This week Fred Goldstein and I review the latest media frenzy over the Omicron sub-variants, which are classified as sub-variants. These Omicron sub-variant do appear to be more contagious than the original but so far no evidence of it being more virulent or deadly
We discuss wastewater and its use in surveillance for COVID19 and perhaps in other diseases and conditions with the CDC adding this technique to its surveillance for COVID19. We also review the strange signals found in wastewater in New York showing genetic fragments from the SARS-CoV-2 virus that have not been found in any sequencing of patients suffering from COVID19
And we finish with some commentary on Denmark that has scrapped their COVID regulations and protocols in light of the data in their country and what lessons we can learn form them
Raw Transcript
Nick van Terheyden
Hi, this is Dr. Nick on the incrementalist here with incremental insights for better business better health.
Fred Goldstein
And I’m Fred Goldstein with Accountable Health here working with healthcare systems, payers and employers and their population health improvement programs. So Nick, there’s another big spread in the news, everyone starts firing out this stuff. There’s a new omachron variant. Oh, my God doesn’t know.
Nick van Terheyden
What are we gonna do? Panic panic? Absolutely, yes, that’s true. And as those that listen and watch as will know that I am quick to point out that an awful lot of this is designed to drag eyeballs onto screens, be those television screens, social media screens. It’s, I think, pre emptive, to start talking about concern, but you know, they use these emotional terms. So first of all, the variants are really not what we would consider true variants. They’re sub variants. So they’re a small modification. It’s still Omicron. And, yes, it seems to be in the case of one. So I think they’re being labeled ba one, ba two, I believe, three and four, even ba two is now overwhelming ba one. What does that mean? Well, it’s more virulent, so it’s not more virulent, it’s more transmissible. So it spreads easier, but does not seem to be more virulent. And what that means is that it’s not causing any more disease. So it’s interesting, this is good science. This is part of the monitoring program, and something that we watch, but it is not something that individuals should be concerned about. And in terms of the vaccine and protection, all of that seems to be consistent across these sub variants. And just
Fred Goldstein
to be clear, for the skew define, creates any more disease, it still does create some disease in individuals.
Nick van Terheyden
Oh, yes. I mean, it’s, it’s like COVID has been in the past, it’s still causing disease, but it’s not causing more symptomatic. And you know, the things that we focus on our admission to hospital, which is you you’ve gotten really sick, and you need medical intensive support, or worse than that death. And it’s not causing any more of that than the other elements or the other sub variants of omachron. But it still does in the same capabilities that we’ve seen in SARS, cov. Two, throughout this pandemic.
Fred Goldstein
Yeah, thanks. I just want to be clear, because somebody could hear any more disease and think, oh, there’s no more disease anymore. So
Nick van Terheyden
people taking our words out of context. Absolutely. Go to a sub edit that down and produce that and they’ll be splashed across somewhere. Yeah,
Fred Goldstein
clickbait right. So then the next thing we want to get on, it’s something we’ve sort of talked about quite a bit for a while we’ve seen some places use it, some places have been more effective than others. But this whole issue of wastewater and measuring the virus or fragments within the wastewater, I know, there are a couple of new news things this week on that.
Nick van Terheyden
Yeah, I just want to say I love wastewater. And let’s, let’s clarify that just a little bit. And to be clear, I’m actually dealing with a little bit of this with my ejector pump in my own house. So I’ve got some real personal interactions with this. I love it from a diagnostic capability, it is non intrusive to the individual. So we’re not sticking things up people’s noses or, you know, in fact, you would be completely unaware. And in fact, I was made aware of some of the work that was going on some years back when I talked about this, when they were monitoring wastewater in cities to look at the opioid epidemic and looking for the metabolites and, you know, things being put into the wastewater, the sewage system. We’ve talked about this in the past, and I think it’s an excellent means. Now, it can be more or less granular. If you sample an individual apartment and look at their wastewater, then you’ve got direct information about that. In most cases, it’s a more general thing where you sample whole sections and maybe at the city level, CDC is sort of advocating this. I think it makes sense. It’s a passive activity. The important thing is you got to do the turnaround time for sensing this. I think what was interesting was the New York Times article that talked about a nature publication that essentially has been identity Defining fragments. So what this does it does the same thing as the PCR a variation of that looks for the fragments of the virus and says, Can we see this in the wastewater, and they’re seeing SARS cov. Two, but they’re able to look at in the same way we do for the variants, you see the alpha, the Delta Omicron, and identify, and they’re finding these odd fragments that they can’t trace back. They’re, you know, sub variants, they’re, you know, ones that we don’t see anywhere else, but they keep recurring. And there’s lots of questions as to where this might be coming from.
Fred Goldstein
Yeah, I think the issue really is, I guess, that they’re seeing these variants, but in the tests on humans, they’re not seeing it in any of the infected people. So it’s believed to be coming from somewhere outside of person, I guess it’s an animal or something, right?
Nick van Terheyden
And, you know, to close the loop on why you would do wastewater? Well, it gives you an early indicator, assuming that you do the turnaround time fast enough of potentially disease occurring in a block, but, you know, maybe you’re doing it for a city block, or maybe for even an individual building, you’ll get an early indicator, because you get concentration of this, we see it in the wastewater, in the case of these small genetic fragments not occurring in any of the other samples where we see infected individuals. And the question is, does that mean? It’s, it’s in humans? The other sort of theory, that’s interesting? Is it occurring in another human, a nonhuman pool, which would be animals in this case? I think they showed or were considering dogs, cats and rats, I believe this was in New York City. So you know, that’s sort of prevalent, and
Fred Goldstein
plenty of rats in New York City? Well, I’ve in the subways.
Nick van Terheyden
I’ve seen him let’s be clear. I’ve seen him. Actually, I saw this massive Fat Rat. When I was walking through Baltimore one day, I was really surprised when straight up this drive by bigger big guy. But if you know, so those are a reservoir pool. Why is that important? Well, that’s somewhere that the virus sits when it’s not infecting the human population, and then re emerges. We think that happens with Ebola, for example. And that’s obviously a concern, because we could get rid of it in humans think we’ve won the battle. And then it re emerges as a different variant with different virulence, you know, escape mutations, all of those kinds of things, and causes us problems. So great way to monitor this, track it and you know, potentially track it back and see if we can find that reservoir.
Fred Goldstein
Yeah, when you’re looking at some of these other reservoirs. We know now that deer apparently, are highly are infected and fairly large numbers now with COVID. And they’ve obviously we’ve seen the reports on various zoo animals, getting the disease as well. So as you said, it could be out there within these groups, and some very could then emerge that might be contagious again to humans, and bring back in a new type of COVID. So really interesting stuff. I think we’ve got about a minute left, you want to comment on Denmark.
Nick van Terheyden
So Denmark, pull back on all its COVID regulations, they’ve said, we’re going to pull back, I think that’s interesting, because they’re doing this based on epidemiology, you know, their death rates are sort of middle of the road in terms of European death rates, comparable populations. They did this before in November, right before the Omicron surge, and actually reversed it. But what’s really interesting is the population says, Okay, that’s what we’ll do they do it, they follow it, they trust, their epidemiology and the following of science. And it’s a political so it is without politics. I’m, to be clear, there’s I’m sure there’s some element of politics involved in here. But the population just sort of trust and that’s the unfortunate thing we seem to have lost, certainly in this country in the United States, and maybe in some others where we’ve lost the trust. We’re not following the science and people, you know, are rejecting guidance, which is, of course causing problems.
Fred Goldstein
Absolutely. Once again, another fantastic week, Nick, this is Fred Goldstein with Accountable Health. If you’d like more information, please reach out to Accountable Health LLC COMM
Nick van Terheyden
And this is Dr. Nick, I’m the incrementalist here with incremental insights for better business, better health.
