Omicron Edition, Open Thread 11/28/21
Uncertainty, uncertainty, uncertainty
We have a new variant in town, Omicron.
I was hoping to avoid learning the Greek alphabet, but here we are.
I’ve written a piece about it at the New York Times, calling for early, precautionary action.
More on that in a bit, but the first key point is that this is very different than where we were with Delta or even Alpha when they came on the scene. I wrote about both of them in a hurry, as soon as it became clear they were a threat—end of December 2020 for Alpha, end May 2021 for Delta.
My New York Times article on Delta has the depressing headline that the pandemic’s deadliest phase could be ahead of us. I was pretty certain by the end of May that Delta, especially, was going to be terrible because it had already left a wide swath of death and suffering in India, and systematic data from the United Kingdom confirmed it wasn’t a fluke. My December 2020 article on Alpha for The Atlantic is titled “The Mutated Coronavirus Is a Ticking Bomb.”
Here, it’s very, very different.
Thanks to South African scientists, their public health infrastructure, their talent and dedication and the transparency of their government WE HAVE AN EARLY WARNING. A VERY EARLY WARNING.
I cannot overemphasize how valuable this is, and what a gift they have given us.
Thank you, thank you, thank you, South African scientists, medical workers, public health employees.
But an early warning on what? Ah, that is the beauty of it. The earlier the warning, the less we know. I’ve done my best to keep up on all the information being shared by scientists on this (amazing! so much open science!) and my current conclusion is that everything is on the table, including that this just fizzles out or turns out to be a catastrophe.
There are three open questions: transmissibility, immune evasion, disease course in infected people.
Of the three, I think some level of immune evasion in terms of antibodies is the clearest prediction: this looks like it could cause more breakthrough infections in vaccinated or previously-infected people. But that is not, by itself, a catastrophe if the virus doesn’t make people very sick, or if it doesn’t transmit well. Both are still unknown, and all the possibilities are more or less on the table.
For example, South Africa has had huge outbreaks, so for all we know, they’re detecting re-infections because of immune evasion, hence the rapid rise in cases: not the same as straightforward more transmissible.
If the re-infections are then very mild to asymptomatic, it likely will not mean much. If they turn out to be severe as well, that’s a terrible outcome.
Or, maybe it is more transmissible and the disease it causes is more severe and it has immune evasion on top. We don’t have enough data to rule this out. Having had some cases that show up be mild isn’t enough to draw any conclusions. Maybe it is mild as a re-infection and severe if no previous immunity from vaccination or previous infection. Maybe this is just an outbreak among a younger population.
With so few detected cases, who can know?
That is why my piece calls for an early, aggressive response until we know more, but we need to understand this is precautionary because we really don’t know.
For all we know, this was first detected in South Africa, and is already widespread elsewhere.
That’s why my New York Times piece today is titled: “We Got a Head Start on Omicron, So Let’s Not Blow It.”
There’s very little we know for sure about Omicron, the Covid variant first detected in South Africa that has caused tremors of panic as winter approaches. That’s actually good news. Fast, honest work by South Africa has allowed the world to get on top of this variant even while clinical and epidemiological data is scarce.
So let’s get our act together now. Omicron, which early indicators suggest it could be more transmissible even than Delta and more likely to cause breakthrough infections, may arrive in the United States soon if it’s not here already.
A dynamic response requires tough containment measures to be modified quickly as evidence comes in, as well as rapid data collection to understand the scope of the threat.
The piece calls for restrictions, testing, quarantine and a massive early effort to both understand what’s going on, and act like it could be terrible, but be ready to reverse quickly.
If it is not a big threat, we can, and we should quickly reverse restrictions that are specific to it. If it is, it is much better to have acted early than to wait till clarity arrives but it’s too late to contain the threat. But precautionary action shouldn’t be unnecessarily sticky.
Unfortunately, there are already a few signs that we will do theatrics and haphazard measures, rather than a comprehensive effort.
Many countries have started issuing travel bans, but targeting passports rather than the virus.
The one in the United States doesn’t even start till Monday (viruses don’t work on the weekends?) and isn’t paired with testing or quarantine at the border—just a blanket ban on a few nationalities.
That’s pandemic theatrics, and we have had too much of that already for two years.
The United States, the European Union and many nations have already announced a travel ban on several African countries. Such restrictions can buy time, even if the variant has started to spread, but only if they are implemented in a smart way along with other measures, not as pandemic theatrics.
As I conclude the piece:
All this requires leadership and a global outlook. Unlike in the terrible days of early last year, we have an early warning, vaccines, effective drugs, greater understanding of the disease and many painful lessons. It’s time to demonstrate that we learned them.
An early alert like this is the difference between calling firefighters at the first sign of an ember versus waiting to see if the house goes up in flames. To have the gift of this early warning about Omicron without taking fast aggressive action would be as if those firefighters waited for billows of smoke before responding.
South Africa has given the world a precious gift, and along with our gratitude and support and resources so that they can better battle their own outbreak, this gift deserves to be treated with the respect it deserves, by acting on it.
Thank you for acknowledging that South Africa did the whole world an enormous solid and most of the world reacted by treating them like pariahs… because they have better surveillance and sequencing than us? 😑 it’s really frustrating. Your analysis of the situation is spot on and I hope some world leaders are reading this.
I'm hoping those disclaimers one sees re investments hold true for our response to this new mutation: "A fund's past performance does not necessarily predict future results." Given that 'the best health system in the world' so totally, inexcusably snafu-ed our public health response for almost two years now, I'm not confident that the NIH, CDC, FDA, etal will do better with this one. And re the travel bans? Great way to reward vigilance and transparency! We keep making the same mistakes - taking mostly performative measures - and expecting a different result. Insane!