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.
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.
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
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?)
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.
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.
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
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)
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.
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.
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
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?)
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.
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.