Omicron: Omigod???

The World Health Organization has designated a new COVID variant, B.1.1.529, as a “Variant of Concern,” and given it the handle “Omicron.” They skipped over Nu and Xi for obvious reasons. VOC is their most serious rating, though not every VOC is equally dangerous. Omicron was discovered in Botswana and South Africa just a few days previously.

It has already shown up in a number of African countries, plus Israel, Hong Kong, the UK, Germany, Italy and Belgium. Travel bans covering certain African countries have already been set by Israel, Japan, the UK, the EU and the US. The South Africans who detected the new variant are among the best in the world at this, and are now not happy with the travel bans, which feel like punishment to them.

Omicron has prompted this rapid reaction because it exhibits an astonishing 32 (or so) spike protein mutations, including some recognized as being associated with high transmissibility in other variants, some recognized as being associated with vaccine evasion, and others which have not previously been seen. For perspective, the Delta variant has 9 significant mutations.

Scientists speculate that this variant incubated for quite a long time in an immune-compromised person, perhaps someone living with HIV. It is not a direct descendant of Delta. Early data in South Africa suggests that Omicron may be much more transmissible than Delta. Because this data is early and is based on a “short cut” in detection, it may not prove to be true, but the scale of difference is sobering.

Delta was 70% more transmissible than Alpha, it’s already-transmissive predecessor. Omicron may be 500% more transmissive than Delta. The sheer scale of the difference is reason for caution about the data. If it is true, however, Omicron has every chance of doing to Delta what Delta did to previous variants–run the global table.

This is a concern for three reasons: first, it would make the unvaccinated even more vulnerable: “herd immunity” would require so close to 100% immunity rates as to be useless. The second reason is the risk that Omicron could have reduced susceptibility to the current vaccines. If it does (and the mutations suggest that it could) the world will have to create modified boosters and deploy them to contain the threat. This is technically possible, but our economic, political, and social track record doesn’t suggest it will happen as rapidly or completely as it should. The third reason is the risk that Omicron could create more serious infections. There’s no specific reason to believe that it does, but all those mutations are a reason to be wary.

It’s important to note that there is no firm data yet about whether Omicron will be better at evading vaccines (and antivirals) than Delta–we should know more within two weeks. There’s also no data at all about whether it creates more serious infections–that data may take longer to uncover. The transmissibility data is preliminary–it might not predict what Omicron will do outside of certain provinces in South Africa. We should understand that better in a few weeks. The combination of alarm and uncertainty is jarring. In a world battered by almost two years of COVID, another global call to battle stations just as another Delta wave is breaking is an emotional blow. The Dow Jones Industrial Average dropped 900 points yesterday, which is as close as it gets to showing emotion.

Omicron arrives at a challenging moment—there’s a new wave of Delta variant cases in Europe sufficient to lead to new lockdowns and vaccine mandates, and riots against the lockdowns and mandates. A Delta wave seems to be building in the US as well, which is likely to be accelerated by holiday travel, now nearly back to its pre-COVID levels. As hospitalizations rise again across the US northern tier, the parlous state of our healthcare workforce is being exposed. Ed Yong in The Atlantic points out that we’ve lost perhaps 20% of such workers to COVID deaths, Long COVID, COVID risk, COVID burnout, and healthcare mismanagement, with the wounds salted by pugnacious anti-vaccination behavior.

The fragility of our healthcare system has been increasing since well before COVID arrived, but COVID is amplifying it to a crisis point. If Omicron piles in on top of the Delta wave now building, our healthcare system may be badly overwhelmed, with a consequent price paid in deaths and more Long COVID. Speaking of Long COVID, recent research also claims that it’s much more prevalent than first realized, with about 50% of COVID patients still showing symptoms six months after initial infection, even in mild cases.

This moment is also challenging because so many people are feeling “just done” with the pandemic and are desperately ready to live more normally again. A recent spate of high-profile commentary has urged people to understand that we’re “entering the endemic phase” (spoiler: were not) and that we “need to learn to live with the virus” in ways that accept a certain degree of risk but also restore the benefits of relatively normal living.

The popularity of this particular thread of thought leadership is understandable, but in my view premature. The US has a low vaccination rate of under 60% fully vaccinated. Even Europe, with vaccination rates in Western Europe ranging from 68% to nearly 90%, is suffering a Delta surge, and now waits to see what Omicron will do. If it’s bad there, it will be worse here, and we’ll be scrambling back to defensive positions.

Over the next few days we’ll see a torrent of Omicron stories, on a spectrum between “the end of the world is nigh” and “calm down, this may turn out to be nothing.” Over the next few weeks scientists will learn a lot about Omicron, and we’ll begin to get a sense of whether we will dodge this bullet or be scourged anew.

For an excellent close review of the Omicron situation by an actual epidemiologist, I highly recommend this post by Katelyn Jetelina, written in lucid English: