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COVID-19 Omicron Frequently Asked Questions

Questions and Answers updated as of January 31, 2022

General COVID-19 Questions

 

Are Alphas at a higher risk of contracting the Omicron variant?

There is no evidence that Alphas are at higher risk of becoming infected. It might be that Alphas with lung or liver disease are more likely to get symptomatic infection than healthy younger adults, but this has not been studied.

Should I avoid seeing my school aged grandchildren again?

The answer to this question depends on your age, underlying medical conditions (including lung or liver disease from Alpha-1), and tolerance for risk which will incorporate the COVID prevalence in your location at the time of your planned visit. As with many questions like this, it’s a risk/benefit decision.

Has COVID in vaccinated Alphas caused long term issues?

Yes. As with many people who contract COVID, there is a fairly high risk of having symptoms that persist for weeks or months. It is not clear if Alphas are at greater risk for these long-term symptoms but AlphaNet’s data suggest not. Vaccination appears to reduce long term symptoms.

Are Alphas at a higher risk of developing permanent lung damage after a bout of pneumonia, influenza or COVID-19?

While there are no formal studies of this, it is generally assumed based on our understanding of the role of alpha-1 antitrypsin (AAT) in moderating inflammation and resultant injury, that people with low levels of AAT will likely develop greater lung tissue injury than those with normal levels of AAT. Those on augmentation therapy would be expected to reduce this injury risk.

If I have been experiencing stomach pains and vomiting for 5 days with a low-grade fever, do I need to get a COVID test?

Yes, you should get tested as the symptoms for COVID are variable in different individuals and we see a lot of stomach complaints.

How long is the incubation period for the Omicron variant?

The typical exposure to symptoms with Omicron is 3 days.

Could the COVID vaccine RNA from a vaccinated blood/plasma donor be in the plasma that is used for weekly infusions?

The type of RNA used in mRNA vaccines is destroyed almost immediately in plasma and the mRNA that gets into the cells around the site of injection is destroyed within those cells very quickly. While I don’t know if this has been specifically looked at, there is virtually no possibility that augmentation therapy would contain any vaccine mRNA.

Would REGENCOV be a good treatment for anyone at risk, including those with Alpha-1?

It does not cover for Omicron and so it is not being used now. It was protective for the Delta variant.

My mom is a carrier, works as a kindergarten teacher, kids do not wear masks, testing for kids is voluntary. She just caught Omicron and had a mild case, she is also boostered. Can she get sick again since she is constantly exposed at work?

We do know that people can get reinfected from COVID and the data does not exist yet to know if your mom would be susceptible to the next variant. That said, recent data suggests that individuals who were infected and then vaccinated or vaccinated and then infected (like your mom) develop antibodies and immunity that is greater than vaccinated or infected alone. Researchers are calling it hybrid immunity and are wondering if individuals who develop hybrid immunity might not need boosters since serum from those individuals can actually neutralize variants that the individual was not yet exposed to. This is not yet proven but it looks very interesting, and the data is strong.

What is the new medication Evusheld and how can it benefit Alphas as it becomes more available?

Evusheld is a treatment that is used preventively in immunosuppressed people who have been or might be exposed to COVID. Since Alpha-1 is not a condition that causes immunosuppression, it does not currently have a role in preventing COVID. Alphas who have had a lung transplant or liver transplant and are therefore immunosuppressed are candidates for this drug and it is widely used at transplant centers.

Is there a new Omicron variant to be concerned about?

There is a new variant that is a derivative of Omicron, called B1.2. It has just arrived in the United States and may be more contagious that Omicron B1.1 but not thought to be more virulent. The data on Omicron B1.2 is rapidly evolving and in some countries, it is becoming the predominant variant.

Are monoclonal antibodies safe and recommended? Can they cause your body to not develop antibodies from future booster vaccines or not develop antibodies to fight the infection in the future? Would you need to always receive the antibodies as a treatment if you contracted COVID again?

Thanks to the Omicron variant, a couple of the available monoclonals are no longer recommended for treatment (namely those from Regeneron and from Lily). The newer Glaxo monoclonal does cover all the currently known strains. Unfortunately, this monoclonal is the newest and is in short supply. A fourth monoclonal is also becoming available as well.

Do you have data about the outcomes of COVID in Alphas that are on augmentation therapy vs. those not on augmentation therapy?

While AlphaNet has lots of data on Alphas receiving augmentation therapy, AlphaNet follows very few patients not receiving augmentation therapy and those not on therapy generally have normal lung function. There is certainly scientific evidence that alpha-1 antitrypsin protein plays a major role in protecting the lungs from the type of inflammation caused by COVID-19.

Are drugs like Paxlovid and Molnupiravir relatively safe and effective? Who will it be available to?

Paxlovid is benefiting patients but is in limited supply at this point in time and Molnupiravir was just released. It has more side effects than Paxlovid.

If hospitalized with COVID, should you continue receiving augmentation therapy?

For reasons mentioned above, we highly recommend you continue augmentation therapy when hospitalized.

Does augmentation therapy add an extra level of protection against COVID? Are there any studies on this?

There’s every reason to suspect that augmentation therapy will improve your outcomes from COVID if you have lung disease due to Alpha-1 but there have been no formal studies to confirm this.

If an Alpha if not on therapy, should they get on therapy if they contract COVID and/or if they are hospitalized with COVID?

From a practical standpoint, this would be extremely difficult to arrange and we don’t have sufficient evidence to recommend this.

Are there studies on using augmentation therapy on non-Alphas to help protect the lungs if a person contracts COVID?

Yes, there is a study on augmentation in non-Alphas and that should be published soon.

Are there studies on using augmentation therapy on non-Alphas to help protect the lungs if a person contracts COVID?

Yes, there is a study on augmentation in non-Alphas and that should be published soon.

Vaccines & Boosters:

 

What is the recommendation time for the booster third dose? Four months, six months or within 8 months?

Currently, it is recommended you get your booster 5 or more months after the first cycle of vaccination.

How important is it for me to vaccinate a child between 5-12 years of age?

This is a personal decision. It is based on your tolerance for side effects and your concern about the risks for some of the serious COVID effects seen rarely in children, such as myocarditis (inflammation of the heart muscle).

Should I get my 12–16-year-old child a booster shot? What is the earliest after the second dose that they can receive the booster?

The booster can be given 6 months after the original vaccines. There is some evidence that the booster’s benefit is small compared to the original vaccination in teenagers and young adults.

Is there any proof in the medical world that the mRNA vaccines are ineffective in slowing the spread of COVID-19?

The primary well-documented effects of mRNA (and other) vaccines against COVID are in preventing serious disease, hospitalization, and death. Vaccines may have a mild effect on the spread of the virus.

Does the booster shot target the current Omicron variant?

Both mRNA vaccines available in the US are effective at reducing hospitalization and death from Omicron.

Should I get a “second” booster if I have Alpha-1 and I am on augmentation therapy?

Unless you are a transplant patient, there is no evidence that you should get a “second” booster. Initial data on fourth shots does not show any benefit but it is too early to know whether they will help.

Should transplant patients get a second booster?

It is recommended that you discuss this with your transplant physician.

Are there any preventative recommendations to reduce the severity of COVID-19 infections besides vaccines? Ivermectin?

There are not yet known preventative measures for COVID. There are some pharmaceutical companies developing drugs similar to the ones used in flu such that you might be able to take upon exposure, but they are not yet available. Regarding Ivermectin, the data does not show any benefit from Ivermectin, and some people have suffered serious side effects from taking it for COVID.

Why recommend taking the current booster at all if it does not protect against Omicron?

While the current boosters may have minimal effect at protecting against becoming infected with Omicron, they both have dramatic benefit at protecting against hospitalization and death from Omicron. We are awaiting evidence evaluating whether boosters might make it much more likely that people infected with Omicron will be asymptomatic.

Were the vaccines created from the original spike of COVID?

The mRNA vaccines are not created from actual spike protein but by utilizing the published gene sequences of the spike protein from the medical literature and modifying them to make the spike protein generated in the recipient’s cell to be more stable.

Masks

Do I need to wear a mask outdoors now with the highly contagious Omicron variant?

Generally, only if you are in an outdoor situation where you can’t maintain a safe distance from others.

What masks are now effective?

All masks have some degree of effectiveness. Cloth masks are least effective. Surgical masks provide better protection. N95 and KN95 masks provide the best available protection available to the public. With any mask, good fit improves the protection provided.

If you wear two masks, will you be better protected if exposed to the virus?

Putting a cloth mask over a surgical mask, an N95, or a KN95 adds to their protection but may also make it more difficult to breath for those with underlying breathing problems.

What advice do you give to those with severe COPD who find wearing a mask very difficult? Are there any dangers for those with very low lung function wearing N95 masks?

There is not specific danger to wearing an N95 for those with more severe lung disease but the more effective the mask, the more breathing difficulties may occur. If you are too short of breath to wear an N95, you may have to switch to a surgical mask.

What are your feelings on face shields for those who have difficulty breathing with a mask on?

A face shield alone does not provide protection against infection. It’s better to switch from an N95 to a surgical mask, or if necessary to a cloth mask, than to use a face shield alone. A face shield plus a cloth mask increases the protection versus a cloth mask alone. Generally, face shields are used to prevent splatter of bodily fluids from infected individuals in a hospital environment.

Accreditations

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