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COVID surges around the country, omicron variant concern for health officials

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The holiday week brought 71 more COVID-19 related deaths in Montana, boosting the total to 2,638 since the start of the pandemic.

Active cases came to 4,248 on Monday, down from 5,911 seven days ago. The state added 1,919 new cases over the week. Yellowstone County has the highest number of active cases at 901. Missoula, Flathead and Lewis and Clark counties follow with 549, 472 and 370 respectively.

Hospitalizations continue a downward trend with 215 active hospitalizations, down from 266 last Monday.

The decreasing case numbers and hospitalizations are a combination of many factors including early detection due to a rise in testing acceptance, said Dr. Neil Ku, infectious disease expert at Billings Clinic.

Early intervention has also increased as monoclonal antibody treatments became available to those 12 years and older following updated guidance from the Food and Drug Administration in August. Monoclonal antibody therapy has been available since late last year for those with weakened immune systems or for those 65 years old and up. In October, the state’s first government sponsored clinic for the antibody therapy opened in Butte.

Of the eligible population in Montana, 51% are vaccinated and 8% of kids age five to 11 are vaccinated, the age group most recently added to the pool of eligible individuals.

Increased vaccination numbers have also helped, but Ku said the COVID-19 events occurring in the U.S. and around the world are a warning that it is too early to become complacent when it comes to mitigating the spread of COVID-19.

Surging cases in the rest of the country could hold implications for Montana in the coming months.

On Saturday, New York declared a state of emergency amid rising COVID cases which makes supplies available to the state and helps them prepare for an upcoming surge. Michigan has the highest cases per 100,000 people in the country and has seen a nearly 60% increase in cases in the last two weeks, according to the Mayo Clinic.

Even states with high vaccination rates like Vermont where about 73% of the eligible population is vaccinated are experiencing a surge in cases, illustrating what we already knew: that vaccination alone isn’t going to completely prevent the spread of COVID-19. However, Vermont’s hospitalizations remain low with an average of 64 people hospitalized a day.

“Up to this point (Montana has) always seen a delay in our surging in numbers. It’s definitely a concern because what’s going on in other states forecasts what will be happening to us,” Ku said.

The surges elsewhere are likely a result of lax masking, social distancing and other mitigation measures.

“When the urgency and the need is not as apparent, people are less inclined to be cautious. Complacency kicks in and that’s where the fear is for health care workers,” Ku said.

As the virus goes through the replication process in a new host, mutations occur and the probability of a clinically significant variant increases.

The weekend brought news of a new variant of concern, the omicron variant, which was classified by the World Health Organization under its most serious designation. Though the variant has not been tied to an outcropping of severe illness, regular surveillance of mutations showed that the variant has a number of indicators that could point to high transmissibility. The number of mutations could also mean the variant is somewhat resistant to the current vaccine, but it is too early to know if the variant will follow any of these patterns, Ku said.

Variants often arise out of places with low vaccination rates. The surge in India brought on the Delta variant and the recent omicron has been traced back to South Africa, where about 25% of the eligible population is vaccinated, highlighting the vaccine inequality around the world.

The new variant is a wakeup call for those who have become negligent when it comes to mitigation measures, said Ku. He is cautious of raising the alarm bells too early though, saying that if the research reveals the variant is less of a threat than originally thought it could come across as "crying wolf."

Though vaccination isn’t 100% effective at preventing illness, it does reduce symptoms that allow viruses to flourish such as riding on a wave of coughing and sneezing.

Booster recommendations were updated by the CDC, stating that anyone over the age of 18 should get a booster shot as opposed to the original wording that those over 18 "may" get a booster shot. It is a slight but significant change in wording. The change to recommendations comes in preparation for a more transmissible variant.

Ku says if you’re young and healthy, you can consider getting a booster as there is some evidence of waning antibodies from the vaccination.

“It’s not unreasonable for everyone to get a booster,” Ku said, adding that usually kids in the five to 11 age range usually don’t need boosters for vaccination because of their robust immune response.

On average, about four out of five people hospitalized for COVID at Billings Clinic are unvaccinated.

On Monday, 76 COVID positive inpatients were receiving care at Billings hospitals with 26 requiring ICU level care and 19 on ventilators. Of those, 62 were unvaccinated.

“I hope the news of this variant will raise awareness. To get this under control more people need to get vaccinated,” Ku said. “Right now the buzz is out of precaution rather than out of documented concern. What will happen is still up in the air.”

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