Dr. Ghinwa Dumyati, Professor of Medicine at the University of Rochester Medical Center, joined the LeadingAge Coronavirus Update Call on December 1, 2021. She responded to questions from Ruth Katz and from callers. Here are highlights of the call.

Q: You focus on infectious diseases and have been working with nursing homes on antibiotic use, and most recently with COVID-19. Since you were last here in the summer, we have seen a surge, then a bit of flattening. What are we seeing now and what do you anticipate?

A: With the Delta variant we did see a surge, though thankfully less of a surge in nursing homes because of high resident vaccination rates. In the past few weeks, we are seeing an increase in cases – maybe because of a change in the weather and more people being indoors. To get control of COVID we need to get everyone vaccinated, as we still have about a third of people in this country who have not been vaccinated. Breakthrough infections are generally less severe, and the majority of current severe disease is in unvaccinated people. We need to vaccinate as many people as we can.

Q: Older adults were among the first to be vaccinated. Is the length of time since they were vaccinated an important variable?

A: We are seeing breakthrough infections across ages. We don’t yet know if there is a correlation between people who were vaccinated in January and waning immunity prior to boosters. There are likely multiple variables.

Q: Cases jumped up in South Africa and subsequently the Omicron variant was discovered. What do we know about this Omicron variant?

A: The first case was identified on November 11 in Botswana. There were a cluster of cases in young people. They did PCR test sand saw something unusual, so they sequenced the samples and saw many mutations and contacted the World Health Organization. What we don’t know yet is how severe these infections are, or if transmissibility is similar to, or higher than, Delta. We also don’t know what the combination of these mutations will do. But, based on prior experience, we anticipate that the vaccines will still be helpful.

Q: Our members serve older adults, should we be worried that Omicron will also target older people?

A: It is difficult to know yet, but we are hopeful that since so many older adults in congregate settings are vaccinated that will offer some protection. And we want to be sure these people have received booster shots.

Q: Please tell us more about how variants are identified and tracked.

A: All over the world, samples are collected and then they are sequenced to identify the genetic makeup of the virus. That process allows researchers to identify mutations. What is unusual about Omicron is the number of mutations – at least 30. They suspect that is because of multiple replications perhaps in an immunocompromised person. We still have a great deal to learn about Omicron -its transmissibility and how well vaccines protect against it- but we will learn more in the next few weeks.

Q: If you had a crystal ball, what would you predict going forward?

A: Even before Omicron, we were expecting another surge this winter. So, we need to work hard to get people vaccinated and to get boosters. I would also say that the flu is back, so we want to make sure we focus on immunizing for influenza as well.

Q: Will the Omicron variant evade testing? Will current tests detect it?

A: Both the PCR and rapid antigen test will detect Omicron COVID. Testing will not change.

Q: Will core infection principles be useful against Omicron?

A: Yes, we need to use good infection prevention techniques to prevent transmission.

Q: Please comment on the role of natural immunity.

A: With natural infection we don’t yet know if it will protect against the Omicron variant. Vaccines give a wider protection, so people who have had COVID should still receive vaccines.

Q: Will vaccine manufacturers be tweaking the vaccines to address Omicron?

A: It will take some time to know if that is needed and if so, to develop targeted vaccines. However, the companies are already working on that.