Take it One Day at a Time
Hooboy! What a weekend.
Within hours on Thanksgiving day, the media went bananas over the Omicron variant, first detected in Botswana and South Africa, then quickly identified by the WHO as a variant of concern given its multiple mutations along the spike protein and a rapid uptick in cases in South Africa where Delta was at a lull.
Browsing hideous Christmas sweaters at TJMaxx on Black Friday provided a brief reprieve, but since then, we’ve been thrust into (yet another) state of limbo with more questions than answers about three pressing issues:
How contagious is Omicron compared to the “ancestral” strain of SARS-CoV-2 and other variants?
Does this variant cause more significant disease? and
Will immune protection from vaccination and/or past infection hold up against this variant?
Right now we simply don’t know much about Omicron.
And what we do know should not be taken as predictive of the future. Nonetheless we do have some threads of information. (I was happy to contribute to this summary piece about Omicron in today’s Huffington Post.)
So far it appears that Omicron is more transmissible (contagious). But again, this isn’t certain.
So far it appears that most people infected with Omicron are only mildly ill, especially if vaccinated. But this doesn’t mean that mild illness is the rule, i.e., it’s not surprising given that most illnesses start with mild symptoms.
And so far it appears that it’s largely unvaccinated and partially-vaccinated people who are being hospitalized for COVID-19 in South Africa (which is one of at least a dozen countries with Omicron, but it’s where data is being carefully collected).
HUGE CAVEAT: all of the above is anecdotal evidence. We need much more data. We need time to monitor people who’ve been infected with Omicron to see how their disease progresses (i.e., do the symptoms remain mild? or do the symptoms escalate over time?) and to learn whether vaccinated people experience an attenuated version of COVID-19 compared to unvaccinated people. We need careful immunological studies to understand how protective the current vaccines will be against Omicron.
Meanwhile, the best and worst case scenarios are still possible. The best case? That Omicron is less virulent and is susceptible to the current vaccines. Ashish Jha, MD, MPH, Dean of Brown’s School of Public Health was optimistic last night. My molecular biologist friend Chise was cautiously hopeful today. The worst case? That Omicron causes more severe disease and escapes immune protection from the vaccine. (See any mainstream media outlet for doomsday predictions!)
What do we do if the Omicron variant is able to completely slip by our vaccine-induced immunity? Pfizer, Moderna, and the other vaccine manufacturers reconfigure the vaccine to target Omicron directly. (They have already started this process just in case.)
PLEASE NOTE that 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. (Here is a great thread on the breadth and depth of our immune system from my friend Monica Gandhi, MD, MPH.)
In the meantime, we can take comfort in the facts that 1) our PCR and rapid antigen testing will continue to detect the presence of Omicron, 2) we have two oral antiviral medications in the pipeline (due on the market by the year’s end, and both of which will work against Omicron), and 3) we know how to combat coronavirus; we just have to do more of it—i.e., vaccinate the world.
The upshot? Getting vaccinated is the single best thing you can do for yourself, your family, and your community right now.
My other take-home message du jour? It’s time (again) to dust off The Serenity Prayer:
“...grant me the serenity to accept the things I cannot change, courage to change the things I can, and wisdom to know the difference.”
When we accept fixed, unpleasant realities; focus our thoughts and energy on the things we have agency over; and fact-check our internal narratives (and the chit-chat around us), we’re better equipped to cope with uncertainty.
For example, we cannot change that:
Viruses mutate. That is what they do. Sometimes they hit upon a more “fit” version of themselves that outcompetes others, such that the virus spreads more efficiently.
Coronavirus is here to stay. Full eradication simply isn’t possible because coronavirus 1) has animal reservoirs, 2) is spread by people who aren’t symptomatic, and because 3) the vaccines aren’t perfect (though they’re close). In other words, ultimately SARS-CoV-2 will become endemic like influenza, RSV, and the four other coronaviruses we know well and will be woven into the fabric of our lives. Could this Omicron variant be the “last hurrah” of the pandemic, i.e., the common cold that infects but doesn’t kill multitudes of people? It certainly could; I’m just not taking any bets right now.
At this moment, far too many people around the world are unvaccinated due to the tragic phenomena of vaccine refusal, widespread vaccine misinformation, and global vaccine inequity. When the virus is allowed to replicate and spread unchecked, it has more opportunity to mutate in worrisome ways.
Meanwhile, here are a few things we have agency over:
Vaccination. Get vaccinated and boosted if eligible. Today the CDC expanded their booster recommendation, saying all adults, even without risk factors, “should” get a booster. If you’re due for your booster now, go ahead and get it. (If we end up needing Omicron-specific booster shots, they likely won’t be on the market for a few months.) Know that once you’re fully vaccinated, your chance of getting severely ill from COVID-19 is tiny. Encourage your friends, neighbors, co-workers, and community members to take the vaccine. Remind them of the extraordinary safety and efficacy profile of the vaccines. Make room for questions from vaccine-hesitant people. Help lead them to the facts without judgment.
Care for our physical health. This is another good moment to take stock of our everyday habits and to make sure we’re meeting our basic biological needs (sleeping, eating, moving, connecting with others). Under stress, we’re prone to abandoning the foundations of our health when we need them the most. So do whatever it takes to rest up, walk, eat decent meals, and avoid social isolation. Get your flu shot. Schedule your physical, your mammogram, your colonoscopy, your dental cleaning. Caring for our own bodies can help bring us back in the driver’s seat of our health.
Tend to our mental health. It’s also a great time to take stock of our emotional health (stress, mood, relationships with food, alcohol, work, family/friends) and to connect the dots between our thoughts, feelings, and behaviors. For example, in the face of ongoing uncertainty, you may find yourself overeating, binge drinking, or staying up too late on social media. As a result, you might feel more anxious, blue, tired, or all of the above. Instead of punishing yourself for engaging in less-than-ideal behaviors, address the root causes. Name your feelings. Journal them! Turn off your phone. Prune your media inputs. Get in bed by 10 pm with a book. Plan to exercise most days this week. Phone a friend while you’re walking. Chop some veggies. Watch comedy TV. Heck, try chopping and chuckling at the same time!
Ask for help. Wintertime and the holiday season can invite the “blues” even without a global pandemic. Reach out to your therapist, pastor, rabbi, or other trusted guide as we navigate the weeks and months ahead.
Be kind to yourself and others. At the risk of sounding “woo-woo,” engaging in random acts of kindness actually increases Serotonin and Dopamine levels in the brain and helps with mood and anxiety. So do it!
Global vaccine equity. Lobby our government to equitably distribute vaccine doses. Help amplify the voices of physicians and scientists like Dr. Tedros Adhanom Ghebreyesus, Dr. Maria Van Kerkhove, Tulio de Oliveira and Dr. Mati Hlatshwayo Davis (to name a few) who are pushing for worldwide vaccination. Vaccinating the world isn’t just the right thing to do, it protects all of us from ongoing suffering.
This moment of limbo reminds me of the many times over my career where I’ve had to deliver bad news to a patient (a cancer diagnosis, for example)—that special kind of purgatory where we know just enough to be worried but not enough to reliably predict the future.
The gulf between bits of knowledge and the “so what” can be exquisitely painful. It’s where “what-if” thinking and catastrophizing run wild. It’s where stomachs churn and hearts race. It’s where primitive coping mechanisms—like denial, anger, and self-medication—poke out from under the rug.
Uncertain times also test our ability to be fully present. So let’s try it. Let’s walk through the next few weeks with intention—by sticking to the facts, tuning out the noise, and taking it one day at a time.
I will see you next week. Until then, be well.