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!
I was hoping you would post. Thank you for doing so. Some countries may respond to the Omicron with alacrity. I do not believe the US will exercise much caution. People are still filing lawsuits about mask wearing. State governments are challenging executive order. They are fining businesses that require masks. In my home state, I am usually the only person I see wearing a mask.
Thank you for this. Please, however, don’t skim over the problems of long covid. We don’t know enough about it yet to conclude that mild or moderate Covid cases in the acute stage are unimportant long term!
Sadly, It feels more like we're returning to our standard playbook: panicked ineffective overreaction (travel bans by passport, but not on weekends), which I expect will be followed by a "too soon" return to a complacent acceptance of high rates of infection/hospitalization and death, that would be considered unacceptable in other parts of the world, e.g., South Korea, Japan
There is a very key snipped above: “tough containment measures to be modified quickly as evidence comes in”
Please understand, for some in the public there is a growing loss of trust in those supposedly in charge and their so-called expert allies because new measures are very unlikely to be modified or removed once introduced.
I know this may not be the case for some US states but it is absolutely the case for European countries.
The mental model in several places (say Italy, but increasingly many more) has been
- introduce vax pass because there is an emergency
- avoid stating at which point vax pass is phased out
- if pandemic data improves, attribute that to the vax pass, “we can’t remove it now!”
- if pandemic data does not improve, attribute that to the vax pass not being stringent enough, “we need more of it now!”
So, while it is good to have a rational discussion based on the precautionary principle, it would also be good to see an acknowledgement that people will be fatigued by “new restrictions” unless some very objective metrics to slip out of them are communicated (and again, I am not merely talking of the US here)
The 1918 flu pandemic strain turned into circulating H1N1 mild seasonal flu. I think lots of people are assuming that's what's going to happen here, especially since four widely circulated coronaviruses cause some fraction of colds.
However, that isn't an inevitable trajectory with respiratory infections. Measles, which like Covid and unlike H1N1, can spread throughout the body as an infection entered the human population at some unknown time in the past, at least centuries and possibly millennia. It never managed to become mild. We don't know what "long Covid" is, and that probably is irrelevant one way or another for the survival of the virus. Like nervous system involvement in polio. The average polio infection is mild, and the nervous system involvement which only happens in some people is late in infection and simply irrelevant to whether the next person gets infected. So the virus doesn't care.
So, the virus could turn into another cold in five years. Or a new childhood disease with long-term consequences in some. Right now, we don't know.
Just because someone's going to point this out if I don't, measles is a respiratory infection. I know very well that polio isn't, but that has nothing to do with my point regarding "long polio"
I wonder too whether the heavy media coverage is healthy, since there's not much the average person can do aside from upgrading masks and going to restaurants less. It probably is good though in making it easier to get politicians to pay attention.
But people were burned twice, by Alpha, then by Delta, so I think this would blow into a major news item no matter what.
I also wonder about the heavy media coverage. I'm old, so I know to ignore most "maybe gonna happen" news stories, especially as the breathless headlines continue day after day without any new information. Omicron is no exception. Nevertheless, it's good to have a heads-up for every "variant of concern."
Beyond upgrading masks, I'm taking the opportunity to engage in anticipatory disappointment in case Christmas and early 2022 travel seem too risky. (I never have started eating indoors, and only got two weeks back at the gym before Delta.) We're gradually adopting life strategies that take expected and unexpected circumstances of pandemics into account. That said, I feel for those with kids and jobs that pretty much preclude any manageable strategies.
Zeynep, you are a very good commentator on the pandemic. That is why it's so perplexing (and distressing!) that you fall into the camp of making gratuitous slams against pharmaceutical companies. Examples: 1) "The callous mistreatment of South Africa by big pharmaceutical companies continued into this pandemic. " 2) "...their production or price cannot be held hostage to the vagaries of even more profits by companies that have received substantial taxpayer support and use publicly funded research to develop their drugs." (As an aside, there was nothing stopping first world countries from buying the AIDS drugs for poorer countries. Hmmm, I guess we want pharmaceutical companies to bear the full burden. I wonder why? The answer doesn't reflect well on *us*.)
We *want* pharma to make a lot of money on a strictly utilitarian basis so that they continue to develop these amazing drugs. There can be a healthy debate about how to provide the right incentives and the length of protection for IP, but what is not up for debate is that we need these companies *motivated* to do the often thankless task of vaccine research and for other drugs. You have developed an informed opinion about the pandemic by doing a ton of reading and educating yourself. I suggest that you also develop an informed opinion of how *f'ing hard* it is to take publicly funded research to a final product. Derek Lowe might be a good person to read and talk with: https://www.science.org/blogs/pipeline
It's a longer conversation but... Yes, they do a lot of things right but they also do act terrible! The HIV/AIDS drug crisis is a moral stain of terrible proportions... Millions died while they blocked generic versions of drugs. And yes, the moral stain is shared by rich countries.
Sure, it is a subtle conversation about pharma. But two points: 1) Isn't it ironic that we are most up in arms about profits from drugs that help the *most* people? We want to go to generic immediately for drugs that are most beneficial. Meanwhile another cancer drug that is good for rich countries doesn't hear any demands to go immediately generic. Those are really twisted incentives. 2) You said in your comment, "they do a lot of things right." But you didn't have any sentence of praise in your article about the amazing things pharma does right. If we want to live in a society that focuses our best people on worthwhile problems, then we need to create an intellectual climate that gives status and incentives to people and companies that work on those problems. Having thoughtless sentences painting a vital industry as terrible doesn't help create such a climate. Instead, learning about the subtleties of the technical and *economic* difficulties of drug development and *bringing* that knowledge to the public as you do with the pandemic would be much more beneficial.
Travis, you have indeed raised a large and complicated question, and I'll pick only a few bits of it. I agree with you that we do want pharmaceutical companies to make money and continue to develop drugs.
At first it looked like the tremendous quantities of vaccine would mean the virus was eliminated and that would be the end of the income. Negotiations were of course made during the time we believed that. Government funding helped the drugs get to market faster. That period is over. The vaccines (modified as they lose effectiveness) will be needed for a long time. Yet, the development was, *explicitly, for this one vaccine*, government-funded at a high level. This upstarting period is the most expensive for drug companies, and that is paid for. What assurance do we have that these companies will now manufacture and sell the modified-as-needed vaccine at a profit, but not an egregious one, going forward?
Regarding the AIDS drugs, you are correct that the pharmacy companies largely developed these, using of course the research publicly funded by the U.S. and other countries. They received whatever they wanted for them until the patents ran out. Zeynep is talking about when the patents did run out, and the successful efforts of these countries to block production of what many people think should have been legal generics after that. As a response to your aside, the U.S., directly and through foundations and other donations, did indeed buy lots of high-priced AIDS drugs while campaigning for the right to produce generics.
Vaccine research is of interest to many researchers. Much of this research is funded through government research grants and private citizens and organizations. Dr. Peter Hotez was able to get a head start on his lab's Covid vaccine because of grant-supported work on a vaccine for SARS. Once SARS fizzled, the grants stopped and the work was shelved, but fortunately the team was still in place and could pick up where they left off. As Dr. Hotez noted, if he had been able to continue the research on coronavirus vaccines after SARS (and we knew more coronavirus strains would lead to mass infections), he would have been much closer to being able to develop a vaccine for Covid-19. Instead, primarily private funding has developed Corbevax, now in Phase 3 trials in India. I just found a new article on this, in which Dr. Hotez (and his partner Dr. Botazzi) say the total development cost from creation to marketing was $5-$7 million dollars (this does not include the cost of the trials in India), and the vaccine is expected to cost $3.00-$4.00 a dose. The most recent article I could find on this is https://www.texastribune.org/2021/10/19/texas-covid-19-vaccine-peter-hotez/
I will add that we need these companies motivated to produce antibiotics and antifungals. Or we need to fund the private and academic researchers who are looking for them.
I am an avid supporter of pointing out abuses or gaming of the system for IP. The patent system in general needs to be radically improved. It is incredibly frustrating to me that there's zero political momentum behind IP reform. I also readily acknowledge that reform is an incredibly difficult issue that takes deep subject matter expertise in order to reach conclusions that won't be more harmful than our current system. And thank you for the link to the story about Hotez. Inspiring stuff. All the same, my impression is that it has been incredibly difficult to bring a new vaccine to *market* (pre-pandemic), much less make money. Look what happened to LYMERix for lime disease.
I agree with you 100%. And do we ever need either a vaccine or treatment for Lyme disease. Many people get that who are just visting an area for a short time, and who wouldn't have gotten a vaccine, that I'd like to see both.
I don't see much on the news about Corbevax, but according to the NYT vaccine tracker the Phase 3 trial is to end soon.
Thanks so much for writing this!! As far as early action, should we also be doing stuff personally? or is the big effects going to only occur if governments and systems act?
Travel bans can work for islands (see New Zealand). But you have to be really aggressive and block the whole world. I don't know if Great Britain is self-sufficient in food, but if Boris Johnson is serious, that is the question he should be asking.
Italy, meanwhile, heavily restricts travel from quite a few countries but specifically allows it from Great Britain, which has higher rates of Covid than many restricted countries, and also from the US.
This could be theater, it could also be politicians not understanding exponentials.
Zeynep, is it possible that in our efforts to win the "War on Covid" we are unwittingly succumbing to a pandemic of scrutiny?
You acknowledge that we don't know much that is useful about Omicron (transmissibility, immune evasion, disease course).
Therefore, of what use is it to raise alarm? At what point does the "precautionary principle" transform into "the boy who cried wolf" and create panic?
How much of what we are witnessing through our first ever mass testing campaign is merely revealing what has always been happening with Influenza like Illnesses? Is it possible that the same frequency and pattern of mutations have always been occurring in the other known coronaviruses, only we didn't realize it because we didn't do 4,278,469,251
tests until now? (without evidence, I suspect we have never tested for any single virus more than 10 million times via PCR in the 20 years+ since we started employing the technology).
Isn't the consensus leaning towards this becoming endemic, that zero covid is off the table, and we have to live with it? If that is true, then won't there always be a new variant? Won't we cycle through the greek alphabet every 7-8 years?
Is it appropriate that with every letter change we incite panic in the market, cut off travel to specific countries, disrupt families, and spent money and resources which may have better use on other threats with a clearer ROI [1]?
To your firefighter analogy, we don't yell "fire" in a theater because we know the harms of that panic outweigh the good of having the firefighters there promptly "just in case".
It seems we just screamed "fire" in the world's theater.
The market is down, which impacts livelihoods. Panic is setting in, which causes stress, raises cortisol levels (which in turn, makes us more susceptible to, respiratory viruses). People will horde goods, they will retreat from social interactions. Another holiday may be lost, maybe two. Trillions will be spent.
And why? Because B.1.1.529 may replace B.1.617.2 as the dominant strain? Which may be a bad thing, but might actually be a good thing, or completely neutral event? We simply don't know. Is my understanding incorrect?
It is fascinating that we have the technology, resources, and expertise to scrutinize viruses to this degree. But before we get carried away with our new toys, it seems we should probably understand how they actually work and how much of what we are seeing is truly novel and how much is completely ordinary.
Zeynep, if you happen to see this comment, why did you halt paid subscriptions? Just curious, really enjoy your work and wanted to do more than just follow you on my NYT subscription.
*Note - I wrote this comment before reading your NYT piece, will go through that now and see if my initial reaction is changed.
________________
[1] By ROI, specifically I wonder how much of a dent the 6 trillion or so dollars we (the US) printed for Covid response could have made towards combating cancer, tackling income inequality, affordable housing/healthcare, Alzheimer's research, or simply giving each American $18,000 and seeing if that improves their health and longevity. (Open question if anyone can "do the math" for me, what is the best estimate of how much has been spent worldwide on the Covid 19 pandemic?)
We do track, sequence and name influenza variants. It's obviously not at the same fine-grain level, but new appearances at the level of Alpha, Beta, Gamma and Delta are easily identified. The difference with Omicron is that to my knowledge no successful influenza strain has so suddenly accumulated mutations to this extent, so we don't have a precedent. A big fear here is that there could be widespread and dangerous reinfections of people who thought themselves immune. That might not pan out, or there might be mild reinfections, but we are currently on the region of the map labeled, "There be dragons."
What I understand of GISAID is that since its inception in 2008 it has mostly focused on influenza strains, so while it may be true that no influenza strain has so suddenly accumulated mutations to this extent, do we expect influenza viruses to mutate at the same pace as coronaviruses? Are they comparable?
Appears that in the first 8 years of GISAID they obtained 650,000 samples, predominately flu, unclear if this means unique strains or total submissions (the wording I inferred submissions). Between March 2020 and April 2021 they received 2.2 million samples of Covid 19. So again, the scale of scrutiny here is unlike anything before.
It may be true that this is the first time in history a coronavirus has mutated so quickly and to such an extent.
But the odds of that happening precisely at the exact point in human history where we first turned on the spotlight feels like a massive coincidence.
If we had been doing 4 billion tests a year for decades and now saw this phenomenon, that would be noteworthy.
That aside, the admission that these tools can neither predict nor confirm which mutations are cause for concern leads me to wonder how we can base policy decisions with such dramatic effects when we haven't even taken the time to assign penalty costs for our models (maybe we have, but I haven't seen such work done).
If Omicron fades (like some of the other previous strains) you've got a point, as the flu surveillance might miss unsuccessful strains. Right now, it's dominant, but over a small area. Certainly, if it become dominant on a continent-wide scale, it would be picked up by even very small numbers of samples. I think the concern is that being dominant in a small area where the competitor is Delta, suggests its on its way unless there is some southern Africa specific circumstance of which we're unaware.
We've never observed a human pandemic with modern tools my knowledge of any virus other than flu or HIV, so I'm wondering if we're fitting too many expectations in from flu.
Whether it is Omicron or some other strain, I was under the impression eventually something will replace Delta - no? Isn't that part of what being endemic is all about?
Do we know if Omicron is less serious than Delta? What if it turned out it was more transmissible but lead to less disease - we would probably want it to spread.
It doesn't seem like we have the tools to determine which variants pose a threat in advance. All we can tell is "this is different, but we don't know if that is good different or bad different". Given that limitation, I am not sure I agree that we need to always take action every time something changes.
My concern would be that this is a vaccine buster, and that's where having so many mutations concentrated on good antibody binding targets is a concern. So, it can't be ruled out right now that we're back to March, 2020 (although with a quicker route out of that situation). However, that is easy to get some information on quickly, and Biontech says they will have an answer within two weeks. They didn't say what they will do, but, for sure, on that timescale, they could measure binding of post-vaccination antibodies to lab-synthesized Omicron Spike. If there's a 5x-10x hit it will look bad in the press reporting but we'll still be okay, perhaps urging caution and boosters for the not-recently-vaccinated and J&J, and perhaps having to deal with more breakthrough infections of the kind we're seeing with Delta. If there's a 100x hit, we may be in trouble, and might need to observe what happens in actual breakthrough infections whether protection against serious illness is lost.
Enhanced spread among the unvaccinated compared to Delta is a different issue and I think we should just expect that will happen with this or with improved Delta strains. Also, there's no evidence this is worse or better than Delta in terms of symptoms. Mostly young people were infected in SA, and these are least informative if nothing unusual happens. Again, we're going to see a lot of variants like that, and no cause for alarm unless something weird with the infections.
Large-scale lockdowns were pretty economically devastating and costs were staggering. I thought more again about Zeynep's suggestions regarding border closures. For the US and Canada, shutting non-commercial traffic for more than a year actually had very little impact except on some tourism-dependent locations and border towns. This would be a different story in places like Italy, but honestly there's little economic or political cost for the US. Also, vaccines would be a rounding error in the US budget.
Canada had difficulty negotiating the border reopening this summer, and in the end opened unilaterally because that was a low priority on the US side except for Schumer. Being able to go outside the country is just not important for most Americans, so I think a short border closure while making sure would not be costly. However, it might not quickly reverse if Omicron proved less threatening exactly because most Americans wouldn't care.
Absurdity knows no bounds. At this point, the pandemic is over, folks are immune in one way or another, and mutants are all part of the game. Shutting down anything is not a public health measure. It is a gift for those making bank from the lockdowns while eliminating their competition on Main St. Viruses don't act like this, however, bioweapons and planning do. Stop giving in to tyrannical policies designed to take your freedom and life away from you. It's time to fight back.
Not sure if everyone is immune. My suspicion is that young healthy people will probably (but not as a guarantee) be able to avoid death or serious illness from reinfection by Omicron.
However, older people in poor health are being reinfected with some frequency, and with a high fatality rate, and that's without being hit with a crazy variant like Omicron.
That is a sobering and informative article. I recommend it to other Insight readers. John, thank yo for continuing to provide so much good information and analysis.
Thank you for this piece, and for the delicious phrase "targeting passports rather than the virus".
I'm no longer surprised that government actions are stupid. Ban flights direct from affected areas, while allowing your citizens to return via somewhere else? If they have the virus, they get to spread it on the way home. Allow travel into the country from the affected areas, and don't impose a quarantine requirement? The freedom of one's citizens is so much more important than the health of one's other citizens and residents. Etc. etc. etc.
But it sure would be nice if a few more government decision makers cared more about their people's welfare, and indeed the welfare of all people regardless of citizenship, and comparatively less about their own career prospects. Or if doing the right thing could reasonably be expected to enhance their career prospects rather than diminish them.
Zeynep, I found this Insight post to be much easier to read because it names the variants instead of numbering them. I have been closely following Covid-19 from the beginning, and even so I had to stop and think the first time each number dropped, which meant I had to go back and re-read.
I took a look at when Delta was first identified, and apparently December last year, although it wasn't named till later. It then hit India hard late spring, and started to get bad in the US in the summer. Assuming a similar or slower development, that is a lot of time to ramp up and strategically deploy vaccine production.
The following thread from Trevor Bedford (also retweeted by Zeynep) gives to me what seems a reasonable summary now. R = 2 in the South African setting where it was detected, but degree of immune escape unknown. He assumes 90% immunity among the population where it's spreading, so the extreme scenarios could be widespread immune escape but R0 not much bigger (i.e., would rise slower than Delta but be harder to stop) or much less immune escape (R0 much bigger than R, with spread primarily through the non-infected, not ruling out that breakthrough cases are frequent but not retransmitting). That's a fair range of possibilities, but nothing wild.
One caution is that a lot of the cases were apparently university students. These may not be representative of the general South African population, and might be taking more precautions (masking, vaccinations) or less (parties). Connectiveness with the rest of Africa might also be higher, due to families elsewhere, etc. I've never been to SA, and would have no idea.
So, this suggests significant potential for spread, but along timelines we've seen before unless we're unlucky and the early data is misleading. We're in far better shape than with Delta to react, thanks to much larger vaccine deployment and production capability.
If this is a Delta-like scenario, Africa gets hit hard in April/May, and there may be enough time to rush vaccines in first. I don't think existing production will do it, but the speed of bringing factories online in early 2020 was impressive. It's also possible that Omicron isn't very bad, but becomes much harder to stop with a very few more mutations. In that case, vaccinating Africa give a fighting chance of strangling the improved Omicron in the cradle. First, we need some worst-case idea of the effectiveness of the existing vaccines against Omicron both boosted and unboosted, and we're likely to get that quickly for the mRNA ones, so if Biden or someone else of similar stature could provide leadership, we could get moving quickly. However, it will be important to evaluate AstraZeneca, Sinovac, Sputnik etc in case these prove more practical to supply. Cell-mediated immunity won't be captured in neutralization assays and may also be important, which is why I talked about "worst-case" effectiveness. Also, non-neutralizing antibodies may have some effect, as virus particles even if not neutralized would be tagged, and would have some chance of being removed and destroyed by macrophages before they infect a cell. We've already seen 10x hits in neutralization assays with variants without widespread breakdown of vaccine effectiveness, but we may see more here and we're then into unexplored territory.
It seems in Europe / North America we have an easier problem unless Omicron is a booster-buster, and absolutely requires a new vaccine. Boosting people by summer is not a problem, getting people to take their first shot may be. Even if boosting provides only say six months of protection, that should buy enough time for Omicron-specific vaccines. But looks like the timeline for this info is 2 weeks or less, so we'll know soon.
I see I messed up one sentence. "spread primarily through the non-infected" should be "spread primarily through the non-immune"
While I'm here, I'm wondering about the Israel Minister of Health's announcement about preliminary indications that boosters would work against Omicron given that it's very unlikely they have had time yet to do any neutralization assays and they have only a couple known cases. Does the Mossad have better epidemiological data on South Africa than South Africa does? Or is this another case (of which we've seen many) of authority figures simply throwing out guesses or gut feelings without properly labeling them as such?
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!
It is pretty tragic. You'd hope we'd have learned better by now.
I was hoping you would post. Thank you for doing so. Some countries may respond to the Omicron with alacrity. I do not believe the US will exercise much caution. People are still filing lawsuits about mask wearing. State governments are challenging executive order. They are fining businesses that require masks. In my home state, I am usually the only person I see wearing a mask.
Thank you for this. Please, however, don’t skim over the problems of long covid. We don’t know enough about it yet to conclude that mild or moderate Covid cases in the acute stage are unimportant long term!
Sadly, It feels more like we're returning to our standard playbook: panicked ineffective overreaction (travel bans by passport, but not on weekends), which I expect will be followed by a "too soon" return to a complacent acceptance of high rates of infection/hospitalization and death, that would be considered unacceptable in other parts of the world, e.g., South Korea, Japan
Kai Kupferschmidt just published an article entitled "Patience is Crucial", our (the US + others) response to the pandemic so far has shown that patience doesn't seem to be part of our skillset. https://www.science.org/content/article/patience-crucial-why-we-won-t-know-weeks-how-dangerous-omicron
I'd very much like for this prediction to be proven terribly pessimistic and wrong
There is a very key snipped above: “tough containment measures to be modified quickly as evidence comes in”
Please understand, for some in the public there is a growing loss of trust in those supposedly in charge and their so-called expert allies because new measures are very unlikely to be modified or removed once introduced.
I know this may not be the case for some US states but it is absolutely the case for European countries.
The mental model in several places (say Italy, but increasingly many more) has been
- introduce vax pass because there is an emergency
- avoid stating at which point vax pass is phased out
- if pandemic data improves, attribute that to the vax pass, “we can’t remove it now!”
- if pandemic data does not improve, attribute that to the vax pass not being stringent enough, “we need more of it now!”
So, while it is good to have a rational discussion based on the precautionary principle, it would also be good to see an acknowledgement that people will be fatigued by “new restrictions” unless some very objective metrics to slip out of them are communicated (and again, I am not merely talking of the US here)
Yeah, I agree. I discuss that in detail in the NYT piece. You need to be able to stand down quickly if precautionary action is to be acceptable.
The 1918 flu pandemic strain turned into circulating H1N1 mild seasonal flu. I think lots of people are assuming that's what's going to happen here, especially since four widely circulated coronaviruses cause some fraction of colds.
However, that isn't an inevitable trajectory with respiratory infections. Measles, which like Covid and unlike H1N1, can spread throughout the body as an infection entered the human population at some unknown time in the past, at least centuries and possibly millennia. It never managed to become mild. We don't know what "long Covid" is, and that probably is irrelevant one way or another for the survival of the virus. Like nervous system involvement in polio. The average polio infection is mild, and the nervous system involvement which only happens in some people is late in infection and simply irrelevant to whether the next person gets infected. So the virus doesn't care.
So, the virus could turn into another cold in five years. Or a new childhood disease with long-term consequences in some. Right now, we don't know.
Just because someone's going to point this out if I don't, measles is a respiratory infection. I know very well that polio isn't, but that has nothing to do with my point regarding "long polio"
I wonder too whether the heavy media coverage is healthy, since there's not much the average person can do aside from upgrading masks and going to restaurants less. It probably is good though in making it easier to get politicians to pay attention.
But people were burned twice, by Alpha, then by Delta, so I think this would blow into a major news item no matter what.
I also wonder about the heavy media coverage. I'm old, so I know to ignore most "maybe gonna happen" news stories, especially as the breathless headlines continue day after day without any new information. Omicron is no exception. Nevertheless, it's good to have a heads-up for every "variant of concern."
Beyond upgrading masks, I'm taking the opportunity to engage in anticipatory disappointment in case Christmas and early 2022 travel seem too risky. (I never have started eating indoors, and only got two weeks back at the gym before Delta.) We're gradually adopting life strategies that take expected and unexpected circumstances of pandemics into account. That said, I feel for those with kids and jobs that pretty much preclude any manageable strategies.
Zeynep, you are a very good commentator on the pandemic. That is why it's so perplexing (and distressing!) that you fall into the camp of making gratuitous slams against pharmaceutical companies. Examples: 1) "The callous mistreatment of South Africa by big pharmaceutical companies continued into this pandemic. " 2) "...their production or price cannot be held hostage to the vagaries of even more profits by companies that have received substantial taxpayer support and use publicly funded research to develop their drugs." (As an aside, there was nothing stopping first world countries from buying the AIDS drugs for poorer countries. Hmmm, I guess we want pharmaceutical companies to bear the full burden. I wonder why? The answer doesn't reflect well on *us*.)
We *want* pharma to make a lot of money on a strictly utilitarian basis so that they continue to develop these amazing drugs. There can be a healthy debate about how to provide the right incentives and the length of protection for IP, but what is not up for debate is that we need these companies *motivated* to do the often thankless task of vaccine research and for other drugs. You have developed an informed opinion about the pandemic by doing a ton of reading and educating yourself. I suggest that you also develop an informed opinion of how *f'ing hard* it is to take publicly funded research to a final product. Derek Lowe might be a good person to read and talk with: https://www.science.org/blogs/pipeline
It's a longer conversation but... Yes, they do a lot of things right but they also do act terrible! The HIV/AIDS drug crisis is a moral stain of terrible proportions... Millions died while they blocked generic versions of drugs. And yes, the moral stain is shared by rich countries.
Sure, it is a subtle conversation about pharma. But two points: 1) Isn't it ironic that we are most up in arms about profits from drugs that help the *most* people? We want to go to generic immediately for drugs that are most beneficial. Meanwhile another cancer drug that is good for rich countries doesn't hear any demands to go immediately generic. Those are really twisted incentives. 2) You said in your comment, "they do a lot of things right." But you didn't have any sentence of praise in your article about the amazing things pharma does right. If we want to live in a society that focuses our best people on worthwhile problems, then we need to create an intellectual climate that gives status and incentives to people and companies that work on those problems. Having thoughtless sentences painting a vital industry as terrible doesn't help create such a climate. Instead, learning about the subtleties of the technical and *economic* difficulties of drug development and *bringing* that knowledge to the public as you do with the pandemic would be much more beneficial.
Travis, you have indeed raised a large and complicated question, and I'll pick only a few bits of it. I agree with you that we do want pharmaceutical companies to make money and continue to develop drugs.
At first it looked like the tremendous quantities of vaccine would mean the virus was eliminated and that would be the end of the income. Negotiations were of course made during the time we believed that. Government funding helped the drugs get to market faster. That period is over. The vaccines (modified as they lose effectiveness) will be needed for a long time. Yet, the development was, *explicitly, for this one vaccine*, government-funded at a high level. This upstarting period is the most expensive for drug companies, and that is paid for. What assurance do we have that these companies will now manufacture and sell the modified-as-needed vaccine at a profit, but not an egregious one, going forward?
Regarding the AIDS drugs, you are correct that the pharmacy companies largely developed these, using of course the research publicly funded by the U.S. and other countries. They received whatever they wanted for them until the patents ran out. Zeynep is talking about when the patents did run out, and the successful efforts of these countries to block production of what many people think should have been legal generics after that. As a response to your aside, the U.S., directly and through foundations and other donations, did indeed buy lots of high-priced AIDS drugs while campaigning for the right to produce generics.
Vaccine research is of interest to many researchers. Much of this research is funded through government research grants and private citizens and organizations. Dr. Peter Hotez was able to get a head start on his lab's Covid vaccine because of grant-supported work on a vaccine for SARS. Once SARS fizzled, the grants stopped and the work was shelved, but fortunately the team was still in place and could pick up where they left off. As Dr. Hotez noted, if he had been able to continue the research on coronavirus vaccines after SARS (and we knew more coronavirus strains would lead to mass infections), he would have been much closer to being able to develop a vaccine for Covid-19. Instead, primarily private funding has developed Corbevax, now in Phase 3 trials in India. I just found a new article on this, in which Dr. Hotez (and his partner Dr. Botazzi) say the total development cost from creation to marketing was $5-$7 million dollars (this does not include the cost of the trials in India), and the vaccine is expected to cost $3.00-$4.00 a dose. The most recent article I could find on this is https://www.texastribune.org/2021/10/19/texas-covid-19-vaccine-peter-hotez/
I will add that we need these companies motivated to produce antibiotics and antifungals. Or we need to fund the private and academic researchers who are looking for them.
I am an avid supporter of pointing out abuses or gaming of the system for IP. The patent system in general needs to be radically improved. It is incredibly frustrating to me that there's zero political momentum behind IP reform. I also readily acknowledge that reform is an incredibly difficult issue that takes deep subject matter expertise in order to reach conclusions that won't be more harmful than our current system. And thank you for the link to the story about Hotez. Inspiring stuff. All the same, my impression is that it has been incredibly difficult to bring a new vaccine to *market* (pre-pandemic), much less make money. Look what happened to LYMERix for lime disease.
I agree with you 100%. And do we ever need either a vaccine or treatment for Lyme disease. Many people get that who are just visting an area for a short time, and who wouldn't have gotten a vaccine, that I'd like to see both.
I don't see much on the news about Corbevax, but according to the NYT vaccine tracker the Phase 3 trial is to end soon.
Thanks so much for writing this!! As far as early action, should we also be doing stuff personally? or is the big effects going to only occur if governments and systems act?
Travel bans can work for islands (see New Zealand). But you have to be really aggressive and block the whole world. I don't know if Great Britain is self-sufficient in food, but if Boris Johnson is serious, that is the question he should be asking.
Italy, meanwhile, heavily restricts travel from quite a few countries but specifically allows it from Great Britain, which has higher rates of Covid than many restricted countries, and also from the US.
This could be theater, it could also be politicians not understanding exponentials.
Zeynep, is it possible that in our efforts to win the "War on Covid" we are unwittingly succumbing to a pandemic of scrutiny?
You acknowledge that we don't know much that is useful about Omicron (transmissibility, immune evasion, disease course).
Therefore, of what use is it to raise alarm? At what point does the "precautionary principle" transform into "the boy who cried wolf" and create panic?
How much of what we are witnessing through our first ever mass testing campaign is merely revealing what has always been happening with Influenza like Illnesses? Is it possible that the same frequency and pattern of mutations have always been occurring in the other known coronaviruses, only we didn't realize it because we didn't do 4,278,469,251
tests until now? (without evidence, I suspect we have never tested for any single virus more than 10 million times via PCR in the 20 years+ since we started employing the technology).
Isn't the consensus leaning towards this becoming endemic, that zero covid is off the table, and we have to live with it? If that is true, then won't there always be a new variant? Won't we cycle through the greek alphabet every 7-8 years?
Is it appropriate that with every letter change we incite panic in the market, cut off travel to specific countries, disrupt families, and spent money and resources which may have better use on other threats with a clearer ROI [1]?
To your firefighter analogy, we don't yell "fire" in a theater because we know the harms of that panic outweigh the good of having the firefighters there promptly "just in case".
It seems we just screamed "fire" in the world's theater.
The market is down, which impacts livelihoods. Panic is setting in, which causes stress, raises cortisol levels (which in turn, makes us more susceptible to, respiratory viruses). People will horde goods, they will retreat from social interactions. Another holiday may be lost, maybe two. Trillions will be spent.
And why? Because B.1.1.529 may replace B.1.617.2 as the dominant strain? Which may be a bad thing, but might actually be a good thing, or completely neutral event? We simply don't know. Is my understanding incorrect?
It is fascinating that we have the technology, resources, and expertise to scrutinize viruses to this degree. But before we get carried away with our new toys, it seems we should probably understand how they actually work and how much of what we are seeing is truly novel and how much is completely ordinary.
Zeynep, if you happen to see this comment, why did you halt paid subscriptions? Just curious, really enjoy your work and wanted to do more than just follow you on my NYT subscription.
*Note - I wrote this comment before reading your NYT piece, will go through that now and see if my initial reaction is changed.
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[1] By ROI, specifically I wonder how much of a dent the 6 trillion or so dollars we (the US) printed for Covid response could have made towards combating cancer, tackling income inequality, affordable housing/healthcare, Alzheimer's research, or simply giving each American $18,000 and seeing if that improves their health and longevity. (Open question if anyone can "do the math" for me, what is the best estimate of how much has been spent worldwide on the Covid 19 pandemic?)
We do track, sequence and name influenza variants. It's obviously not at the same fine-grain level, but new appearances at the level of Alpha, Beta, Gamma and Delta are easily identified. The difference with Omicron is that to my knowledge no successful influenza strain has so suddenly accumulated mutations to this extent, so we don't have a precedent. A big fear here is that there could be widespread and dangerous reinfections of people who thought themselves immune. That might not pan out, or there might be mild reinfections, but we are currently on the region of the map labeled, "There be dragons."
Appreciate the feedback John.
What I understand of GISAID is that since its inception in 2008 it has mostly focused on influenza strains, so while it may be true that no influenza strain has so suddenly accumulated mutations to this extent, do we expect influenza viruses to mutate at the same pace as coronaviruses? Are they comparable?
Appears that in the first 8 years of GISAID they obtained 650,000 samples, predominately flu, unclear if this means unique strains or total submissions (the wording I inferred submissions). Between March 2020 and April 2021 they received 2.2 million samples of Covid 19. So again, the scale of scrutiny here is unlike anything before.
It may be true that this is the first time in history a coronavirus has mutated so quickly and to such an extent.
But the odds of that happening precisely at the exact point in human history where we first turned on the spotlight feels like a massive coincidence.
If we had been doing 4 billion tests a year for decades and now saw this phenomenon, that would be noteworthy.
That aside, the admission that these tools can neither predict nor confirm which mutations are cause for concern leads me to wonder how we can base policy decisions with such dramatic effects when we haven't even taken the time to assign penalty costs for our models (maybe we have, but I haven't seen such work done).
If Omicron fades (like some of the other previous strains) you've got a point, as the flu surveillance might miss unsuccessful strains. Right now, it's dominant, but over a small area. Certainly, if it become dominant on a continent-wide scale, it would be picked up by even very small numbers of samples. I think the concern is that being dominant in a small area where the competitor is Delta, suggests its on its way unless there is some southern Africa specific circumstance of which we're unaware.
We've never observed a human pandemic with modern tools my knowledge of any virus other than flu or HIV, so I'm wondering if we're fitting too many expectations in from flu.
Whether it is Omicron or some other strain, I was under the impression eventually something will replace Delta - no? Isn't that part of what being endemic is all about?
Do we know if Omicron is less serious than Delta? What if it turned out it was more transmissible but lead to less disease - we would probably want it to spread.
It doesn't seem like we have the tools to determine which variants pose a threat in advance. All we can tell is "this is different, but we don't know if that is good different or bad different". Given that limitation, I am not sure I agree that we need to always take action every time something changes.
My concern would be that this is a vaccine buster, and that's where having so many mutations concentrated on good antibody binding targets is a concern. So, it can't be ruled out right now that we're back to March, 2020 (although with a quicker route out of that situation). However, that is easy to get some information on quickly, and Biontech says they will have an answer within two weeks. They didn't say what they will do, but, for sure, on that timescale, they could measure binding of post-vaccination antibodies to lab-synthesized Omicron Spike. If there's a 5x-10x hit it will look bad in the press reporting but we'll still be okay, perhaps urging caution and boosters for the not-recently-vaccinated and J&J, and perhaps having to deal with more breakthrough infections of the kind we're seeing with Delta. If there's a 100x hit, we may be in trouble, and might need to observe what happens in actual breakthrough infections whether protection against serious illness is lost.
Enhanced spread among the unvaccinated compared to Delta is a different issue and I think we should just expect that will happen with this or with improved Delta strains. Also, there's no evidence this is worse or better than Delta in terms of symptoms. Mostly young people were infected in SA, and these are least informative if nothing unusual happens. Again, we're going to see a lot of variants like that, and no cause for alarm unless something weird with the infections.
Large-scale lockdowns were pretty economically devastating and costs were staggering. I thought more again about Zeynep's suggestions regarding border closures. For the US and Canada, shutting non-commercial traffic for more than a year actually had very little impact except on some tourism-dependent locations and border towns. This would be a different story in places like Italy, but honestly there's little economic or political cost for the US. Also, vaccines would be a rounding error in the US budget.
Canada had difficulty negotiating the border reopening this summer, and in the end opened unilaterally because that was a low priority on the US side except for Schumer. Being able to go outside the country is just not important for most Americans, so I think a short border closure while making sure would not be costly. However, it might not quickly reverse if Omicron proved less threatening exactly because most Americans wouldn't care.
Absurdity knows no bounds. At this point, the pandemic is over, folks are immune in one way or another, and mutants are all part of the game. Shutting down anything is not a public health measure. It is a gift for those making bank from the lockdowns while eliminating their competition on Main St. Viruses don't act like this, however, bioweapons and planning do. Stop giving in to tyrannical policies designed to take your freedom and life away from you. It's time to fight back.
Not sure if everyone is immune. My suspicion is that young healthy people will probably (but not as a guarantee) be able to avoid death or serious illness from reinfection by Omicron.
However, older people in poor health are being reinfected with some frequency, and with a high fatality rate, and that's without being hit with a crazy variant like Omicron.
https://www.futurity.org/nursing-homes-covid-reinfections-2621092/
That is a sobering and informative article. I recommend it to other Insight readers. John, thank yo for continuing to provide so much good information and analysis.
Thank you for this piece, and for the delicious phrase "targeting passports rather than the virus".
I'm no longer surprised that government actions are stupid. Ban flights direct from affected areas, while allowing your citizens to return via somewhere else? If they have the virus, they get to spread it on the way home. Allow travel into the country from the affected areas, and don't impose a quarantine requirement? The freedom of one's citizens is so much more important than the health of one's other citizens and residents. Etc. etc. etc.
But it sure would be nice if a few more government decision makers cared more about their people's welfare, and indeed the welfare of all people regardless of citizenship, and comparatively less about their own career prospects. Or if doing the right thing could reasonably be expected to enhance their career prospects rather than diminish them.
Zeynep, I found this Insight post to be much easier to read because it names the variants instead of numbering them. I have been closely following Covid-19 from the beginning, and even so I had to stop and think the first time each number dropped, which meant I had to go back and re-read.
For Insight readers looking for more on Omicron, I recommend John Timmer's article in Ars Technica for covering a different range of information than Zeynep did: https://arstechnica.com/science/2021/11/why-omicron-quickly-became-a-variant-of-concern/
I took a look at when Delta was first identified, and apparently December last year, although it wasn't named till later. It then hit India hard late spring, and started to get bad in the US in the summer. Assuming a similar or slower development, that is a lot of time to ramp up and strategically deploy vaccine production.
The following thread from Trevor Bedford (also retweeted by Zeynep) gives to me what seems a reasonable summary now. R = 2 in the South African setting where it was detected, but degree of immune escape unknown. He assumes 90% immunity among the population where it's spreading, so the extreme scenarios could be widespread immune escape but R0 not much bigger (i.e., would rise slower than Delta but be harder to stop) or much less immune escape (R0 much bigger than R, with spread primarily through the non-infected, not ruling out that breakthrough cases are frequent but not retransmitting). That's a fair range of possibilities, but nothing wild.
https://twitter.com/trvrb/status/1466076808764297217
One caution is that a lot of the cases were apparently university students. These may not be representative of the general South African population, and might be taking more precautions (masking, vaccinations) or less (parties). Connectiveness with the rest of Africa might also be higher, due to families elsewhere, etc. I've never been to SA, and would have no idea.
So, this suggests significant potential for spread, but along timelines we've seen before unless we're unlucky and the early data is misleading. We're in far better shape than with Delta to react, thanks to much larger vaccine deployment and production capability.
If this is a Delta-like scenario, Africa gets hit hard in April/May, and there may be enough time to rush vaccines in first. I don't think existing production will do it, but the speed of bringing factories online in early 2020 was impressive. It's also possible that Omicron isn't very bad, but becomes much harder to stop with a very few more mutations. In that case, vaccinating Africa give a fighting chance of strangling the improved Omicron in the cradle. First, we need some worst-case idea of the effectiveness of the existing vaccines against Omicron both boosted and unboosted, and we're likely to get that quickly for the mRNA ones, so if Biden or someone else of similar stature could provide leadership, we could get moving quickly. However, it will be important to evaluate AstraZeneca, Sinovac, Sputnik etc in case these prove more practical to supply. Cell-mediated immunity won't be captured in neutralization assays and may also be important, which is why I talked about "worst-case" effectiveness. Also, non-neutralizing antibodies may have some effect, as virus particles even if not neutralized would be tagged, and would have some chance of being removed and destroyed by macrophages before they infect a cell. We've already seen 10x hits in neutralization assays with variants without widespread breakdown of vaccine effectiveness, but we may see more here and we're then into unexplored territory.
It seems in Europe / North America we have an easier problem unless Omicron is a booster-buster, and absolutely requires a new vaccine. Boosting people by summer is not a problem, getting people to take their first shot may be. Even if boosting provides only say six months of protection, that should buy enough time for Omicron-specific vaccines. But looks like the timeline for this info is 2 weeks or less, so we'll know soon.
I see I messed up one sentence. "spread primarily through the non-infected" should be "spread primarily through the non-immune"
While I'm here, I'm wondering about the Israel Minister of Health's announcement about preliminary indications that boosters would work against Omicron given that it's very unlikely they have had time yet to do any neutralization assays and they have only a couple known cases. Does the Mossad have better epidemiological data on South Africa than South Africa does? Or is this another case (of which we've seen many) of authority figures simply throwing out guesses or gut feelings without properly labeling them as such?