Omicron & Mild Versus Severe COVID-19: Why You Need the Booster Jab When Pregnant

Along with being more contagious than other variants of SARS-CoV2 (the virus that causes COVID-19), the Omicron variant has become a keystone in false narratives that anti-vaxxers circulate as part of an effort to dissuade people from getting jabbed and re-jabbed with one of the approved COVID-19 vaccines. So today, we will unpack this issue, weaving in a theme that we have emphasized previously, namely that for medical interventions to be science based, they must have a scientifically valid mechanism for how they work, in addition to having evidence correlating their use to outcomes (things that happen to the patient). To give you an extreme example of what I mean, in order to illustrate the point, consider the practice of acupuncture. This involves the insertion of needles into particular locations on the body to alleviate pain, limitations of motion, and other discomfort. While it’s possible to find evidence here and there of people’s symptoms improving after they receive acupuncture treatment, the points on the body and the so-called energy flow (Qi) pathways that acupuncturists believe relate those points to health, have no basis in the anatomy of the human body that has been elucidated in the centuries since acupuncture was invented. I have digressed, but it’s to make a point. The reasoning of anti-vaxxer activists is equivalent to the reasoning of other groups that often claim to be scientifically founded, yet are not reasoning based on the world that science has begun to reveal to us, down to the levels of cells, molecules, and atoms.

That’s why you should not so much as flinch, when antivaxxers give you their latest narrative, which is that the increasing incidence of infections of the Omicron variant among people who are fully vaccinated proves that “the vaccine” (anti-vaxxers typically refer to the various COVID-19 vaccines in the singular, since amalgamating various things into broad categories to misconstrue is what they do) doesn’t work. So let’s begin by making one thing clear, as we have done before: the purpose of COVID-19 vaccination is not to prevent all spread of the virus from one person to another, although would be a nice added benefit. The purpose of getting jabbed, rather, just like for the flu and certain other infectious diseases, is to keep people from getting severely sick or dying, if and when they do become infected. The purpose is to keep hospitals and intensive care units (ICUs), hospital oxygen supplies, mechanical ventilators, and extracorporeal membrane oxygenation (ECMO) equipment from being inundated with cases of preventable severe disease, thereby making those facilities and resources unavailable to people who need them for other reasons. In the case of you being pregnant, the purpose is to reduce, by orders of magnitude, the chances that you’ll wind up in the ICU on seven or eight different intravenous medications, induced into a coma, with a tube down your throat, giving birth to a pre-term infant with health problems, instead of being home with a mild case of COVID-19, taking one or two pills, with your lungs working normally. For these purposes, preventing severe, life threatening disease, the vaccines work extremely well, particularly after three doses (two, if your first was the Janssen vaccine), including for the highly contagious Omicron variant.

Let’s consider now what the reason might be for these outcomes. Earlier in the pandemic, we discussed how SARS-CoV2 can cause upper respiratory tract (cold-like) symptoms, yet causes much, much worse disease, if it is able to penetrate cells in the lower respiratory track (lung cells). This starts a disease process in the lungs, while also getting the virus inside the body to cause problems outside the lungs as well. The penetration of the virus into lung cells and other body cells happens through a receptor, a protein on the surface of the body cells, called ACE-2. The virus is able to attach to the ACE-2 receptor by way of the spike protein that projects outward from the viral coat, getting the virus into the cell while also distracting the ACE-2 from its day job, thus further contributing to health problems. The spike protein projections are what give the virus a crown-like (coronal) shape when viewed in electron microscopy, and it’s only because of the spike proteins that the virus can invade cells. Now, what the vaccines (Moderna, Pfizer/BioNTech, AstraZeneca/Oxford, and Janssen) are designed to do is to equip your cells with spike protein to project on their surfaces (Novavax, in contrast, provides piece of the spike protein itself). Some of the cells that end up doing this are special cells called antigen presenting cells, which teach the immune system to recognize the virus and also remember it. The spike protein that the vaccines cause your cells to make and present on their surfaces, cannot cause those cells to harm other cells, because the vaccines are programmed to make a form of the spike protein that is locked into a certain shape that prevents it from binding to the ACE-2 receptor. All that it can do is to provoke an immune response and the vaccines are designed to that the immune response produces antibodies mostly against the region of the spike protein that binds the ACE-2 receptor. This means that, even when dealing with variants like Omicron that are able to escape the immune response of vaccination —such that you can be vaccinated and be hit with mild COVID-19, due to the virus causing upper respiratory tract (cold) symptoms— the antibodies that an otherwise healthy person will make as a result of vaccination will neutralize the very part of the virus that otherwise would connect with the ACE-2 receptor and infect your body cells. This is especially true for those who get that third dose (and in some countries, such as Israel, even a fourth dose being given to older people may increase this effect). This is a hypothetical, but scientifically plausible, reason for why you should not be surprised about people getting mildly ill and testing positive for SARS-CoV2, even after three jabs, yet those who are otherwise healthy and vaccinated are staying fairly well-protected against severe COVID-19. And guess what; this proposed mechanism is consistent also with the epidemiological data which say: Who is getting severely ill and dying? The unvaccinated. Who is not getting sick, or getting only mildly sick? The vaccinated. So go get that third dose now.

David Warmflash
Dr. David Warmflash is a science communicator and physician with a research background in astrobiology and space medicine. He has completed research fellowships at NASA Johnson Space Center, the University of Pennsylvania, and Brandeis University. Since 2002, he has been collaborating with The Planetary Society on experiments helping us to understand the effects of deep space radiation on life forms, and since 2011 has worked nearly full time in medical writing and science journalism. His focus area includes the emergence of new biotechnologies and their impact on biomedicine, public health, and society.

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