Now is the winter of our discontent, as 2021 draws to a close accompanied by some sobering COVID-19 statistics.
Before the end of the year, the U.S. will pass two grim pandemic benchmarks: 50 million total cases diagnosed and 800,000 total deaths. We are in the middle of a new surge that began in early November, fueled by the unvaccinated and those who were vaccinated early on but have not yet gotten a booster and have waning immunity. And now comes the omicron variant.
The first public reports of the omicron variant came from South Africa less than three weeks ago, although the variant was undoubtedly circulating earlier. Omicron, which presented unexpectedly, has a significant number of mutations, another example of how variant problems can emerge under the radar. It has spread rapidly throughout South Africa, and at last count was present in 50 countries and 19 states in the U.S., including Illinois.
Omicron’s dramatic emergence and fast spread are disconcerting. There are three urgent questions: How transmissible is omicron and will it displace the delta variant? Is omicron able to evade our immune systems, thus rendering vaccines less effective, and neutralize the monoclonal antibodies and forthcoming oral drugs used to treat COVID-19? Finally, how sick will people who contract omicron get?
With less than a month’s worth of experience, our answers to these questions are incomplete. It does appear based on the South African reports that omicron may be more transmissible than delta and could become the dominant strain. This is in part because of the variant’s natural cunning in attacking the body and in part because it may be circumventing our immune defenses. Whether this will make it resistant to vaccines and medications is still unknown.
The most important question may be how sick will people become. If the viral evolution of omicron causes only mild disease, then it could act in the same way as a live virus vaccine — conferring immunity without causing an increase in hospitalizations and deaths. The early reports from South Africa are optimistic in this respect, but it is too early to tell. This is clearly what we should hope for — infection without significant sickness — because it would provide a potential “exit ramp” from the pandemic.
One of the most important lessons of the pandemic is how much of what happens is outside of human agency. Karestan Koenen, a professor of psychiatric epidemiology at the Harvard T.H. Chan School of Public Health, told The Washington Post: “As humans, we don’t have as much control as we think we do. The virus has just made it very clear … adjusting our expectations to account for unpredictability, uncontrollability and the fact that our lives may be disrupted on and off, and building that into our expectations would be good for our mental health.”
But given those limitations, there are still things we can do during the holiday season, even if omicron displaces delta. Vaccination for the unvaccinated and boosters for the vaccinated are probably more important than ever. Outdoor gatherings are safer than indoor gatherings. When gathering outdoors is impossible, indoor gatherings should be limited, in both the number of people and the duration of the event. If you are around people indoors who aren’t vaccinated or if you don’t know their status, wear a mask.
Regarding the big picture for science, our virology labs, accustomed in the past to more slowly evolving epidemics, must ramp up advanced molecular testing to detect viral mutations at their first appearance. This information is essential to directing control efforts. From our research scientists, every effort should go into developing a universal COVID-19 vaccine that is not affected by variants and a nasal spray vaccine that can neutralize the virus at the point of attack. From the government, we need expeditious deployment of rapid home testing and the new antiviral medications.
So far, the countries with the most omicron cases besides South Africa are other African nations, the United Kingdom, Israel, Denmark and Norway, where a corporate Christmas party became a superspreader. Evaluating short-term outcomes from COVID-19 generally takes at least four to six weeks, and these are the countries we should watch closely for information about how severe the omicron cases will be.
At this holiday time of year, you may be inclined to read Charles Dickens’ “A Christmas Carol” or watch one of its movie adaptations. One of the most stirring scenes occurs at night in a church graveyard when a chastened and humbled Ebenezer Scrooge asks the Ghost of Christmas Yet To Come: “Are these the shadows of the things that will be, or are they shadows of things that may be, only?” The experience of the next several weeks with omicron should answer that question about COVID-19.
Dr. Cory Franklin is a retired intensive care physician.
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