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.
Agree, thank you. And we, US, have just got to do better with testing supply and capacity. We have been in this pandemic for almost two years and one still has to wonder why, when we knew Omicron was here, it took us so long to actually find the first case. How can a "test-to-stay" strategy to keep kids in school possibly be successful without adequate testing capacity?
Lots of good points. I think most will be hard to address in time for the current Omicron, but better ventilation etc will be a variant independent defense. Ideal would be a drug so safe and inexpensive you could take it after suspected exposure even without a positive test. I don't know if such is feasible, however you can be quite sure that a ton of research money is already going into this area. From the point of view of trying to send a message to governments, I'm thinking your points #2, #3, both of which relate to airborne transmission are especially important as I think improvements in the other areas are less likely to require a big external push.
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.
My husband and I travelled to North Carolina last weekend to attend my aunt’s funeral. I regret to say we were recklessly unmasked three times: twice in restaurants and once at the church reception following the service. Should we come down with COVID, we won’t feel sorry for ourselves. We knew the risks. We have quarantined since then. I went to Romania in November, when it was a code red. I received the third booster the day it came out, so went fully vaccinated . Ironically, I felt safer there. Everyone was masked even outside. Restaurants required proof of vaccination. I went to several museums and attended a ballet. Proof of vaccination and masks were required at all of these venues. At the ballet, seating was limited to allow for social distancing. I understand the sane option would have been to stay home. That said, I had a fantastic time. Had I contracted and died of COVID, I think the trip would have been worth it. Had I contracted COVID and turned into a long hauler, my feelings would have been mixed. At any rate, I knew the risks. I got a test upon returning home and quarantined for 10 days. While I was in Romania, I did not feel like I posed a big risk to others. Now with Omicron which appears to be super transmissible, I do not think I stand on ethically defensible grounds. Judy, I am wishing you and all others well this holiday season. And may we all be free of schadenfreude this coming year. I say this because I have struggled with the schadenfreude demon during this time of COVID.
Thank you Mary. Regarding the schadenfreude, one thing I learned more about recently was what the population that does not trust the shots is learning on their news and social media about the effects of the vaccines. I know they were getting bad advice, but not how specific it was about the terrible things that were happening to those who got the vaccine (which news they believe is of course covered up for most of us). If I believed what they do, I wouldn't get the vaccine either. That helped me get over blaming others.
As we all know, "Trust the science" is a very flawed motto. Science is an investigative process with results that periodically reinvents all of the fields it studies.
Regarding ethically defensible grounds, when I am in areas such as those described in the Atlantic article that I will llnk to below, where no one is paying attention to Covid, I will not do such as selectively visit immunocompromised people, but I don't feel responsible for being around people who have lived their unconstrained lives.
Thank you Judy. The article you reference pretty much describes what I see here in East Tennessee. I am usually one of only a few people masked up in stores. I haven’t eaten inside a restaurant in the US (except for last weekend’s colossal and horrible lapse) since the pandemic started. I am more afraid of giving someone COVID than of getting it. I wish COVID were an individual problem. But it’s not. My aunt, who had not yet received the third vaccine, died in a nursing home that was not requiring visitors to mask, nor had it taken any steps to get the latest boosters for its residents. She was as healthy as it is possible to be at 90. She died within three days of a positive test result. Did age play a role? Of course. Would she still be alive had she not contracted COVID. Probably. Might the outbreak at her nursing home been caused by someone like me, someone who normally masks up, but just that once didn’t? Possibly. I try to be good, but obviously I can’t cast stones.
I am so sorry about your loss of your aunt. I have a beloved cousin in Tennessee who is 91 and also very healthy. She got her third shot in January! So, who knows how protective it still is for her.
Wow -- that is just about the most extreme COVID gaslighting I've seen in a non-QAnon-type publication. Does this guy not actually know people who have died, had long COVID, and that sort of thing, or... what's going on with that?
John, more and more I think that our not seeing these kinds of statements is because what we think of as the mainstream media just does not cover the beliefs and actions of many people who are not Qanon, but are the quite prevalent regular people in our society.
I don't consider it gaslighting, and I don't have a great term for it. For most of the recently past presidency I used Kellyanne Conway's phrase "alternative facts." I shaded the meaning of that for myself because I have roots and friends and relatives and interests in alternative worlds (farmers, working class, big city, higher education, various religions, very dedicated to staying put vs. very insistent on living in new and virtual worlds, etc.) that do indeed have alternative facts that are important in their worlds.
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.
I too am contemplating testing positive, but I want to put it off as long as possible. Fatigue episodes since the mid-80s (not too debilitating, fortunately) have me on the alert in terms of Long Covid. I still remember the doctor saying about my first fatigue episode "you're probably still recovering from that 'flu' you had three weeks ago" (so: does having Long-Some-Other-Virus/post-viral syndrome predispose someone to Long Covid and further disability?)
Fortunately at this point there's maybe a pill coming out to actually treat the virus. There is also info on the internet indicating that Long Covid is possible in breakthrough cases (the final nail on my Christmas Amtrak trip to see family.) Within the year I expect to see correlations (or not) between patients with pre-existing ME/CFS and Long Covid. So, it's worth it to me to wear the mask for awhile longer as we learn more.
I pretty much refuse to mask up outside (distancing is easy where I live) unless there's evidence that a single exhalation from a passing runner can get you. I believe that our expensive N-95s are ruined if they get wet.
All this with heartfelt gratitude for my first-world status, of course ...
The Omicron wave in S.A. is already subsiding. I assume that it will be fast-moving in most of the rest of the world as well. So, I'm foreseeing heightened vigilance for a few months, after which we can all stand down a bit.
On the other hand, I have not minded wearing masks in the subway, grocery, etc., and I will not much mind wearing them in the park when there are lots of other people in the park. It's not a problem, esp. in the winter months when it keeps my face warmer.
On the third hand, Covid-19 is unlikely to have finished sending us new waves. and we are unlikely to be able to do anything about that. So, in answer to Michael. what alternative to personal planning do you suggest?
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.
Yes but that's pretty good for the first try. I think the expectation was of something more like annual updates being needed. I think testing a block of volunteers for safety and antibodies is a limiting factor here which might be hard to speed up. The other thing needed though would be surplus factory capacity so production could be ramped up fast. That might not make sense from a business standpoint, so could be a good place for government support.
Annual update sounds reasonable, but the re-infection susceptibility interval seems to be around 6 months, which is coincidentally the interval for a fully vaxxed Phizer or Moderna recipient to need a boost.
Spread is important, but not as important as hospitalizations, and I am annoyed that there is only health messaging about how P and M can better fend off infections with a boost. What about severity and death? Do those protections decline in 6 months after jab 2? to what extent? And to what extent does the boost improve that protection against Omicron?
We need a study to determine % of severe cases in second infections. That may point us to the way out, either live with it as background noise, or get an omnibus coronavirus vaxxine and shoot for eradication.
I believe I saw a study which suggested reinfection after Covid infection tended to be milder. Also, I think that you are correct that reinfections pick up after six months or so after mild or asymptomatic infections. A difficulty though is that the mildest infections may be the most important here, but mild and asymptomatic infections will be tracked the most poorly. I think severe infections protect against reinfection for longer. However, the studies I'm remembering were pre-Delta, and there's evidence it's already better at reinfection, while Omicron is a champ there.
The questions you ask are reasonable, and I'm thinking there are already published studies addressing all of them (excluding Omicron specific questions). I believe protection against severity holds on quite well past two months with a two-dose series, but that has primarily been measured against Delta.
My remark regarding "annual update" was describing pre-Omicron expectations based on assuming Sars-CoV-2 will change at a rate comparable to Influenza A or Influenza B. I think I wasn't clear there. There are currently two circulating variants of each for four flu viruses total, and there are quadravalent vaccines that hit them all. Each of the four components needs tweaking over every 1 to 5 years, so annual updates are sufficient. Omicron, in contrast to what we see with flu ( with flu some change every year, eventually becoming enough to escape the old vaccines), seems to be giving us impossibly little time (mere weeks) to make, test, manufacture and distribute the vaccines.
I had a hard time prying any information out of the CDC about how effective to expect this year's flu vaccine to be. (Maybe I just missed it.) They responded to my inquiry that they found last year's vaccine to be 30% effective. I had hoped for early data from this year, but what they sent me did not answer that. Given that flu hits me so hard I do not expect to live through the next bout, 30% was disheartening to me.
Was that a multivalent vaccine against all four viruses? 30% would be pretty bad. Some of the vaccines target just what are thought will be the dominant ones, but now I'm wondering how aggressively they actually update. Or does it depend on the company?
I looked up the efficacy for the H1N1 vaccine that came out during the 2009/2010 pandemic once to compare with the new anti-COVID ones. I read a figure of 95% for the vaccine against H1N1, but only 60% against total flu because other strains were going around. This suggests the flu vaccines CAN be quite good.
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.
Yeah, that one is particularly alarming, because the student population there was 99% fully vaccinated. And it still ripped through there like a freight-train. Crazy contagious.
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.
Until we have a pan-coronavirus vaccine, I'm also wondering if we have a general-principle sense of whether a boost of the latest variant-tailored vaccine would likely be more/less helpful (relative to original formulation) against potential future variants; or if that's too speculative to venture a hypothesis.
Granted that general principles can be wrong, but why wouldn't inserting the Omicron spike protein into the same lipid envelope of the vaccine NOT be more effective?
Fauchi balances a lot of variables, social, political, and scientific. He learned that in the trenches of Aids and became a very effective catalyst for that process. In my mind he has not come up with a good way to balance his scales for Covid. I still fault him for saying that masks are not effective. It seems to me that some of his decision points are hard binary: Americans can/cannot accept that risk is a scale, Americans can/cannot be trusted to make decisions about masks that take into account the needs of the medical community. He may be right. In any case, I have not heard him show his work.
He is a fantastic and dedicated public servant. He has faults.
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?
I'll take a stab at this so long as you realize it's 90% speculation.
Some detailed threads in Trevor Bedford's Twitter feed (pre-Omicron) suggest that Sars-CoV-2 is changing at a pace comparable to the fastest flu viruses, and much faster than the four coronaviruses that cause some colds. He suggested that this was due to Sars-CoV-2 adapting itself to humans, and he thought this process was already moving towards completion. After that, he predicted accumulation of mutations to slow down to some extent. He made a comment that all the major variants had in fact been generated in 2020, including Delta. Omicron doesn't fit in here and seems to have way more mutations than expected, so some people have speculated (I think reasonably) that it was produced in a prolonged infection in an immunocompromised person.
We're getting to the point that most of the global population has been vaccinated or infected, so new variants, unless they possess extreme ability to spread or a high degree of immune escape (higher than Beta, Gamma or Delta) or both won't pose much of a threat. My feeling is that the threat of improved Delta or improved Omicron will persist for a few months, but then infections will begin to massively drop (if nothing new and sufficiently nasty appears), there won't be enough infected people, and that potential source of variants will dry up.
If more immunocompromised people have been infected though and if that was the source of Omicron, we can guess from Omicron that a threat of new variants serious enough to trigger new pandemic waves emerging might remain for at least a year after a pandemic wave and possibly longer. The big question is will new "Omicrons", appear out of the blue like Omicron did? I.e., was Omicron a fluke that we were unlikely to be hit with, or are others in the works. Unfortunately, the only way to know will be to wait till next winter. By then, the answer will be clear.
Really appreciate the help here. You elucidate well the way I was thinking prior to Omicron, which is why it was a bit of a surprise (for me). The possible factor of the virus incubating and mutating within an immunocompromised person is what gives me the most pause. I would think, statistically, this was allowed to happen through the sheer volume of infections worldwide and concentrated in extremely varying locals and people. Now there seems to be much more...
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.
Remember the attention the first re-infections got? That's because they were rare, and took about six months to become commonplace. Catching the virus makes your body an unsuitable host for the virus after recovery, for what seems like 4-6 months. So omicron is 'winning' the race to fresh meat, out competing delta.
It's a bit more complex. There's a reasonable possibility that cross-protection between Delta and Omicron is weak enough that infection with one only slightly protects against infection with the other.
Trevor Bedford raises the possibility that Omicron and Delta could co-exist more or less indefinitely. However, the degree of cross-protection is currently unknown, so either could drive the other to extinction depending on that and relative ability to spread.
One possibility he didn't raise, but I think is realistic, is that there could be cross-protection, but with time-dependent loss of cross-protection. In that scenario, Omicron could suppress Delta, but with Delta roaring back after say 2-3 months.
This is all guessing. However, Omicron's first fatality in the US had previously had Covid according to this news report.
Thanks, that was super interesting. The public voices on this are advising that o is much more contagious, so higher R0. But they might be wrong because they are not factoring in possibility of high immune escape? Fascinating. If high immune escape were true, am I right that it means much higher % of pop in areas of o surge were infected with D than we had otherwise thought? My deduction has been, throughout, that the n for SARS CoV2 was considerably higher than the health experts were upwardly assuming. The clear policy reason for this is that a lower n supports higher apparent severity, lethality. I understand why they would want to make that choice, made for better public messaging. But if the n is up where I'm pretty sure it is, we may be working our way out of this via the Infection route.
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.
As long as breakthrough infections are possible, that has to happen when most of the population is vaccinated. If it spreads thru the vaccinated population at 1/4 speed, that will add up to = when you get to 80% vaxed (US around 70%)
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.
Yeah, there is no reason from the evidence to worry about it, and in fact, that is rarely an issue for any vaccine. (Dengue being the exception and they know how to handle that--it's one of the many things people invoke without understanding either the evidence or mechanism for it--we would have long ago seen it given the scale of this pandemic).
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.
Indeed, I think air exchange should be added to current "sustainable" technology for new construction.
Agree, thank you. And we, US, have just got to do better with testing supply and capacity. We have been in this pandemic for almost two years and one still has to wonder why, when we knew Omicron was here, it took us so long to actually find the first case. How can a "test-to-stay" strategy to keep kids in school possibly be successful without adequate testing capacity?
Thanks for this intellegent post
Lots of good points. I think most will be hard to address in time for the current Omicron, but better ventilation etc will be a variant independent defense. Ideal would be a drug so safe and inexpensive you could take it after suspected exposure even without a positive test. I don't know if such is feasible, however you can be quite sure that a ton of research money is already going into this area. From the point of view of trying to send a message to governments, I'm thinking your points #2, #3, both of which relate to airborne transmission are especially important as I think improvements in the other areas are less likely to require a big external push.
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.
My husband and I travelled to North Carolina last weekend to attend my aunt’s funeral. I regret to say we were recklessly unmasked three times: twice in restaurants and once at the church reception following the service. Should we come down with COVID, we won’t feel sorry for ourselves. We knew the risks. We have quarantined since then. I went to Romania in November, when it was a code red. I received the third booster the day it came out, so went fully vaccinated . Ironically, I felt safer there. Everyone was masked even outside. Restaurants required proof of vaccination. I went to several museums and attended a ballet. Proof of vaccination and masks were required at all of these venues. At the ballet, seating was limited to allow for social distancing. I understand the sane option would have been to stay home. That said, I had a fantastic time. Had I contracted and died of COVID, I think the trip would have been worth it. Had I contracted COVID and turned into a long hauler, my feelings would have been mixed. At any rate, I knew the risks. I got a test upon returning home and quarantined for 10 days. While I was in Romania, I did not feel like I posed a big risk to others. Now with Omicron which appears to be super transmissible, I do not think I stand on ethically defensible grounds. Judy, I am wishing you and all others well this holiday season. And may we all be free of schadenfreude this coming year. I say this because I have struggled with the schadenfreude demon during this time of COVID.
Thank you Mary. Regarding the schadenfreude, one thing I learned more about recently was what the population that does not trust the shots is learning on their news and social media about the effects of the vaccines. I know they were getting bad advice, but not how specific it was about the terrible things that were happening to those who got the vaccine (which news they believe is of course covered up for most of us). If I believed what they do, I wouldn't get the vaccine either. That helped me get over blaming others.
As we all know, "Trust the science" is a very flawed motto. Science is an investigative process with results that periodically reinvents all of the fields it studies.
Regarding ethically defensible grounds, when I am in areas such as those described in the Atlantic article that I will llnk to below, where no one is paying attention to Covid, I will not do such as selectively visit immunocompromised people, but I don't feel responsible for being around people who have lived their unconstrained lives.
https://www.theatlantic.com/ideas/archive/2021/12/where-i-live-no-one-cares-about-covid/620958/
Thank you Judy. The article you reference pretty much describes what I see here in East Tennessee. I am usually one of only a few people masked up in stores. I haven’t eaten inside a restaurant in the US (except for last weekend’s colossal and horrible lapse) since the pandemic started. I am more afraid of giving someone COVID than of getting it. I wish COVID were an individual problem. But it’s not. My aunt, who had not yet received the third vaccine, died in a nursing home that was not requiring visitors to mask, nor had it taken any steps to get the latest boosters for its residents. She was as healthy as it is possible to be at 90. She died within three days of a positive test result. Did age play a role? Of course. Would she still be alive had she not contracted COVID. Probably. Might the outbreak at her nursing home been caused by someone like me, someone who normally masks up, but just that once didn’t? Possibly. I try to be good, but obviously I can’t cast stones.
I am so sorry about your loss of your aunt. I have a beloved cousin in Tennessee who is 91 and also very healthy. She got her third shot in January! So, who knows how protective it still is for her.
Wow -- that is just about the most extreme COVID gaslighting I've seen in a non-QAnon-type publication. Does this guy not actually know people who have died, had long COVID, and that sort of thing, or... what's going on with that?
John, the NYTimes had what I thought was an excellent analysis of the social underpinnings of vaccine hesitancy. In case you don't have a subscription, this is a gift link that should work for anyone who wants to read it. https://www.nytimes.com/2021/12/03/opinion/vaccine-hesitancy-covid.html?unlocked_article_code=AAAAAAAAAAAAAAAACEIPuonUktbfqohlSlUbACbSRdkhrxqAwubGy7c9gHK7LCWOSCpLye8ERoOH5UbBI6p_Yt95lxKqeOh8Cp59Dvpj0r0YeEV3VwijppbDyMoLLnU-9N72AjNtgNeQBulmtG62ZTT8drwkzbC2tE7abGnuS7WfhSN6XHttp5Zud1ig2GVZhfuWV74ohaQtmKspFZt4Rj8fZCKVv_OOChR2O9uOax-0-RBhEqgCGmmVxYjAnupGJAZCClvGTGd84nI87r5eMdAXOqX5KX0waaRitNUFEuWgfMftiZX7U40&smid=url-share
John, more and more I think that our not seeing these kinds of statements is because what we think of as the mainstream media just does not cover the beliefs and actions of many people who are not Qanon, but are the quite prevalent regular people in our society.
I don't consider it gaslighting, and I don't have a great term for it. For most of the recently past presidency I used Kellyanne Conway's phrase "alternative facts." I shaded the meaning of that for myself because I have roots and friends and relatives and interests in alternative worlds (farmers, working class, big city, higher education, various religions, very dedicated to staying put vs. very insistent on living in new and virtual worlds, etc.) that do indeed have alternative facts that are important in their worlds.
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.
https://www.youtube.com/watch?v=MpUWrl3-mc8
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.
I too am contemplating testing positive, but I want to put it off as long as possible. Fatigue episodes since the mid-80s (not too debilitating, fortunately) have me on the alert in terms of Long Covid. I still remember the doctor saying about my first fatigue episode "you're probably still recovering from that 'flu' you had three weeks ago" (so: does having Long-Some-Other-Virus/post-viral syndrome predispose someone to Long Covid and further disability?)
Fortunately at this point there's maybe a pill coming out to actually treat the virus. There is also info on the internet indicating that Long Covid is possible in breakthrough cases (the final nail on my Christmas Amtrak trip to see family.) Within the year I expect to see correlations (or not) between patients with pre-existing ME/CFS and Long Covid. So, it's worth it to me to wear the mask for awhile longer as we learn more.
I pretty much refuse to mask up outside (distancing is easy where I live) unless there's evidence that a single exhalation from a passing runner can get you. I believe that our expensive N-95s are ruined if they get wet.
All this with heartfelt gratitude for my first-world status, of course ...
Only trying to understand where you are coming from, how many more years would you reasonably plan to live like this?
Could this be a permanent lifestyle you choose? Or, are there specific metrics you are waiting for us to achieve?
The Omicron wave in S.A. is already subsiding. I assume that it will be fast-moving in most of the rest of the world as well. So, I'm foreseeing heightened vigilance for a few months, after which we can all stand down a bit.
On the other hand, I have not minded wearing masks in the subway, grocery, etc., and I will not much mind wearing them in the park when there are lots of other people in the park. It's not a problem, esp. in the winter months when it keeps my face warmer.
On the third hand, Covid-19 is unlikely to have finished sending us new waves. and we are unlikely to be able to do anything about that. So, in answer to Michael. what alternative to personal planning do you suggest?
" Covid-19 is unlikely to have finished sending us new waves...."
No, I'm pretty sure that we're running out of Greek letters, so we'll be okay.
I do wonder, though, why Omicron was not designated "COVID-21", given how different it is from the original COVID-19 profile.
How different will a coronavirus have to be, to be called "COVID-22"?
That will suck, of course, but at least we'll be able to start with a fresh set of Greek letters.
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.
It might be better to have a less than 100 day lag between new variant and new vaccine.
Yes but that's pretty good for the first try. I think the expectation was of something more like annual updates being needed. I think testing a block of volunteers for safety and antibodies is a limiting factor here which might be hard to speed up. The other thing needed though would be surplus factory capacity so production could be ramped up fast. That might not make sense from a business standpoint, so could be a good place for government support.
Annual update sounds reasonable, but the re-infection susceptibility interval seems to be around 6 months, which is coincidentally the interval for a fully vaxxed Phizer or Moderna recipient to need a boost.
Spread is important, but not as important as hospitalizations, and I am annoyed that there is only health messaging about how P and M can better fend off infections with a boost. What about severity and death? Do those protections decline in 6 months after jab 2? to what extent? And to what extent does the boost improve that protection against Omicron?
We need a study to determine % of severe cases in second infections. That may point us to the way out, either live with it as background noise, or get an omnibus coronavirus vaxxine and shoot for eradication.
I believe I saw a study which suggested reinfection after Covid infection tended to be milder. Also, I think that you are correct that reinfections pick up after six months or so after mild or asymptomatic infections. A difficulty though is that the mildest infections may be the most important here, but mild and asymptomatic infections will be tracked the most poorly. I think severe infections protect against reinfection for longer. However, the studies I'm remembering were pre-Delta, and there's evidence it's already better at reinfection, while Omicron is a champ there.
The questions you ask are reasonable, and I'm thinking there are already published studies addressing all of them (excluding Omicron specific questions). I believe protection against severity holds on quite well past two months with a two-dose series, but that has primarily been measured against Delta.
My remark regarding "annual update" was describing pre-Omicron expectations based on assuming Sars-CoV-2 will change at a rate comparable to Influenza A or Influenza B. I think I wasn't clear there. There are currently two circulating variants of each for four flu viruses total, and there are quadravalent vaccines that hit them all. Each of the four components needs tweaking over every 1 to 5 years, so annual updates are sufficient. Omicron, in contrast to what we see with flu ( with flu some change every year, eventually becoming enough to escape the old vaccines), seems to be giving us impossibly little time (mere weeks) to make, test, manufacture and distribute the vaccines.
I had a hard time prying any information out of the CDC about how effective to expect this year's flu vaccine to be. (Maybe I just missed it.) They responded to my inquiry that they found last year's vaccine to be 30% effective. I had hoped for early data from this year, but what they sent me did not answer that. Given that flu hits me so hard I do not expect to live through the next bout, 30% was disheartening to me.
Was that a multivalent vaccine against all four viruses? 30% would be pretty bad. Some of the vaccines target just what are thought will be the dominant ones, but now I'm wondering how aggressively they actually update. Or does it depend on the company?
I looked up the efficacy for the H1N1 vaccine that came out during the 2009/2010 pandemic once to compare with the new anti-COVID ones. I read a figure of 95% for the vaccine against H1N1, but only 60% against total flu because other strains were going around. This suggests the flu vaccines CAN be quite good.
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.
Yeah, that one is particularly alarming, because the student population there was 99% fully vaccinated. And it still ripped through there like a freight-train. Crazy contagious.
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.
Until we have a pan-coronavirus vaccine, I'm also wondering if we have a general-principle sense of whether a boost of the latest variant-tailored vaccine would likely be more/less helpful (relative to original formulation) against potential future variants; or if that's too speculative to venture a hypothesis.
Granted that general principles can be wrong, but why wouldn't inserting the Omicron spike protein into the same lipid envelope of the vaccine NOT be more effective?
Both Biontech/Pfizer and Moderna are doing just that. Timeline to ship seems to be March.
Is that the optimum timeline? Seem a little slow. What about Christmas?
Dr. Fauchi is saying we don't need it. Yeah, right.
I just want Fauci to show his work. What is the calculation of costs and benefits that lead to the conclusion.
Fauchi balances a lot of variables, social, political, and scientific. He learned that in the trenches of Aids and became a very effective catalyst for that process. In my mind he has not come up with a good way to balance his scales for Covid. I still fault him for saying that masks are not effective. It seems to me that some of his decision points are hard binary: Americans can/cannot accept that risk is a scale, Americans can/cannot be trusted to make decisions about masks that take into account the needs of the medical community. He may be right. In any case, I have not heard him show his work.
He is a fantastic and dedicated public servant. He has faults.
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?
I'll take a stab at this so long as you realize it's 90% speculation.
Some detailed threads in Trevor Bedford's Twitter feed (pre-Omicron) suggest that Sars-CoV-2 is changing at a pace comparable to the fastest flu viruses, and much faster than the four coronaviruses that cause some colds. He suggested that this was due to Sars-CoV-2 adapting itself to humans, and he thought this process was already moving towards completion. After that, he predicted accumulation of mutations to slow down to some extent. He made a comment that all the major variants had in fact been generated in 2020, including Delta. Omicron doesn't fit in here and seems to have way more mutations than expected, so some people have speculated (I think reasonably) that it was produced in a prolonged infection in an immunocompromised person.
We're getting to the point that most of the global population has been vaccinated or infected, so new variants, unless they possess extreme ability to spread or a high degree of immune escape (higher than Beta, Gamma or Delta) or both won't pose much of a threat. My feeling is that the threat of improved Delta or improved Omicron will persist for a few months, but then infections will begin to massively drop (if nothing new and sufficiently nasty appears), there won't be enough infected people, and that potential source of variants will dry up.
If more immunocompromised people have been infected though and if that was the source of Omicron, we can guess from Omicron that a threat of new variants serious enough to trigger new pandemic waves emerging might remain for at least a year after a pandemic wave and possibly longer. The big question is will new "Omicrons", appear out of the blue like Omicron did? I.e., was Omicron a fluke that we were unlikely to be hit with, or are others in the works. Unfortunately, the only way to know will be to wait till next winter. By then, the answer will be clear.
Really appreciate the help here. You elucidate well the way I was thinking prior to Omicron, which is why it was a bit of a surprise (for me). The possible factor of the virus incubating and mutating within an immunocompromised person is what gives me the most pause. I would think, statistically, this was allowed to happen through the sheer volume of infections worldwide and concentrated in extremely varying locals and people. Now there seems to be much more...
@zeynep?
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.
Remember the attention the first re-infections got? That's because they were rare, and took about six months to become commonplace. Catching the virus makes your body an unsuitable host for the virus after recovery, for what seems like 4-6 months. So omicron is 'winning' the race to fresh meat, out competing delta.
It's a bit more complex. There's a reasonable possibility that cross-protection between Delta and Omicron is weak enough that infection with one only slightly protects against infection with the other.
Trevor Bedford raises the possibility that Omicron and Delta could co-exist more or less indefinitely. However, the degree of cross-protection is currently unknown, so either could drive the other to extinction depending on that and relative ability to spread.
https://mobile.twitter.com/trvrb/status/1470420216232374281
One possibility he didn't raise, but I think is realistic, is that there could be cross-protection, but with time-dependent loss of cross-protection. In that scenario, Omicron could suppress Delta, but with Delta roaring back after say 2-3 months.
This is all guessing. However, Omicron's first fatality in the US had previously had Covid according to this news report.
https://www.upi.com/Top_News/US/2021/12/21/first-US-Omicron-related-death-reported-Houston/7901640061635/
Thanks, that was super interesting. The public voices on this are advising that o is much more contagious, so higher R0. But they might be wrong because they are not factoring in possibility of high immune escape? Fascinating. If high immune escape were true, am I right that it means much higher % of pop in areas of o surge were infected with D than we had otherwise thought? My deduction has been, throughout, that the n for SARS CoV2 was considerably higher than the health experts were upwardly assuming. The clear policy reason for this is that a lower n supports higher apparent severity, lethality. I understand why they would want to make that choice, made for better public messaging. But if the n is up where I'm pretty sure it is, we may be working our way out of this via the Infection route.
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.
As long as breakthrough infections are possible, that has to happen when most of the population is vaccinated. If it spreads thru the vaccinated population at 1/4 speed, that will add up to = when you get to 80% vaxed (US around 70%)
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.
https://www.nature.com/articles/d41586-021-03794-8
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?
Yeah, there is no reason from the evidence to worry about it, and in fact, that is rarely an issue for any vaccine. (Dengue being the exception and they know how to handle that--it's one of the many things people invoke without understanding either the evidence or mechanism for it--we would have long ago seen it given the scale of this pandemic).
It does not seem that the corinavirus colds have much effect.