Omicron is making its impact felt not just in Colorado, but across the country and globe. 

With cold and flu season also at its peak – and general pandemic uncertainty still present – CU Anschutz infectious disease experts, and CU Medicine providers, Dr. Thomas Campbell, and Dr. Steven Johnson, laid out nine facts on identifying and treating the highly infectious omicron variant.

1. Omicron symptoms mimic other SARS-CoV-2 variant symptoms

They include: 

• Cough
• Shortness of breath
• Stuffy nose/nasal congestion
• Runny nose
• Sore throat
• Headache
• Fatigue
• Muscle aches and pain (myalgia)
• Chills
• Fever 
• Gastrointestinal symptoms, such as nausea or diarrhea

2. Standout omicron symptoms are primarily respiratory

Johnson and Campbell note that there have been some reports of higher rates of upper respiratory tract symptoms with omicron, including sore throat and nasal congestion.

“Omicron is less likely to infect the lungs compared to previous variants,” Campbell said, adding that the infection can, however, progress to bronchitis or pneumonia.

While some other symptoms, such as lower back pain and night sweats, have been reported with omicron, Campbell said those symptoms are more indicative of the flu, and that there might be some case confusion given the peak cold and flu season. 

People experiencing any of the above symptoms should get a COVID-19 test to be sure.

3. Immunity can account for some milder symptoms 

Our bodies and their immune system response are adapting to mutations of the new omicron variant, Campbell and Johnson said. 

“What's different about omicron is that it has way more mutations in the spike protein than other variants,” Campbell said of the coronavirus’s entryway into the cells. “You're going from 10 to 15 mutations in previous variants to over 30 mutations in omicron.” 

Also, Johnson said, “most people in the U.S. already have some degree of partial immunity to SARS-CoV-2 based on vaccination, prior infection, or both. Consequently, symptoms may be modified because of this partial immunity, including lower-symptom severity.” 

4. Basic medicine cabinet essentials can help

For those without any underlying health issues, treating omicron is primarily supportive, similar to previous variants. 

Both Campbell and Johnson recommended using acetaminophen (Tylenol) when needed for symptoms that include headache, muscle aches or fever. 

The Food and Drug Administration (FDA) has evaluated anti-inflammatory medications, such as ibuprofen (Advil) and naproxen (Aleve), Johnson said. “At this time, there is no clear evidence that these are harmful, but I personally recommend acetaminophen for symptom management.”

For that runny or stuffy nose or cough, Campbell said over-the-counter nasal decongestants and cough syrup can help.

5. Staying hydrated can relieve some symptoms 

Good hydration is important and can help all bodily functions, including preventing kidney problems during sickness and lessening feelings of weakness, malaise and dizziness, Johnson said.

Electrolyte drinks can help with hydration, but for most people, water and juice will suffice, Johnson said.

6. High-risk individuals should ask doctors about oxygen monitors

During the pandemic, some people have purchased oxygen monitors (pulse oximeters) to track their oxygen levels at home.

Johnson warned that people shouldn’t rely solely on such devices. “Anyone with shortness of breath should contact their provider, because that could be a sign of pneumonia.”

For high-risk individuals, an oxygen monitor might be useful, and Johnson said they should consult their doctors.

7. Everyone should get tested. High-risk individuals should call their doctor 

Campbell and Johnson both stressed that people at higher risk for COVID-19 should contact their doctor when experiencing symptoms, regardless of severity. And everyone should get a test as soon as they experience symptoms, the experts said.

Specific warning signs to look for are: 

• High fever 
• Shortness of breath
• Chest pain
• Weakness
• Neurologic symptoms such as: dizziness, confusion, or severe headache

8. Some newer treatments can help, but come with caveats 

For more severe cases of COVID-19, treatment using antiviral pills or monoclonal antibodies is an option. 

However, Campbell and Johnson stressed that the treatments are in limited supply, are currently under FDA Emergency Use Authorization and are reserved for those at highest risk. They are also meant to be taken early on during infection. 

As a result, these treatments are not available at a pharmacy. Monoclonal antibodies are also an IV infusion, meaning they are only given at an infusion center or an emergency room. 

However, these treatments are effective at preventing serious hospitalization or death. 

Previously in the pandemic, providers have been using a monoclonal antibody combination produced by Eli Lilly and by Regeneron (bamlanivimab with etesevimab and casirivimab with imdevimab, respectively) in severe cases of COVID-19. 

The combination does not work against omicron, due to the mutations in how the virus attaches itself to human cells, Campbell said. “Fortunately, there is one antibody preparation, a monoclonal antibody called Sotrovimab that is made by GlaxoSmithKline, that does have full activity against Omicron,” he said. But, again, that is in short supply, he said.

Johnson added that the AstraZeneca monoclonal antibody treatment (a combination of tixagevimab with cilgavimab) does appear to retain effectiveness against omicron when taken as a pre-exposure preventative measure in immunocompromised patients.

There are also three antiviral drugs available for COVID-19 (all currently in short supply):

• Paxlovid (two medicines of nirmatrelivir/ritonavir) 
• Molnupiravir
• Remdesivir 

Paxlovid in particular, Campbell noted, has the ability to work around omicron’s mutations. “By interfering with virus replication, we get the same benefits (with Paxlovid) as with the monoclonal antibodies – reduced risk of hospitalization and death,” he said.

However, Paxlovid does have a number of other drug interactions. Campbell says that providers are needing to look carefully at a patient’s list of medicines they are taking to avoid any serious interactions. 

Data has also shown that short, three-day courses of Remdesivir in an outpatient setting reduces hospitalization and death from COVID-19.

Molnupiravir has also been used during COVID-19 treatment, as it doesn’t have the same drug interaction concerns as Paxlovid. However, it “doesn’t work as well” in treating moderate to severe COVID-19, Campbell said.

9. The best shot at avoiding severe COVID-19? Get boosted 

If Campbell had to give a final recommendation for people concerning omicron, it’s to get your booster shot. 

“It's really clear that two doses of either the Pfizer or Moderna vaccine do not protect very well against omicron,” Campbell said. Third doses (four for immunosuppressed individuals) are, however, making a difference, he said.

Need a booster? Or your first round of the COVID-19 vaccine? Click/tap here for more information.

This story was originally published in CU Anschutz Today.