By mid-January, the omicron phase of the COVID-19 pandemic is in full progress. According to the Centers for Disease Control and Prevention, more than 98% of U.S. cases as of Jan. 18 are caused by the omicron variant, with less than 2% due to the previously dominant delta.
Although omicron symptoms appear to be milder in many cases, for other people — particularly the unvaccinated — severe complications like COVID pneumonia, hospitalization in intensive care units or worse still threaten.
Experts in adult and child infectious disease outline the symptoms to watch for.
Omicron vs. Other Variants
The omicron variant has many mutations, or changes, in the spike protein, the part of the virus that attaches to human cells and influences how COVID-19 spreads. Omicron appears to be more contagious than the delta variant and became the predominant strain more quickly. In addition, omicron may cause more reinfection in people who have previously had COVID-19, and more breakthrough infections in vaccinated people than previous variants.
On Dec. 1, 2021, the first omicron case was reported in the U.S. It was identified in an international traveler returning to California from South Africa in late November, who then developed mild COVID-19 symptoms and tested positive for the variant.
“Omicron has now been reported in all 50 states,” noted a CDC health advisory released on Dec. 24. “Multiple large clusters of omicron variant cases have demonstrated the rapid spread of the virus.”
Although omicron cases might be less severe than with previous variants in general, according to early data, the increase in the sheer number of infections exposes more people to the risk of serious outcomes and is straining the health care system nationwide.
[SEE: What to Say to Friends or Family Members Who Hesitate to Wear a Mask.]
Omicron Symptoms
Comparing symptoms, omicron manifests itself somewhat similarly to previous COVID-19 versions, but with some shifts in emphasis.
“Omicron looks like much more of an upper respiratory tract infection,” says Dr. Diego Hijano, a pediatric infectious disease specialist at St. Jude Children’s Research Hospital in Memphis, Tennessee.
Patients are experiencing a lot of nasal congestion, stuffy nose and cough. With omicron in particular, he adds, scratchy throat is gaining traction as a frequently reported symptom, and one that he and colleagues are seeing.
Common upper respiratory symptoms associated with omicron include the following:
— Cough.
— Shortness of breath/difficulty breathing.
— Nasal congestion/stuffy nose.
— Runny nose.
— Sore, scratchy throat.
Croup is an upper respiratory infection with a distinctive barking cough. Anecdotal reports of omicron-related croup in children under 5 have appeared in some parts of the country, according to local news reports, for instance from a CBS affiliate in Alabama. However, Hijano says that St. Jude isn’t seeing this symptom, nor are colleagues at Le Bonheur Children’s Hospital in Memphis, where many children with COVID-19 receive care.
COVID-19 Symptoms to Watch For
Patients may also experience general, body-wide symptoms for COVID-19, such as:
— Headache.
— Fever.
— Fatigue.
— Muscle or body aches.
— Diarrhea.
— Nausea or vomiting.
Urgent symptoms of possible COVID-19 pneumonia or other severe complications include:
— Difficulty breathing.
— Intense chest pain.
— Disorientation or confusion.
— Extreme weakness.
— Rapid chest movement in kids (a sign of breathing struggle).
— Blue lips, skin or nail beds (depending on skin tone).
Whatever the COVID-19 variant, “It is still always is going to be those lower respiratory symptoms” that should prompt a hospital emergency room visit, says Dr. Judith O’Donnell, a professor of clinical medicine at the University of Pennsylvania and director of infection prevention and control at Penn Presbyterian Medical Center in Philadelphia. “If you’ve got shortness of breath, cough or fever, those should be the clue that you get to the emergency department for further evaluation.”
Signs that you need to urgently seek medical treatment are largely the same as they’ve been throughout the pandemic, Hijano agrees. “What we typically see in very small children is the need for oxygen: that difficulty breathing, the respiratory distress,” he says. “The most worrisome thing for parents is when kids have breathing problems, or you see your kid has very fast chest movement, or their lips turning blue,” he adds. “These are red flags to take them to the ER.”
Omicron Wave
Early international data offer some encouragement. Investigators contrasted the fourth COVID-19 wave in South Africa, this time related to omicron, compared to previous waves in that nation caused by other variants.
“A different pattern of characteristics and outcomes in patients hospitalized with COVID-19 was observed in the early phases of the fourth wave compared with earlier waves in South Africa, with younger patients having fewer comorbidities, fewer hospitalizations and respiratory diagnoses, and a decrease in severity and mortality,” according to a research letter published online Dec. 30 in JAMA.
Despite a trend toward milder cases, dangerous consequences can still arise.
“We’re not seeing that much of complications in terms of going into the intensive area unit, mechanical ventilation or complications,” Hijano notes. “But those are still there. The same thing that’s happened with delta is what we see with omicron. It’s not that the virus is more severe, it’s just that the more cases you have, the more people we’ll see in the hospital. And the more people we see in the hospital, the more people will get complications, as a matter of numbers.”
Once at the hospital, O’Donnell says, “We need to make an assessment as to whether or not you have adequate oxygen levels in your blood,” she says. If not, “You’re going to need supplemental oxygen. That’s one of the key supportive care therapeutics that we do for patients with COVID-19.”
You’ll also get a chest X-ray to assess your lungs. “If you’re unvaccinated, if you’re immunocompromised, if you’re someone who’s having a severe breakthrough infection for another reason and now you have lower respiratory tract pneumonia, we need a chest X-ray to see that,” O’Donnell says.
If that’s the case, “There are therapeutic options that we would institute.”
[See: Ways to Boost Your Immune System.]
Treatment Options
Therapeutic options to treat COVID pneumonia include the antiviral medication Remdesivir and dexamethasone, a specific type of steroid to help with some of the inflammatory response from the pneumonia, O’Donnell says.
“And then there are other biologic medications that we also know are effective when patients have more severe COVID, to try to treat them and prevent them from requiring a ventilator, or worse like going into a full-throated respiratory failure with sepsis and shock,” O’Donnell explains.
Vaccination Impact on Symptoms
Your vaccination status influences the seriousness of COVID-19 symptoms. “It depends a bit whether you are an unvaccinated person, a vaccinated person or a vaccinated and boosted person in terms of what kinds of symptoms you will experience if you are infected with the omicron variant,” O’Donnell says.
Not surprisingly, the biggest contrast in symptom severity across the vaccination spectrum exists between people who’ve received any vaccine doses versus those who’ve received none at all:
Unvaccinated. “For patients who are unvaccinated and who get an omicron infection, we would expect and we have seen that the types of symptoms you get are very similar to the symptoms that you would get with delta or the original, or alpha, variant,” O’Donnell says. “Those are things we’ve talked about, really, since the beginning of the pandemic. Patients get a cough and shortness of breath, and they get fever and fatigue. And they can also have a host of other symptoms including, of course, the well-known loss of sense of taste and smell.”
Also as throughout the pandemic, she says, “Some of the symptoms can be also similar to cold symptoms like nasal congestion, runny nose or sore throat.”
Vaccinated at any level. “What’s being reported anecdotally and in some very early, not yet peer-reviewed data from South Africa and Europe, is that for the boosted or vaccinated population, the symptoms do appear, in general, to be much milder and to be more commonly associated with the common cold-type symptoms: runny, stuffy nose, nasal congestion, sore throat and headache,” O’Donnell says. “Less so are people getting fever.”
Vaccinated plus booster dose. With omicron, O’Donnell says, “If you’re vaccinated and boosted, we’re not seeing people with shortness of breath and cough to the same degree that we did in earlier versions — or certainly not as compared to the unvaccinated.”
Although omicron appears milder that previous variants, “It’s not milder for everybody,” O’Donnell emphasizes. “If you’re not vaccinated, this is still going to cause the same symptoms that we’ve talked about with all versions of SARS-CoV-2 (the COVID-19 virus) since the beginning of the pandemic. And you’ve very much at risk for ultimately getting shortness of breath, cough and pneumonia associated with an omicron infection.”
[READ: Should I Get the COVID-19 Booster?]
No Symptoms Whatsoever
You can be infected with omicron without experiencing any symptoms. “Hospitals across the country have instituted COVID testing on admission for patients who are coming into the hospital for any reason and in need of a hospital bed,” O’Donnell says. “As we are managing through the omicron wave right now, we are finding a lot of people who have no symptoms but are COVID-positive.”
Overwhelmingly, she says, asymptomatic people are those who have been vaccinated or vaccinated and boosted.
The positive point about vaccinated people who become infected while having few or no symptoms is what that implies: “To me, that’s an indication that vaccines work and they’re really effective,” O’Donnell says. “Because, if that person had not been vaccinated, or vaccinated and boosted, they may very well have developed further complications and COVID pneumonia.”
Hijano also stresses the importance of immunization. “The good news is that the booster really makes a difference,” he says. “The problem is that we cannot get enough people to actually go for a booster.”
Vigilance Is Still Key
Omicron’s dominating presence makes it difficult to avoid. However, taking the same steps to protect yourself and your family as with previous COVID-19 variants is imperative for reducing the risk of exposure or severe symptoms and complications.
“Right now, what anybody and everybody should also be doing — in addition to making sure that they’re optimizing their immunity through vaccines — is to wear a well-fitted mask, certainly when they’re out in public or around others,” O’Donnell says. “And to continue to make assessments about what they think is the safest way to go about their daily lives — meaning, large events, indoors, unmasked are very unsafe at this point in time. Wearing a mask, limiting your attendance in large crowds, sticking with people that you know if you’re getting together” are all safety measures.
If you’re going somewhere where you or others might be maskless or otherwise vulnerable, such as making a nursing home visit, COVID-19 testing may well be mandated. As of Jan. 18, you can order four free COVID-19 test kits per residential address via the COVIDtests.gov website. (Keep in mind the potential for false negatives with rapid testing and continue to practice caution.)
More from U.S. News
Items to Pack in Your Hospital Bag
Personal Protective Equipment (PPE): Definition and Examples
How to Describe Medical Symptoms to Your Doctor
What Are the Symptoms of Omicron? originally appeared on usnews.com
