This time, why we are still not sure.
As I'm sure most on here are aware, The Atlantic "Covid response team" has some good articles coming out on all things Omicron, though I their tone is coming across as more alarming than yours Zynep. It's interesting because it really reads the same in regard to general messaging.
Thanks for sharing your thoughts on The Insight back to back with Omicron, we know you are busy with all of your other tasks.
I remain cautiously optimistic personally (as a bosted vax'er 46 y.o.), less so globally, but not panicked thanks to your analysis. The fast spread of Omicron does have me focused on the possibility of the next mutation. Pandemics suck, but they come and they go. Health, Strength, Luck and Joy for 2022 all.
As always, I'm deeply appreciative of Insight. Thank you.
I'd like to focus on what I think we can be sure of...
1) We, US and world, are not collecting enough data. The US could change this, especially with help from EU.
2) We, US and world, need mask education, mask production, and mask utilization. This need is independent of what we do or don't know about Omicron. Or Delta. It was true and obvious as soon as we knew Covid-19 is largely airborne.
3) We, US and world, need to rethink our approach to architecture—much as we once rethought systems for providing water and removing sewage. Air filtering, circulation, maximum access to sunlight, etc. should not be afterthoughts.
4) It looks like a qualitative improvement in anti-virals is near, or at least possible. We know that needs investigation and funding.
5) We, US and world, know not everyone will get jabs and that the vaccine itself is not enough when we consider the population as a whole and that putting all hope in vaccines has been and continues to be giving into needless deaths—especially among those who are vulnerable because of age, health, occupation, access to medical care, etc.
This note is already too long, so I will cut it here. In summary: advice to individuals in rich nations does not substitute for social and political policy on a national or international basis. We, the US, know that and we, the US, should act on that knowledge.
I have written here often and have done everything I can to take care of my elderly self. It is a great time to be reading Neal Stepenson's Quicksilver because I always wondered why people stayed in London and other cities during the plague or went back into them. Now I know. Most of course did not have the resources to leave, but of those who did, many just had to come back.
We went to one indoor event between Alpha and Delta. We got boosted and did a few careful things between the boosters and now. We have been to two funerals (non-Delta) since then as part of what families do for those who have mattered throughout our lives.
We are going to be with a large number of people over Christmas. Some of the people we have been with and will be with are not vaccinated. These folks have accepted their own cases of Covid, variously, as God's will, or as part of the ritual of their social/political beliefs, or as preferable to putting something they do not trust into their bodies. I understand all of these reasons. That understanding has been a bit of a journey for me.
We are taking our masks and our rapid tests. Except for this many-day Christmas gathering, we have engaged in what we consider these risky behaviors no more often than once a week, so that if we get sick we won't infect others and will be at home if we get sick.
If you are so inclined you may wish us well or pray for us and we will do the same for you.
We may not be facing the worst case scenarios, but it looks to me like we are still squarely in the range of the "Not great, Bob!" scenarios.
I saw this statement from the WaPo health reporter, Dan Diamond, on his FB page (linked from his twitter feed):
"Every expert I've interviewed, including some of the nation's top health officials, has adjusted his or her mindset and now is mentally bracing to test positive after spending two years dodging the virus. "Breakthrough" cases are going to be normalized in a hurry, if they aren't already."
That's me. I have dodged it for two years, I am triple-vaxxed with Pfizer, and I wear an N-95 mask whenever indoors in a public place. From now on, I will probably mask up outside, as well, if I'm going to be near people's breath. I'll do what I can to keep dodging as long as I can.
But I'm bracing to test positive, with whatever that will mean. Omicron is crazy contagious, and nobody's luck holds forever.
What I find discouraging here is that it looks like the virus is showing us that it is capable of throwing up variants that can both go through fully vaccinated populations and do so so fast that the whole thing will be finishing by the 100 day timeline where the first variant-specific vaccines are ready. There might be only one "Omicron" solution, but there might be many, and in the second case we can expect repeat performances at some unknown interval.
I would recommend more and better masking, boosting as quickly as possible (by priority groups) and expect not to have enough people boosted before it hits. Rapid tests will do some good to the extent they exist, but there won't be enough time to ramp up production. So, do what is possible and expect it not to be enough. Besides that, I think good information regarding airborne transmission for people who want to protect themselves.
Apprecited the long covid complicated comment.
Given that so many people are about to be surprised, with the accompanying feelings of dissapoinment, anger, etc...
Wondering how this will influence the political situation. As you've referenced, admins language has been, uh, not clear, particularly on breakthrough potential. But also no one likes "told you so".
Seems like we are in the middle of an evolution in how we learn, looking at epidemiology community and other coordinating efforts. Many have done a better job explaining their reasoning, assumptions and inferences too during a rapidly evolving situation.
CDC and policy peeps seem to still be struggling with difference b/t sound science and sound inference.
Thanks for helping us be informed with sound inference.
Based on the real world case study from Cornell, it does seem that countries starting their winters will have a very hard time stopping this spread unless you go back to March-April 2020 style lockdowns.
So all we can hope for is that the rest of the world mimics the curves of South Africa.
Same question again. However much worse or not worse Omicron will be the the US context, are FDA/CDC doing everything that is cost effective to get an Omicron-optimized vaccine into the portfolio? On what margins -- vaccine development, testing availability, 1st, 2nd, booster vaccination -- does the severity of Omicron matter? My inexpert view is, none. I'd be happy to understand why that's wrong.
Always helpful in framing the lens by which we should look at the new data we are about to see. Thank you.
Question: Are we now more or less likely to experience another variant of concern by next winter? If more likely, is there any indication or thought as to where selective pressure would push it at this point (like how we had some expectation that a variant with immunity escape might develop). Are these even the correct questions to be asking?
Trevor Bedford has some good Twitter threads relating Sars-CoV-2 to influenza virus evolution although they might be a bit technical to some people. As of recently, there were four circulating flus (two Influenza A viruses , two strains Influenza B). Going through graphs in Bedford's threads, I can't escape the conclusion that if we had gone after flu the way we went after Covid, flu would be in trouble (at least till a new virus gets in from pigs/birds). Antibody escape comparable to what's seen in Beta, Gamma, Delta seem to be a thing, but that leaves existing vaccines still good enough to hold out to the next update. His graphs don't show anything like a flu Omicron equivalent, and he's tracking four strains over more than a decade. So, I'm wondering regarding Omicron: 1) were we just unlucky, 2) is this part of the process of Sars-CoV-2 adapting to humans, with things stabilizing after another year or so, or 3) is there a factor here different from flu?
When we say that a particular, more transmissible (and possibly weaker) strain might come to dominate, and drive out other ones, why is that? I understand that it will account for more cases because it's more transmissible, but why would it cause other strains to die out? There's room for lots of viruses inside us.
Has anyone seen good commentary, critique or interpretation of the Lancet-published study (which I think) is showing a link between Covid and cognitive decline? https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(21)00324-2/fulltext
Is there data in the U.S. that is demonstrating who are getting infected with Delta who are unvaccinated, who are getting infected with omicron who are unvaccinated, who are getting infected with Delta who are vaccinated, and who are getting infected with omicron who are vaccinated? I saw some information posted that the number of people getting infected with COVID who are vaccinated is approaching the number of those who are unvaccinated.
Here's an article from Nature (probably paywalled), more or less summarizing existing thin data on severity. Likely to be not too different from previous strains on that count for the unvaxxed and uninfected.
We know it spreads like lightning and that double-dose vaccines don't provide community protection (but do provide personal protection). I.e., you likely won't end up in the hospital, but you will easily pass it on to others who might.
I think the important unknown is what happens when Omicron hits a nursing home where everyone is double or triple-vaxxed. We can be pretty confident the staff will do okay (but possibly need sick days), but the real question will be about the residents. If this happens and the residents are okay we can breathe a small sigh of relief.
Any views here on Original Antigenic Sin being a key factor in play?