As the first COVID-19 vaccine deployed in December 2020, the coda to an unprecedented year in so many ways, people all around the world looked forward with optimism to what 2021 would bring.
At the same time, UNLV scientists peered into manholes and identified — in Las Vegas wastewater — what would be next for the pandemic.
“It’s a strange feeling of deja vu,” said Edwin Oh, associate professor and head of the Neurogenetics and Precision Medicine Lab at UNLV. “In some ways we’re back to where we were a year ago having these types of conversations on what does it mean to have such high levels of virus circulating in a community?”
A full month before the Alpha variant showed up in human test results, a team of UNLV scientists in collaboration with the Southern Nevada Water Authority identified the variant in local wastewater, a key indicator of the success of the joint wastewater surveillance program. Later, with the same precision, UNLV scientists detected the Epsilon variant and informed local public health officials well before the first human infection appeared.
Now, it’s a similar story but with a much more highly transmissible yet seemingly milder variant: Omicron.
“For Omicron, we found it a week before the very first human infection in Southern Nevada,” Oh said. “So we know that this type of program can predict up to a month in advance when we’ll see the first reported infections from a variant.”
With case counts “getting to a level we’ve never seen before,” we sat with Oh - virtually - to get an understanding of what this latest development means in our almost-two-year fight against COVID-19.
What are we seeing in the wastewater data now, and are you surprised that we’re at this point a year later?
We have seen a remarkable spike in SARS-CoV-2 levels in wastewater. In addition, Omicron has almost displaced Delta in wastewater, and we now predict at least eight to nine out of 10 infections from here on will be Omicron.
I think when we talked last year, one of our biggest fears was that we would end up with a variant that would be somewhat resistant to the vaccines we have in place. More data needs to be collected, but current wastewater values are suggesting that we’re going to see all-time, record numbers of patients, of cases, of infections over the next two or three weeks. We’ve already hit all-time highs, but there’s a very good chance that we’re not even close to the peak.
How do we know that?
Because of the wastewater values that we’ve seen as of Dec. 27. Those values are predicting individuals who are showing up now and also those who potentially got infected on Christmas, because of celebrations. Those values are going to be derived from pre-symptomatic, asymptomatic, and symptomatic people.
In the wastewater, the speed at which Omicron has displaced Delta is at least two times as fast as what we saw in June for Delta, so this is a variant of concern that is a lot more transmissible than Delta, without a doubt.
What should communities, public health officials, and the government do with this data?
We have to be sure that the rapid tests are readily available, and that the accuracy of the tests for Omicron are going to be highly sensitive. These metrics need to be at a level that we can trust. Because if this is the dominant variant out there, we need testing tools that can tell us whether we’re infected and, if so, we should stay home and avoid spreading the disease further.
Is the data that our program provides going to fix the testing kits right away? No, absolutely not. But at least we won’t be in the dark for a month or two about why these tests aren’t consistent with the high case numbers we’re seeing in our hospitals.
Is Omicron going to be the last variant of concern in our community?
Absolutely not. There are already reports about one or two new variants circulating in the U.K. and France right now that look a little bit like Delta.
When SARS-CoV-25 shows up eventually, we have to be ready. And I think what we learned two years ago is that we were caught off guard. We didn’t have these surveillance programs in place to be able to let us know whether 5% of our community might be at risk, or whether 95% of our community is at risk. And so, our wastewater values are proof that we have this type of infection throughout all communities in Southern Nevada.
Where is the wastewater surveillance program headed as we enter this new territory of the pandemic?
For the last year and a half, we focused mainly on urban areas in Clark County, but we’re now expanding the program to be more comprehensive, and cover less-populated areas like Moapa Valley, Searchlight, Blue Diamond, Indian Springs, and Pahrump. Our rural communities are potentially more vulnerable if a dominant variant shows up because we don’t have as many medical and public health resources in those areas. This is a collaboration with Dr. Duane Moser at the Desert Research Institute.
For the rural communities that we’ve started tracking, a big silver lining is that Omicron is definitely not as dominant, and we want to keep it that way.
We know that the virus will mutate, but will it mutate to a point where vaccines are completely ineffective? We don’t know but, again, surveillance programs like ours will let us know if it happens and will let us plan in advance. With these new mutations, we can then go back to the lab to figure out whether vaccines will still work when variants start to evolve.
Are there any other silver linings?
Collaborations matter! Through our community collaborations with the Southern Nevada Health District, the Southern Nevada Water Authority, DRI, and the Clark County School District, we have been able to provide real-time information about this virus in Southern Nevada. In addition, our program began monitoring for flu strains this past fall, and we’ve expanded our program to partner with 20 states. While we have seen influenza at really high levels in Michigan, Rhode Island, and Florida, we haven’t seen high levels of influenza here in Las Vegas, Henderson, or from the Strip, and from the less urban areas in Nevada. That’s a great thing; we have yet to see the twindemic that everyone feared. And this is likely thanks to our mask mandates, as well as the fact that our local communities are being a little more vigilant.
Overall, we’re also better prepared to deal with pandemic-like situations. Back in March 2020, there was this paralysis that shocked all of us. Now in January 2022, we know that you have a highly transmissible variant around so you should: wear your mask, take extra measures to wash your hands, stay home when sick, and most importantly, you get vaccinated or boosted. Folks need to remember that things will get better and we will emerge from this pandemic smarter and empowered to deal with the unknown.