As omicron overtakes delta as the dominant COVID variant, the number of infections – and people seeking testing – have risen sharply.

Omicron accounts for an estimated 98% of U.S. COVID cases, and nearly 100% of infections in North and South Carolina, according to the Centers for Disease Control and Prevention (CDC). And unvaccinated individuals are most prone to severe illness, said Dr. David Priest, Novant Health chief, safety, quality and epidemiology officer.

Dr. David Priest
Dr. David Priest

“I think every human on the planet, short of someone who's a castaway on a desert island, will get exposed to the virus. And while we don't see omicron necessarily targeting one age group over another, we certainly do see it preferentially affecting those who are unvaccinated and unboosted,” Priest said.

Omicron is 2 to 3 times more contagious than delta, he said, and up to 6 times more contagious than original strains of COVID, “which explains the incredibly quick movement of this variant.”

Another concern among scientists is that most treatments for COVID are not effective against omicron. Sotrovimab – administered via IV infusion, which delivers the medication directly into the bloodstream – is the only monoclonal antibody treatment holding up, Priest said, and supply is “extremely limited.”

Newer treatments such as Paxlovid and molnupiravir, anti-viral pills approved for people with mild to moderate symptoms, are effective in keeping COVID patients out of the hospital but their supply is also “incredibly low.”

“We’re really excited about these products, and they’ll be game changers once we have access to them, but there’s so little available right now. We need people to know that if they’re unvaccinated or at high-risk for complications from COVID, there will be limited therapies to help them if they get sick,” Priest said.

The bottom line: Don't wait to get vaccinated or receive a booster. Data has shown that three doses of Pfizer's or Moderna's vaccine gives a "significant boost in protection against omicron. It's not 100% but like I've said, nothing in medicine is," he added.

What makes omicron different?

In addition to being more contagious than earlier variants, omicron may also have a shorter incubation period.

"The incubation period could be as short as three days, making people contagious more quickly after they get it. That also leaves a smaller window for someone to discover they have it and get tested," Priest said.

When it comes to the notion that omicron results in less severe illness, he added, “I think for the volume of cases we have, it seems to be a little less serious in general. But when people who are vulnerable (the elderly, immunocompromised) get infected, they're likely to have complications.”

Omicron symptoms most commonly present as upper respiratory infections, sore throat, fever, cough and congestion.

"I don't personally see as much of the loss of taste and smell we saw earlier in the pandemic. So, these variants all have a different predilection for different parts of human anatomy and that can make their presentation a bit different. If you have symptoms of fever, sore throat, headache, congestion and cough right now, there's a pretty good chance you have COVID given the numbers we're seeing,"

Priest said.

Where can I get a COVID test?

For people seeking a COVID-19 test, please do not go to the Emergency Department unless you are experiencing life-threatening symptoms such as shortness of breath or low oxygen levels.

Novant Health testing locations and hours are located here. To help reduce wait times and ensure availability of tests, people are asked to make an appointment. Novant Health patients can also call their primary care physician’s office to inquire about testing.

Keep in mind, asymptomatic patients who are seeking travel, return-to-work or return-to-school clearance are asked to use the NCDHHS website to find a location that best suits their needs.

What are the recommendations on isolation and quarantine?

People with COVID should isolate for five days, the CDC said. If they’re improving or have no symptoms at the end of that time period, isolation is no longer required but guidance suggests they wear a mask around others for five additional days.

“I think this change was brought on by newer data that people with omicron are most likely to be infectious one to two days prior to getting symptoms, as well as the desire to balance safety and keeping society open,” Priest said.

The CDC also updated their recommendations on quarantining if someone is exposed to COVID but asymptomatic. Unvaccinated or unboosted persons should quarantine for five days followed by "strict masking" for five more days.

“If your vaccination is up to date, meaning you're not yet eligible for a booster or you've been boosted, you do not have to quarantine or stay home if exposed to COVID. But the CDC suggests you wear a mask for 10 days when around others. And they did say to consider getting a test on the fifth day,” Priest added.

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Are new COVID vaccines on the way?

Omicron has “raised some alarm bells” because of the number of mutations it has – particularly related to its spike protein. A spike protein is the part of the virus that allows it to interact with human cells, and what the vaccines train the body to recognize and attack.

“We need to understand if these mutations impact how the virus behaves, because it could affect our immune system’s ability to fight it,” Priest said.

He noted the current vaccines, particularly Moderna and Pfizer, remain “incredibly effective” in preventing hospitalization and death. "It shows that having a vigorous immune response to earlier strains, like delta, can protect people against newer ones."

With that being said, vaccine manufacturers are in the process of reformulating their mRNA vaccines. Here’s why: Scientists can find the genetic code that targets a very specific spike protein. Then, design their vaccine to make a spike protein that looks like that. Think of it as an instruction manual for your immune system.

Should I wait to get vaccinated until then?

No. Getting any approved COVID vaccine now is better than waiting, Priest said. That goes for your first vaccination or a booster dose, which the CDC now recommends for anyone 12 and above once enough time has passed since their last dose.

The CDC also shortened the waiting period from six months to five between Pfizer's booster and the second dose in its initial vaccine series. A booster shot is still recommended for all adults who received their initial series of the Moderna vaccine six months ago or the Johnson & Johnson shot at least two months ago.

Additionally, the CDC said immunocompromised children ages 5 to 11 should receive a third Pfizer vaccine (considered an additional primary dose) at least 28 days after their second shot. Pfizer’s vaccine is the only one available for U.S. children in this age range.

Should I be concerned about traveling or gathering with others?

It’s safest to travel if you’ve been fully vaccinated, Priest said, you’re masking in public and when you’re going somewhere with a group of people who are doing the same thing. But this comes back to your tolerance for risk and your potential for exposure to COVID.

"People have to make their own decisions and families have to work this out. I understand how hard this can be, but I think people should try to make the safest decisions they can," he said. As always, people are encouraged to mask indoors, social distance when possible and wash their hands often.

"If you're really concerned about a loved one who is vulnerable, gather outside or wear a mask," Priest said. "If you're symptomatic, of course, please get tested. But I don't think testing is something that has to be done if everyone is vaccinated and asymptomatic," he added.

If someone in your family is "super high risk," meaning they've had an organ transplant, have uncontrolled HIV or are going through cancer treatment, then a family may consider adding COVID testing to their strategy in family gatherings, Priest said.

What else can I do to protect myself?

If you have a child who is five or older, they are eligible for a COVID vaccine. Make sure they get it, doctors say. Vaccination protects the child, siblings who are too young to get one and our most vulnerable family members.

And get your flu shot if you haven’t already. It can be safely administered at the same time as a COVID vaccine or booster.