The Omicron variant of SARS-CoV-2 has made headlines everywhere, which leads to everyone with a platform developing the need to pontificate about what this means. There’s a huge range of possible outcomes that Omicron may have on the trajectory of the pandemic - everything from minimal impact to huge problem is on the table.
It seems like the reason we were able to identify this strain so early is that South Africa has quite advanced genetic surveillance of the virus and their experts were able to effectively sound the international alarm early on:
As a consequence of our prescient warning, things are really early, and I don’t have a strong opinion about just how worried to be. The the most important thing about Omicron at the current moment is that it’s just too soon to tell much of anything.
The more confident that someone is about what Omicron means right now, the less you should trust that person’s opinion.
I figured I’d spent today talking about my framework for thinking about a new variant and what to look for as additional news comes out.
3 things to pay attention to: transmissibility, immune evasion, and illness severity
The whole ballgame here is how Omicron compares to Delta with regards to three major factors:
Transmissibility: How easily does this virus spread?
Immune evasion: How well does current immunity - either acquired through prior infection or through vaccination - hold up?
Illness severity: Does Omicron cause us to get more sick or less sick than prior variants?
You can think about each of these items individually, but their collective impact will determine both personal and societal risk.
Although there’s concern that Omicron is even more contagious than Delta, this hasn’t been established definitively.
There’s some initial alarm about its transmissibility because we’re seeing Omicron take over as the predominant strain in South Africa, but that doesn’t necessarily mean that the virus is more contagious. It may mean that it evades the immune response better than Delta does, so we’re seeing more re-infections and breakthrough infections.
Some suspect that the mutations that give arise to Omicron may make it actually less contagious than Delta, although this remains speculation with a range of possible outcomes:
It’s just too soon to draw any conclusions about transmissibility just yet.
I think that the immune evasion story is the one that’s driving a lot of the concern here.
We spent all this time waiting for vaccines to move past the pandemic, and there’s immediate alarm that a new strain puts us back to square one.
Because Omicron has quite a few mutations in the spike protein (the protein that the vaccines are designed to stimulate an immune response to), it makes intuitive sense to suspect that Omicron will lead to more breakthrough infections and/or reinfections than previous strains:
Think about it this way: if your immune response is conditioned to the spike protein because you were vaccinated, and now the spike protein is changed significantly, there’s risk that your immune system won’t appropriately respond to the new strain.
Although Delta was way more transmissible than prior strains, it didn’t have a level of immune evasion that rendered our immunity acquired through vaccines or prior infectious less protective against severe disease.
If immune escape proves to be a big deal here, it’s possible that even if Omicron is less contagious than Delta that it will still spread through society faster.
I think that there are two important questions to answer with respect to illness severity:
Does Omicron make you more likely to end up in a hospital, on a ventilator, or dead than Delta or prior strains?
Does prior infection or vaccination confer similar protection against severe disease and death as with prior strains?
There’s a plausible case for optimism that even if Omicron is more transmissible and even if Omicron leads to more severe disease that we still don’t need to be concerned if we’ve previously had COVID or previously been vaccinated.
Thus far in the pandemic, natural or vaccination-induced immunity has been a huge protection against severe disease. This is one of the major reasons that my level of concern about the pandemic hasn’t been high despite the spread of Delta that we have been seeing over the past few months.
There doesn’t appear to have been a spike in deaths in South Africa, where cases are rising rapidly, but there are some caveats here:
So far, there’s no news to suggest that the worst case scenario about Omicron - that it has a high chance of making you really sick or dead despite prior immunity - is something that we need to be concerned about on an individual level.
That doesn’t mean it won’t turn out to be the case, but I’m cautiously optimistic that our prior infections and vaccinations will continue to provide protection against severe disease.
What does this news mean on an individual level?
In other words - how you should you change your life as Omicron inevitably spreads around the world (and it may already be here)?
My advice - you should continue living.
Early on in a pandemic or with a new strain is the right time for governments, public health organizations, vaccine manufacturers, and pharmaceutical companies to be over-preparing and ramping up their supplies because aggressive testing and mitigation methods up front are the best on a societal level.
But you wearing three masks to the grocery store? Or quarantining because you’re worried about the lack of definitive news?
That’s not preparation. That’s panic. And you holing up and staying away from society isn’t having any material impact on viral spread.
No one will know anything here for a few weeks, so your best bet is to continue living your life and tune out the apocalyptic news about this.
As has been true since the beginning of this pandemic, your best defense is to get as healthy as you possibly can.
Thank you for reading! Please share with friends and family and encourage them to subscribe!