It’s still wait-and-see time for many key characteristics of the Omicron variant. I think the fact that it’s going to cause more breakthroughs in vaccinated people, and re-infections in people with prior infections, is baked in. The rest will take some time. Herein a few thoughts.
6 December 2021 – It’s been a difficult 18 months. Alongside the inescapable anxiety and dread and horror, the first few months of the coronavirus pandemic brought a promise of collectivity. Here was a crisis that, for all the inequalities it surfaced and recapitulated, didn’t leave anyone out. Even Americans realized that everyone mattered to everyone else.
But then it all vanished. After the first lockdown and Trump’s abandonment of his own suppression plan, the COVID deniers came to the fore in the Red States – America’s bastions of Republicans and the far right. And then the vaccines (and the COVID variants) arrived. And as quickly as the vaccines arrived, disinformation traveled even faster. The anti-lockdown protests of 2020 segued seamlessly into the anti-vax fervor generated by the televised right and the online right. In America, culture war has no territorial limit; it can be expanded to include anything, and in 2021, it came for vaccines. The outcome felt almost inevitable. Safety from infectious disease is a collective problem, and the structure best equipped to address problems at this scale is the state. Without mandates, clear messaging, or a national strategy, the obligation to make an individual decision led everyone – vaccinated and unvaccinated alike – into the maws of the culture war.
Of course, it swept across Europe, too. In Austria (the “Make Austria Great Again” hats were a nice touch), in Belgium, in Germany, in Italy, in The Netherlands.
And then came the Omicron variant. Different than the previous variants, but expected. Because pandemics do not die – they fade away. They just become another endemic disease. The Omicron variant is showing the entire world how all viruses mutate over time, and it’s offering a much clearer picture on our future with COVID-19. No, Covid is not done yet. But by 2023, it will no longer be a life-threatening disease for most people in the developed world. It will still pose a deadly danger to billions in the poor world. But the same is, sadly, true of many other conditions. Covid will be well on the way to becoming just another disease.
As to Omicron variant, as I noted in the header, I think the fact that it’s going to cause more breakthroughs in vaccinated people, and re-infections in people with prior infections, is baked in. The rest will take some time. It’s absolutely too early to conclude that Omicron is milder or more severe on average, or that vaccine efficacy will be preserved as is, or not – or even why exactly it’s spreading. Just too early, and I would not pay any attention to conclusive sounding statements.
From the sequence and what we know so far, maybe the one thing we can say is a good level of antibody evasion is baked in. But that, by itself, doesn’t tell us what it means for the pandemic. Remember Beta? B.1.351? Antibody evasion but little impact on pandemic.
Transmissibility is the more important question. I expect to see more clarity on that from the U.S. and the UK testing: watch especially indicators like spread among the household. Remember, spread can be due to inherent transmissibility or just ability to re-infect people who are otherwise vaccinated or had prior infections before. If it were spreading among immunologically naive populations, we’d also have to wait to see if it was just chance: one strain got introduced earlier than others, but I think we are past that with this: it is spreading more—but how much of what factor is playing what size role? We shall learn, in time.
Severity is the other big question, and it a two-parter.
First: how severe will re-infections or vaccine breakthrough will be? Immunology suggests, everything else equal, they would be milder (see this great post here, by Dylan H. Morris), but everything else is not equal. This is a new variant, and the best data on this will be the epidemiology. There is no way to look at just the sequence and assign a disease course. Still, it is not a brand new disease for the seropositives, people with prior infection and vaccination, and one expects disease course to be, on average, milder – subject to the usual conditions like immunocompetence, age and comorbidities.
Second: what about the seronegatives? People with no vaccination, no prior infection? Well, they are already sitting ducks for Delta, which is highly transmissible and likely more severe than other strains, so the severity question may well play out differently for them. Getting vaccinated would be the best idea, obviously.
It takes about two-three weeks from exposure and infection to hospitalization, and about four-six weeks to death. Plus, all early data is subject to selection effects: if the first superspreader events are in, say, college campuses, we get a young cohort who tend to have milder outcomes anyway, so we can’t really get a picture of severity from them easily – severe cases are already rare, so harder to tell the signal from the noise with smaller samples.
All this means it may take until the end of December or even early January to get clarity on the question of severity, likely from South Africa and United Kingdom and some European countries with good tracking. But maybe the U.S., too, as its Omicron numbers are going up.
I know this isn’t a good way to enter into the winter season, and I think even the best option will suck – many breakthroughs aren’t great to experience even if they turn out to be mild. Plus, the stress on the health system is very real, plus it is winter in the Northern Hemisphere, so peak season anyway for respiratory illnesses.
By the way, getting vaccinated will certainly help even with a new variant, and so will the booster. Especially if Omicron turns out to be severe, we may be in for a variant-specific booster at some point, but the vaccines we have are still expected to provide substantial protection against severe progression, and good masks, ventilation, air-filtering etc. work against all variants.
And what if this does not turn into a crisis? That’s still possible. Still, it’s best to prepare while waiting. A few weeks of stress, and even overreaction, is better than finding out too late that it will cause us more problems than we anticipated, and also that it’s too late to do anything about it.
I’ll end with a great cartoon by Jens von Bergman (deliberately in the style of XKCD) who has PhDs in Physics, Computer Sciences and Mathematics and now has his own company doing data analysis and visualization. As I have noted before, there has been a tsunami of COVID/coronavirus material to read, with high levels of complexity. He has helped me through the infodemic.
He was thinking about how different people interpret data differently and made this xkcd style graphic to illustrate this. Changing the title from “Public Health” to “Politicians” may be appropriate in some jurisdictions 🙂
