists yet. By the time researchers figure out a way to revamp our current generation of mRNA vaccines to match Delta and Omicron, not to mention scale up production and administer doses, the novel coronavirus will likely be on to its next mutation. 

But can't we predict new Covid variants somehow like we do with the flu shot every year?

This is where SARS-CoV-2 beats influenza, and not in a good way. Covid-19 is so new and spreads so quickly that health experts are having a harder time predicting what's coming next. A decade from now, that might be a different story, but remember the novel coronavirus has only been around for about two years.

That all said, Dr. Christine Johnston, an infectious disease doctor and virology researcher at UW Medicine, notes vaccine manufacturers are working on variant vaccines. "There's already been some that have been tested, there are others that are already reacting to Omicron and [they're] trying to create new ones."

If Omicron can escape vaccine immunity, why do we still need to get booster shots?

Here's Johnston again: "I do think that whenever there is increased virus circulation in the community, people are at increased risk to get the infection just because they may be at increased risk to be exposed. And for that reason, just making sure that everyone has the maximal immunity is ideal."

In other words, Omicron with all its spike protein mutations may be able to escape those vaccine-induced antibodies for a while, but if you get your booster shot and are at your "maximal immunity," it may not be able to evade them forever.

About those boosters...will we need to get them every year?

Researchers are still studying how long immunity from our current vaccine and booster regimen lasts, so it's probably too early to say for sure. Any new variants like Omicron that emerge can also throw this for a loop if they evolve enough to evade our current vaccines.

"I could envision getting boosted with a slightly different vaccine every year that covers the variants that may emerge," Johnston says.

Or we may wind up simply needing a basic course of three (or more) doses to reach our baseline level of immunity, which would nix the need for ongoing boosters. Johnston points to certain childhood vaccines like the ones for polio which require a series of shots. "We require several shots to create that baseline immunity, and I think that's part of what we're doing right now, creating that memory immunity and a strong immune response to SARS-CoV-2."

Will kids need boosters too?

Kids five to 11 just became eligible for their initial doses about a month ago, so it's not likely to happen for a while, but the answer is probably. "I can imagine we're going to have similar policy for adults and children," Johnston notes. "If there's a new variant that comes out that's not covered by the vaccine in its current state, we will need to protect everyone in the community." 

I can't find a booster appointment for the same type of vaccine. Can I mix my Covid and booster shot?

You sure can. Johnston, who was the principal investigator for a National Institute of Allergy and Infectious Diseases's mix-and-match Covid booster trial, found that almost all combinations of Pfizer, Moderna, and Johnson and Johnson vaccines and boosters gave participants a strong immune response—and were safe. The only combo that seemed to result in slightly lower antibody levels was Johnson & Johnson followed by a Johnson & Johnson booster. So, uh, J&J folks, maybe hop on the Pfizer and Moderna trains. 

How is Washington doing in terms of booster uptake anyway?

In highly vaccinated King County, over 90 percent of the 16 and up population is fully vaccinated. Statewide we're looking at around 72 percent, which isn't too shabby. 

The numbers show that a lot of booster shots have been administered in the last couple of weeks, right after they were opened up to the general adult population. "The urgency of getting it hasn't been the same as with the primary series, but I would say people are definitely doing a great job, as they did with the primary vaccination series, of following public health recommendations, getting the vaccine, and protecting our community," Johnston says.

If I don't get a booster, am I still considered fully vaccinated?

In the technical sense, yes, meaning you only need to show two doses on your vaccine card to be able to dine in at a restaurant, for example. But again, most health experts recommend boosters for maximum protection.

All right, I'll follow the science. Where can I get my booster shot?

Our Covid vaccine booster shots page has a handy list of vaccination sites, and Public Health—Seattle and King County also has a vaccine locator.

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