Filter The News
Everytime I sit down with the news, I feel very lucky to have a medical filter. Without it, I might be curled up in the fetal position right now. I might feel hopeless, resigned, or angry. I might worry that we’ll never get back to normal. But thanks to some training and experience, right now I’m none of those things.
(But don’t get me started about the politicization of science and the moralization of pandemic restrictions—yowzers.)
While the news about Omicron is fast, furious, and fertile ground for anxiety, there’s a lot to be hopeful about.
In last week’s newsletter, I wrote about Omicron and suggested dusting off the ever-relevant Serenity Prayer as we face yet another wardrobe change in coronavirus’ infinite trousseau.
Fast-forward to today, and we still face a lot of uncertainty about Omicron. We also have a bit more clarity. Recall that there are three questions we’re trying to answer:
How contagious is Omicron compared to the “ancestral” strain of SARS-CoV-2 and other variants like Delta?
Does this variant cause more significant disease? and
Will immune protection from vaccination and/or past infection hold up against this variant?
As for transmissibility, so far the Omicron variant seems to be more contagious than Delta or other variants. This weekend we saw reports that Omicron may actually have picked up the genetic code for the common cold. What does increased contagiousness mean in the real world? It means that:
We can expect more cases of COVID-19, particularly in unvaccinated people.
We can expect more breakthrough COVID-19 cases in vaccinated people.
As a result of more cases, we can expect more hospitalizations and deaths, particularly in unvaccinated people.
This information alone could certainly incite panic, but before you do, please remember that infection is not synonymous with disease. An infection with coronavirus can be asymptomatic (no symptoms whatsoever) or can cause mild to severe illness (which we’ve named “COVID-19”) depending on 1) the amount of viral particles inhaled by the host and 2) the immune status, age, and underlying health of the host.
Also before we work ourselves into a panic about Omicron’s higher degree of contagiousness, we need to look at the question about disease severity first. In other words, while more total infections is of course concerning, the next thing we need to know is how Omicron behaves once it infects the host.
As for severity, so far it looks like Omicron is not more severe—and may be milder—than Delta and other variants. In other words, infected people seem to get less sick with Omicron than with Delta. Doctors on the ground in South Africa are reporting this very phenomenon. What does this mean?
While we can expect more cases of COVID-19 overall from a more contagious variant, we might also expect a larger share of infected people to have mild symptoms with Omicron.
While we can expect more breakthrough infections in vaccinated people, a larger proportion of them will be mild (even more so than was the case with Delta.)
While we can expect more total hospitalizations and deaths (the downstream effect, particularly in unvaccinated populations, of more total infections), we might expect a smaller share of COVID patients infected with Omicron to get seriously ill.
As for evasion of immune protection, so far it looks like Omicron does partially outsmart immunity from past infection and also—to a lesser extent—immunity from the vaccine. What does this mean?
We can expect people who have recovered from COVID-19 and haven't been vaccinated to be at increased risk for reinfection from Omicron. (Therefore people who are relying on natural immunity to protect them should be vaccinated to protect against Omicron).
We can expect more breakthrough infections as a result of Omicron, but if it’s true that infection with Omicron is less severe, most of these breakthrough infections should be relatively mild. As my microbiologist friend Chise reminds us:
“Breakthrough” infections DO NOT mean vaccines don’t work. Remember, they are preventives, NOT cures. One can still contract COVID once vaccinated. As long as that vaccine is preventing you from facing severe disease and worse, it IS working and doing what it was designed to do.
The upshot? There is nothing terribly surprising about the emergence of Omicron.
So far, Omicron is acting like the expected next chapter in the book of endemic viruses.
This is why we needn’t panic about the headlines. It’s also why we needn’t abandon our trust in the vaccines (or our faith in a better tomorrow).
Indeed, we’ve known all along that new variants would emerge. Viruses mutate. That is what they do. Just like we run through the alphabet to name the next hurricane, we decided to assign Greek letters to new coronavirus variants because we knew we weren’t done after Delta. We knew that variants would emerge in populations with low immune protection. We knew that a more contagious version of SARS-CoV-2 would replace a less contagious variant when enough of the global population remained unprotected by the vaccines and/or natural immunity.
This is not to dismiss the natural concern we all have about Omicron and its many unknowns. This is not to diminish the suffering of people around the world who lack vaccine access and are vulnerable to the ravages of COVID-19. Hardly!
I’m simply saying that we shouldn’t be surprised when we hear about cases going up due to a more contagious variant. We shouldn’t be shocked when unvaccinated and non-immune people are tragically needing hospital care for COVID-19. We shouldn’t be flabbergasted when a larger share of unvaccinated kids is getting COVID when a more contagious variant enters the scene.
Instead, let’s take our shock and turn it into action.
Let’s read the news with the confidence of someone who isn’t floored by an expected turn of events.
Let’s advocate for global vaccine equity.
And let’s hit the panic button (fetal position optional) if and only if we learn that:
a larger share of infected people require hospitalization. Should this happen, we’d start to think that Omicron has increased intrinsic virulence. So far we’re seeing a spike in cases and, as a result, a spike in hospitalizations, but hospitalizations seem to represent a lower proportion of cases than in previous waves. In fact, last week we learned that a significant percentage of hospitalized adults and kids in Tshwane (where South Africa’s Omicron outbreak started) are hospitalized with COVID but not for COVID (in other words, they were admitted to the hospital for another reason but while there incidentally yielded a positive COVID screening test).
a larger share of vaccinated people require hospitalization. Should this happen, we’d start to worry about vaccine effectiveness. But so far the vast majority (approximately 90% according to the Minister of Health in South Africa) of people needing hospitalization are unvaccinated.
a larger share of infected people—especially kids—are dying from COVID-19. As of this weekend, none of the 34 hospitalized kids in Tshwane have died. And the mortality rate for adults, too, seems lower than for Delta. But this could change, particularly as we’re so early in this outbreak and it takes time for people to develop more severe illness.
a larger share of vaccinated people require hospital care or are dying. Full immune escape—a scenario where our immunity from vaccination and/or past infection is rendered useless—is highly unlikely. Why? Because the human immune system is sophisticated and redundant. In other words, vaccines enable our immune system to generate antibodies directed at the spike protein and “polyclonal” antibodies that are able to adapt to and attack new variants. We also create memory T cells and B cells that help fight severe disease, regardless of the variant we are exposed to.
The upshot of the upshot? Get vaccinated and boosted if eligible. Know that if you’re vaccinated and boosted your chance of getting sick—and severely so—from Omicron is tiny. Save your sweaty palms and racing heart for another day!
I realize how easy it is to sit in bed and “doom scroll” on your phone. I’m quite good at it myself. But passive ingestion of the news can do harm. So let’s commit to limiting our intake and reading the news with intention.
Our brains are fried. Our eyeballs are weary. Let’s trim the fat and feed them only the good stuff. Our safety and sanity depend on it.
I will see you next week. Until then, be well.