It was not prepared for last winter’s surge. It was not prepared for Delta’s arrival in the summer or its current winter assault. More than 1,000 Americans are still dying of COVID every day, and more have died this year than last. Hospitalizations are rising in 42 states. The University of Nebraska Medical Center in Omaha, which entered the pandemic as arguably the best-prepared hospital in the country, recently went from 70 COVID patients to 110 in four days, leaving its staff “grasping for resolve,” the virologist John Lowe told me. And now comes Omicron.
Will the new and rapidly spreading variant overwhelm the U.S. health-care system? The question is moot because the system is already overwhelmed, in a way that is affecting all patients, COVID or otherwise. “The level of care that we’ve come to expect in our hospitals no longer exists,” Lowe said.
The real unknown is what an Omicron cross will do when it follows a Delta hook. Given what scientists have learned in the three weeks since Omicron’s discovery, “some of the absolute worst-case scenarios that were possible when we saw its genome are off the table, but so are some of the most hopeful scenarios,” Dylan Morris, an evolutionary biologist at UCLA, told me. In any case, America is not prepared for Omicron. The variant’s threat is far greater at the societal level than at the personal one, and policy makers have already cut themselves off from the tools needed to protect the populations they serve. Like the variants that preceded it, Omicron requires individuals to think and act for the collective good—which is to say, it poses a heightened version of the same challenge that the U.S. has failed for two straight years, in bipartisan fashion.
The coronavirus is a microscopic ball studded with specially shaped spikes that it uses to recognize and infect our cells. Antibodies can thwart such infections by glomming onto the spikes, like gum messing up a key. But Omicron has a crucial advantage: 30-plus mutations that change the shape of its spike and disable many antibodies that would have stuck to other variants. One early study suggests that antibodies in vaccinated people are about 40 times worse at neutralizing Omicron than the original virus, and the experts I talked with expect that, as more data arrive, that number will stay in the same range. The implications of that decline are still uncertain, but three simple principles should likely hold.
First, the bad news: In terms of catching the virus, everyone should assume that they are less protected than they were two months ago. As a crude shorthand, assume that Omicron negates one previous immunizing event—either an infection or a vaccine dose. Someone who considered themselves fully vaccinated in September would be just partially vaccinated now (and the official definition may change imminently). But someone who’s been boosted has the same ballpark level of protection against Omicron infection as a vaccinated-but-unboosted person did against Delta. The extra dose not only raises a recipient’s level of antibodies but also broadens their range, giving them better odds of recognizing the shape of even Omicron’s altered spike. In a small British study, a booster effectively doubled the level of protection that two Pfizer doses provided against Omicron infection.
Second, some worse news: Boosting isn’t a foolproof shield against Omicron. In South Africa, the variant managed to infect a cluster of seven people who were all boosted. And according to a CDC report, boosted Americans made up a third of the first known Omicron cases in the U.S. “People who thought that they wouldn’t have to worry about infection this winter if they had their booster do still have to worry about infection with Omicron,” Trevor Bedford, a virologist at Fred Hutchinson Cancer Research Center, told me. “I’ve been going to restaurants and movies, and now with Omicron, that will change.”
Third, some better news: Even if Omicron has an easier time infecting vaccinated individuals, it should still have more trouble causing severe disease. The vaccines were always intended to disconnect infection from dangerous illness, turning a life-threatening event into something closer to a cold. Whether they’ll fulfill that promise for Omicron is a major uncertainty, but we can reasonably expect that they will. The variant might sneak past the initial antibody blockade, but slower-acting branches of the immune system (such as T cells) should eventually mobilize to clear it before it wreaks too much havoc.
To see how these principles play out in practice, Dylan Morris suggests watching highly boosted places, such as Israel, and countries where severe epidemics and successful vaccination campaigns have given people layers of immunity, such as Brazil and Chile. In the meantime, it’s reasonable to treat Omicron as a setback but not a catastrophe for most vaccinated people. It will evade some of our hard-won immune defenses, without obliterating them entirely. “It was better than I expected, given the mutational profile,” Alex Sigal of the Africa Health Research Institute, who led the South African antibody study, told me. “It’s not going to be a common cold, but neither do I think it will be a tremendous monster.”
That’s for individuals, though. At a societal level, the outlook is bleaker.
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Omicron’s main threat is its shocking speed, as my colleague Sarah Zhang has reported. In South Africa, every infected person has been passing the virus on to 3–3.5 other people—at least twice the pace at which Delta spread in the summer. Similarly, British data suggest that Omicron is twice as good at spreading within households as Delta. That might be because the new variant is inherently more transmissible than its predecessors, or because it is specifically better at moving through vaccinated populations. Either way, it has already overtaken Delta as the dominant variant in South Africa. Soon, it will likely do the same in Scotland and Denmark. Even the U.S., which has much poorer genomic surveillance than those other countries, has detected Omicron in 35 states. “I think that a large Omicron wave is baked in,” Bedford told me. “That’s going to happen.”
More positively, Omicron cases have thus far been relatively mild. This pattern has fueled the widespread claim that the variant might be less severe, or even that its rapid spread could be a welcome development. “People are saying ‘Let it rip’ and ‘It’ll help us build more immunity,’ that this is the exit wave and everything’s going to be fine and rosy after,” Richard Lessells, an infectious-disease physician at the University of KwaZulu-Natal, in South Africa, told me. “I have no confidence in that.”
To begin with, as he and others told me, that argument overlooks a key dynamic: Omicron might not actually be intrinsically milder. In South Africa and the United Kingdom, it has mostly infected younger people, whose bouts of COVID-19 tend to be less severe. And in places with lots of prior immunity, it might have caused few hospitalizations or deaths simply because it has mostly infected hosts with some protection, as Natalie Dean, a biostatistician at Emory University, explained in a Twitter thread. That pattern could change once it reaches more vulnerable communities. (The widespread notion that viruses naturally evolve to become less virulent is mistaken, as the virologist Andrew Pekosz of Johns Hopkins University clarified in The New York Times.) Also, deaths and hospitalizations are not the only fates that matter. Supposedly “mild” bouts of COVID-19 have led to cases of long COVID, in which people struggle with debilitating symptoms for months (or even years), while struggling to get care or disability benefits.
And even if Omicron is milder, greater transmissibility will likely trump that reduced virulence. Omicron is spreading so quickly that a small proportion of severe cases could still flood hospitals. To avert that scenario, the variant would need to be substantially milder than Delta—especially because hospitals are already at a breaking point. Two years of trauma have pushed droves of health-care workers, including many of the most experienced and committed, to quit their job. The remaining staff is ever more exhausted and demoralized, and “exceptionally high numbers” can’t work because they got breakthrough Delta infections and had to be separated from vulnerable patients, John Lowe told me. This pattern will only worsen as Omicron spreads, if the large clusters among South African health-care workers are any indication. “In the West, we’ve painted ourselves into a corner because most countries have huge Delta waves and most of them are stretched to the limit of their health-care systems,” Emma Hodcroft, an epidemiologist at the University of Bern, in Switzerland, told me. “What happens if those waves get even bigger with Omicron?”
The Omicron wave won’t completely topple America’s wall of immunity but will seep into its many cracks and weaknesses. It will find the 39 percent of Americans who are still not fully vaccinated (including 28 percent of adults and 13 percent of over-65s). It will find other biologically vulnerable people, including elderly and immunocompromised individuals whose immune systems weren’t sufficiently girded by the vaccines. It will find the socially vulnerable people who face repeated exposures, either because their “essential” jobs leave them with no choice or because they live in epidemic-prone settings, such as prisons and nursing homes. Omicron is poised to speedily recap all the inequities that the U.S. has experienced in the pandemic thus far.
Here, then, is the problem: People who are unlikely to be hospitalized by Omicron might still feel reasonably protected, but they can spread the virus to those who are more vulnerable, quickly enough to seriously batter an already collapsing health-care system that will then struggle to care for anyone—vaccinated, boosted, or otherwise. The collective threat is substantially greater than the individual one. And the U.S. is ill-poised to meet it.
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America’s policy choices have left it with few tangible options for averting an Omicron wave. Boosters can still offer decent protection against infection, but just 17 percent of Americans have had those shots. Many are now struggling to make appointments, and people from rural, low-income, and minority communities will likely experience the greatest delays, “mirroring the inequities we saw with the first two shots,” Arrianna Marie Planey, a medical geographer at the University of North Carolina at Chapel Hill, told me. With a little time, the mRNA vaccines from Pfizer and Moderna could be updated, but “my suspicion is that once we have an Omicron-specific booster, the wave will be past,” Trevor Bedford, the virologist, said.
Two antiviral drugs now exist that could effectively keep people out of the hospital, but neither has been authorized and both are expensive. Both must also be administered within five days of the first symptoms, which means that people need to realize they’re sick and swiftly confirm as much with a test. But instead of distributing rapid tests en masse, the Biden administration opted to merely make them reimbursable through health insurance. “That doesn’t address the need where it is greatest,” Planey told me. Low-wage workers, who face high risk of infection, “are the least able to afford tests up front and the least likely to have insurance,” she said. And testing, rapid or otherwise, is about to get harder, as Omicron’s global spread strains both the supply of reagents and the capacity of laboratories.
Omicron may also be especially difficult to catch before it spreads to others, because its incubation period—the window between infection and symptoms—seems to be very short. At an Oslo Christmas party, almost three-quarters of attendees were infected even though all reported a negative test result one to three days before. That will make Omicron “harder to contain,” Lowe told me. “It’s really going to put a lot of pressure on the prevention measures that are still in place—or rather, the complete lack of prevention that’s still in place.”S
The various measures that controlled the spread of other variants—masks, better ventilation, contact tracing, quarantine, and restrictions on gatherings—should all theoretically work for Omicron too. But the U.S. has either failed to invest in these tools or has actively made it harder to use them. Republican legislators in at least 26 states have passed laws that curtail the very possibility of quarantines and mask mandates. In September, Alexandra Phelan of Georgetown University told me that when the next variant comes, such measures could create “the worst of all worlds” by “removing emergency actions, without the preventive care that would allow people to protect their own health.” Omicron will test her prediction in the coming weeks.
The longer-term future is uncertain. After Delta’s emergence, it became clear that the coronavirus was too transmissible to fully eradicate. Omicron could potentially shunt us more quickly toward a different endgame—endemicity, the point when humanity has gained enough immunity to hold the virus in a tenuous stalemate—albeit at significant cost. But more complicated futures are also plausible. For example, if Omicron and Delta are so different that each can escape the immunity that the other induces, the two variants could co-circulate. (That’s what happened with the viruses behind polio and influenza B.)
Omicron also reminds us that more variants can still arise—and stranger ones than we might expect. Most scientists I talked with figured the next one to emerge would be a descendant of Delta, featuring a few more mutational bells and whistles. Omicron, however, is “dramatically different,” Shane Crotty, from the La Jolla Institute for Immunology, told me. “It showed a lot more evolutionary potential than I or others had hoped for.” It evolved not from Delta but from older lineages of SARS-CoV-2, and seems to have acquired its smorgasbord of mutations in some hidden setting: perhaps a part of the world that does very little sequencing, or an animal species that was infected by humans and then transmitted the virus back to us, or the body of an immunocompromised patient who was chronically infected with the virus. All of these options are possible, but the people I spoke with felt that the third—the chronically ill patient—was most likely. And if that’s the case, with millions of immunocompromised people in the U.S. alone, many of whom feel overlooked in the vaccine era, will more weird variants keep arising? Omicron “doesn’t look like the end of it,” Crotty told me. One cause for concern: For all the mutations in Omicron’s spike, it actually has fewer mutations in the rest of its proteins than Delta did. The virus might still have many new forms to take.
Vaccinating the world can curtail those possibilities, and is now an even greater matter of moral urgency, given Omicron’s speed. And yet, people in rich countries are getting their booster six times faster than those in low-income countries are getting their first shot. Unless the former seriously commits to vaccinating the world—not just donating doses, but allowing other countries to manufacture and disseminate their own supplies—“it’s going to be a very expensive wild-goose chase until the next variant,” Planey said.
Vaccines can’t be the only strategy, either. The rest of the pandemic playbook remains unchanged and necessary: paid sick leave and other policies that protect essential workers, better masks, improved ventilation, rapid tests, places where sick people can easily isolate, social distancing, a stronger public-health system, and ways of retaining the frayed health-care workforce. The U.S. has consistently dropped the ball on many of these, betting that vaccines alone could get us out of the pandemic. Rather than trying to beat the coronavirus one booster at a time, the country needs to do what it has always needed to do—build systems and enact policies that protect the health of entire communities, especially the most vulnerable ones. Individualism couldn’t beat Delta, it won’t beat Omicron, and it won’t beat the rest of the Greek alphabet to come. Self-interest is self-defeating, and as long as its hosts ignore that lesson, the virus will keep teaching it.
America Can't Beat Omicron One Booster at a Time - The Atlantic
"Doctors and Nurses Are ‘Living in a Constant Crisis’ as Covid Fills Hospitals and Omicron Looms "A Covid-19 'viral blizzard' is about to hit the US, expert says, with 'millions' to be infected soon" "
Dr. Norman Swan an Australian expert in the area, just now on tv has said the idea that Omicron is a mild virus is a myth. He said, while not a Delta, it could be as dangerous as the original covid virus.
We are far past the point of hoping that this variant will spare us.
For weeks, the watchword on Omicron in much of America has been some form of phew. A flurry of reports has encouraged a relatively rosy view of the variant, compared with some of its predecessors. Omicron appears to somewhat spare the lungs .. https://www.biorxiv.org/content/10.1101/2021.12.17.473248v2 . Infected laboratory mice and hamsters seem to handily fight it off. Proportionally, fewer of the people .. https://www.washingtonpost.com/world/2021/12/31/south-africa-omicron-coronavirus-peak/ .. who catch it wind up hospitalized or dead. All of this has allowed a deceptively reassuring narrative to take root and grow: Omicron is mild. The variant is docile, harmless, the cause of an #Omicold that’s no worse than a fleeting flu. It is so trivial, some have argued, that the world should simply “allow this mild infection to circulate,” and avoid slowing the spread. Omicron, as Senator Rand Paul of Kentucky would have you believe, is “basically nature’s vaccine.”
[Insert: Asshole]
These dismissals of the variant as trifling—desirable, even—represent “a very dangerous attitude,” Akiko Iwasaki, an immunologist at Yale, told me. At the core of the problem sits the word mild itself, a slippery and pernicious term .. https://www.theatlantic.com/health/archive/2021/12/omicron-mistakes/621112/ .. that “doesn’t mean what people think it means,” Neil Lewis, a behavioral scientist at Cornell, told me. Less severe forms of COVID-19 can certainly be experienced by individual people, especially if they’re vaccinated. And there are true reasons to think that Omicron, particle for particle, might be less toothy than Delta. But Omicron’s unfettered spread has sowed a situation that is not mild at all. And right now, the notion of mildness is making the pandemic worse for everyone.
Much of our Omicron problem can be traced back to a false binary: That the variant is less of a danger too often gets misconstrued as the variant is not a danger at all. Severity works in degrees, which is indeed what we’re seeing. Per capita, Omicron seems less likely than Delta to hospitalize or kill the people it infects. In South Africa .. https://jamanetwork.com/journals/jama/fullarticle/2787776 , one of the first countries to be hit by the variant, cases have already crested at a record-shattering peak, but hospitalizations, admissions to intensive-care units, and deaths remain far below the heights of prior waves; infections also appear to be decoupling from severe disease in parts of continental Europe. Even in the United States, where the pandemic is as bad as it’s ever been, early data are pointing to a blunting in the propensity of Omicron cases to turn severe.
Read: COVID-hospitalization numbers are as bad as they look
It’s tempting to attribute all of this to the virus, but doing so would be overly simplistic. Disease always manifests as an interaction between pathogen and host, which means there are two main reasons that Omicron cases can present with softer symptoms: a more resilient human, or a more docile microbe. In this current surge, we’re likely seeing both effects collide.
The first part of the equation is entirely about us. Two years into a pandemic that’s left hundreds of millions with known infections .. https://covid19.who.int/ .. and prompted billions to sign up for shots, Omicron is knocking up against populations that are better defended than ever. In the United Kingdom, where more than 80 percent of people over 12 are at least doubly vaccinated, the shots are clearly lowering the risk of hospitalization among those infected with Omicron, especially among the boosted. A high number of prior infections from past COVID surges may have had a similarly mollifying effect in South Africa, where the average age of the population is also very young, and thus better steeled against severe COVID-19.
The second part of the equation—the inherent potency of the virus itself—unfortunately gets harder to parse when the world is more immune .. https://cdn1.sph.harvard.edu/wp-content/uploads/sites/2623/2021/12/21_Hanage_Bhattacharyya_Challenges-in-assessing-Omicron-severity_HCPDS-Working-Paper-Volume-21_No-10-1.pdf , Roby Bhattacharyya, a microbiologist and infectious-disease physician at Massachusetts General Hospital in Boston, told me. Still, even unvaccinated people with Omicron seem less likely to end up hospitalized, in the ICU, or on ventilators. Laboratory rodents infected with Omicron don’t seem to be getting all that sick either, perhaps because the new variant is less adept than Delta at colonizing the lungs, where the wildfire-like inflammation of serious respiratory disease often ignites. Similarly, researchers are finding that Omicron isn’t keen on infecting human tissue extracted from the lung, and may prefer to cloister itself in loftier sites like the throat, Ravindra Gupta, a virologist at the University of Cambridge, told me. What happens in a rodent or a plastic dish can’t recapitulate what happens in a human body. But Iwasaki still thinks “there is something intrinsically less virulent about Omicron.”
It’s fair, then, to say that the average Omicron case is indeed “less severe.” And there are plenty of people for whom the math will work out well. They’re hosts who are young, healthy, and up to date on their vaccines, squaring off with a pathogen that packs an oh-so-slightly weaker punch, at least compared with Delta. Keep in mind, though, that Delta is probably nastier than its already-awful ancestors .. https://www.nature.com/articles/s41586-021-04266-9 , so to simply call the virus “mild” massively undersells the danger it still poses, especially when it finds its way into unvaccinated or vaccinated-but-still-vulnerable hosts. Even people who are thrice-vaccinated can’t exempt themselves from Omicron’s risk, especially not while cases are rising at such high rates, and exposures are so frequent and heavy.
COVID-19 doesn’t have to be medically severe to take a toll. Lekshmi Santhosh, a critical-care physician at UCSF, has seen Omicron exacerbate chronic health issues to the point where they turn fatal. “You could say they didn’t die of COVID,” she told me. “But if they didn’t have COVID, they wouldn’t have had this issue.” Iwasaki, of Yale, also worries about the storm of long-COVID cases, which can sprout out of infections that are initially almost symptom-free, that may soon be on the way. “Some of these people are bedridden, unable to return to work for months,” she told me. “There is nothing mild about it.”
In high-enough numbers, any Omicron infection can wreak havoc. Across the country, people are entering isolation in droves, closing schools and businesses, and hamstringing hospitals that can already ill-afford a staffing shortage. In many parts of the country, hospital capacities are already being reached and exceeded, making it difficult for people to seek care for any kind of illness. An overstretched system could also, ironically, mask the extent of Omicron’s tear: When hospitals are full, they cannot accept more patients, artificially deflating recorded rates of severe disease, even as total cases continue to rise. “Omicron may be more mild at the individual symptom level,” Duana Fullwiley, a medical anthropologist at Stanford who has studied how the term mild has affected people’s experience of sickle-cell anemia in Senegal, told me. “But we’re not talking about the severity of Omicron as it’s impacting the system.”
Omicron also still harbors dangerous unknowns. The variant may snub the lungs, but it still accumulates quickly .. https://www.theatlantic.com/science/archive/2021/12/omicron-incubation-period-testing/621066/ .. in the throat and mouth—real estate that positions it to spill easily out of infected people. That, compounded with Omicron’s ability to dodge certain immune defenses, makes it a threat to more of us at once. Subdued symptoms, too, can come with a catch if infected people ignore them and continue to mingle.(And the variant seems to be tougher to detect early in infection with certain rapid antigen tests.) Researchers also don’t yet have a good handle on just how much immunity Omicron infections—especially the gentlest ones—may leave behind.
Stephen Goldstein, an evolutionary virologist at the University of Utah, told me that Omicron might turn out to be about as inherently virulent as the original SARS-CoV-2 variant, the version of the virus that kick-started all this misery. If that’s the case, it would be ironic. Two years ago is also when mild and COVID-19 first insidiously intertwined .. https://www.theatlantic.com/health/archive/2021/12/omicron-mistakes/621112/ : Roughly 80 percent of cases could be described as such, reports noted at the time, inviting dismissive and misleading comparisons to the flu, and jeering calls .. https://www.vox.com/2020/3/5/21166031/trump-hannity-coronavirus-who-death-rate .. to push Americans back to work and school.
[Same in Australia. The leader of the union movement here, Sally McManus, is talking about that on tv now. She just made the point made above that just because you don't have symptoms doesn't mean you aren't infectious. Same with the RAT tests. You could be infectious for a couple of days before they give you a positive reading. Sally, says no way can workers be forced to work in an infectious environment. And rightly so.]
Mild became shorthand for piddling; that soothing framing took hold, then lingered, “diminishing the sense of urgency in prevention,” as the medical anthropologist Martha Lincoln has written, even through the billions of infections, and the many millions of hospitalizations and deaths, that followed.
Today, news reports are using mild and COVID-19 together more than ever before, Elena Semino, a linguist at Lancaster University, in the United Kingdom, told me. Medically, the term mild originated as an academic catchall for all SARS-CoV-2 infections not severe enough to get someone admitted to a hospital—everything from asymptomatic cases all the way up to people just short of going into respiratory failure. But most of that range squares poorly with mild’s colloquial connotations regarding “temperate, pleasant, generally benign” food, weather, even people, Semino said. Mild, to most of us, is whatever, something that blows almost imperceptibly by.
That’s the trap of mildness: the underlying sense of fatalism it engenders. “People say, it’s inevitable; it’s mild; I hope I can catch it and move on,” Santhosh, of UCSF, told me. Calling Omicron “mild” implies that the virus is spontaneously domesticating itself; it punts the responsibility of harm reduction to the pathogen, and away from us. But Omicron is not our deus ex microbe. As Goldstein, of the University of Utah, points out, a virus’s imperative is only to spread .. https://www.theatlantic.com/science/archive/2021/06/coronavirus-evolution-virulence/619301/ —not, necessarily, to treat its hosts more genially. (Omicron is not even descended from Delta, so we can’t frame their severities as a stepwise evolutionary drop.) The attitude that Omicron is hardly anything to worry about is compounding the disaster we’ve found ourselves in: The more opportunities the virus has to enter new hosts, the more variants will arise. And there’s no telling what harm the next SARS-CoV-2 iteration will bring.
It’s worth remembering, then, that severity, or lack thereof, is not up to the virus alone. We, as hosts, dictate its damage at least as much—and that’s the side of the equation we can control. SARS-CoV-2 can’t be counted on to pull its punches, but we have the vaccines to pummel it right back. If mildness is what we’re after, that future is largely up to us.
The Atlantic’s COVID-19 coverage is supported by grants from the Chan Zuckerberg Initiative and the Robert Wood Johnson Foundation.
Katherine J. Wu is a staff writer at The Atlantic, where she covers science.
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