It’s still wait-and-see time for many key characteristics of the Omicron variant. I think the fact that it’s going to cause more breakthroughs in vaccinated people, and re-infections in people with prior infections, is baked in. The rest will take some time.
Thank you so much, Zeynep, for continuing to write this posts. They are the best source of reliable data I've seen and I appreciate your efforts to continue this conversation.
Thanks! Was waiting for your weekend read on this.
I appreciate this and all of your other posts Zeynep.
While it may be too soon to know the course of Omicron, it is not too early to do the things that we should already have done: a) make rapid cheap screening tests for asymptomatic people massively available, get more people vaccinated with 1st 2nd or third shots c) update the vaccine recipe to optimize for Delta and Omicron d) improve indoor ventilation. e) cheer on firms and business venues that require at least two doses of vaccine for entry f) use those rapid cheap massively available tests to reduce the costs of certain social distancing measures such as quarantining all students when one student tests positive.
Always a relief to get a Zeynep update. I now filter out almost all other commentary on Covid. Sky News ran 2 stories a few days ago, within hours of each other, saying first that Omicron could overwhelm the UK health system and then that symptoms are 'mild'. The information landscape is ludicrous.
As an ICU nurse, could you help with some math? I'm in the middle of conservative Pennsylvania where the lines have been drawn and hardened in place re vaccinations. So we are swamped with unvaccinated vent patients now. We put them on the vent knowing full well that very, very, very few, will survive after weeks of mostly futile work. Is it possible to come up with a possible death toll considering how many live in my community with 500,000 people, a vaccination rate of 50 % maybe and what we know of the Delta transmissability? I used to live in Guadalajara Spain, population 250,000, vaccination rate of 80%, and 1 ICU patient as of last week! Thanks for your posts.
Why we should vaccinate Africa, and what we can do to get Biden to move on this are two separate questions. Equity will work to some extent as an argument with him, but vaccinating Africa will then compete with a million other priorities, and the plan will be to take a look four years from now, and if there's still a problem then, to come up with a plan.
If he's scared, he'll think about the situation now. If Omicron is the "classic" version of the virus after a prolonged infection in an HIV+ person, we could get worse starting with Beta, Delta or Omicron. It looks like the lag before getting hit is something like six months to a year, so we're set to get hit again, and again while he's still serving his current term, and potentially with two or multiple new variants at the same time. This now becomes an urgent national security issue, and can be solved quite cheaply compared to buying a new aircraft carrier. This is separate from helping African countries produce locally, as that will be too slow. Long-term, local production is the answer though to make sure this mess doesn't happen again. India and Cuba, for example, can produce all the vaccine they need locally, and that is certainly feasible for Kenya, South Africa etc as well. Note that Cuba wasn't affected by the IP issues, as they developed and tested a vaccine from scratch, but that is trickier than producing something already known to work.
Thank you for your update. I still miss you another topic: Longcovid. We all know that originally mild illness can turn into a severe illness like longcovid (wouldn't address it as mild given how much many longcovid haulers are suffering from it). So even if Omicron causes only mild symptoms in the majority of infections, we won't know about the risk of longcovid for another 2-3 months at least. And it raises another question: People with longcovid are also at risk of reinfection by omicron. How will their weakened immune system fight off omicron? They're supposed to have low antibody titers or a defect in T cells. So before I'm overly optimistic, I hope we get answers to this aspect, too.
There was a recent study which concluded that any of the several vaccines they tested could boost any of the others, which is great. The one exception is that the third dose of Astrazeneca doesn't boost people who received two doses of Astrazeneca previously. This is probably because an immune response is generated against the adenovirus vector used in the Astrazeneca vaccine, and will probably be a problem for J&J and Sputnik as well.
This is bad news for India since they're relying heavily on AZ and would have to scramble for dose 3, but might be good news for Africa because AZ (possibly already retargeted to Omicron) would be freed up for Covax. However, both regions have been hit hard with Delta, so there would be some hope that with most people it would be infection + vaccination providing protection, so boosting wouldn't be needed.
Seems like the early evidence is that "full vaccination" won't do much about spread (in the incident in a Hong Kong quarantine hotel where transmission went across the corridor both cases were fully vaccinated with mRNA vaccines). Boosters may be borderline. One of the cases in Israel had received an mRNA booster and infected one other person. However, he had also interacted with a huge number of possible contacts without precautions, and the ones other than the guy he shared a car with were negative. That is all very thin data, but it suggests that boosters for everyone + some moderate level of precautions (masking and reducing interactions) might do the trick. At least in places where people accept vaccines.
South Africa has been hit by three waves so far, six months apart, with the last wave about five months ago. All three waves were short and sharp. suggesting not a lot of migitation, and possibly a high infection rate each time. This suggests lots of pre-existing partial immunity in SA, which will almost certainly reduce the severity. I.e., we really won't know till we see how the people in the superspread event in Norway do. There's some reports from SA about children under 2 showing up in the hospital at a high rate with severe symptoms, but these are contradicted by other reports suggesting that's not true.
One thing to keep in mind is that antibody neutralization will take a big hit (we know that because the targets for some but not all of the monoclonals used for treatment have been altered). So, a lot less viruses will be taken out before they infect their first cell. There is an independent immune response involving killer T-cells and called cell-mediated immunity. This is completely independent of antibodies and targets infected cells for destruction. I don't want to go into this in detail, but cells send snippets of their own proteins to the cell surface. The T-cells have proteins on their surface with a structure similar to antibodies with which they monitor cells for known foreign proteins, and if something suspicious shows up they will destroy the cell. Vaccines induce the production both of antibody-producing B-cells and of killer T-cells that patrol for Spike, and in the case of infection or whole-virus vaccines other virus proteins as well. Omicron's mutations won't provide much defense here, but the T-cell patrols, like police, don't really clamp down till signs of trouble have already been started. There's lots of evidence that cell-mediated immunity reduces the severity of Covid infections, but it's not so good at preventing them.
How that plays out in actual practice is just a guessing game right now (we have every reason to hope that vaccinated individuals will still have important protection against severe disease, but we'll have to wait to be sure).
According to the CDC, no one except healthcare personnel should wear "good masks" (N95s), but cloth masks (which seem mostly ineffective) and surgical masks (which seem somewhat better than nothing) are a-okay! Updated Oct. 25, 2021.
Why haven't these people been fired yet?
A couple neutralization assays are out done in different places using somewhat different methods (Zeynep retweets both if you want to check yourself). Both state about a 40x reduction in neutralizing ability from 2 doses Pfizer but with large person-to-person variation (but for one I see 7x reported in the tweet, but 40X in the abstract, and I don't have time to read through too carefully right now). There's an indication though that there is sufficient neutralization after infection + 2 Pfizer (and likely 2 Pfizer + booster). It's unlikely that when Pfizer releases its own results they'll be very different. Some things need to be kept in mind.
1) This is consistent with the thin data so far suggesting the double-dosed efficiently spread the virus.
2) According to an article in an Israeli newspaper, one person in Israel with a booster (he was interviewed for the article) didn't efficiently spread Omicron despite not taking precautions but did infect one other person he was in a car with for a prolonged length of time. This is consistent and promising as it suggests boosters might work at least long enough to bridge us to Omicron-specific vaccines. However, the usual caveats of doing statistics at N=1 apply. Doubtless, more data will show up with time.
3) Remember that cell-mediated immunity (killer T-cells) are unlikely to be much affected. The vaccines would likely significantly reduce illness (although not prevent infection) even with a worse variant where there was no antibody binding at all.
Thanks for this. Since the direction of Omicron is unknown, the question that seem most important to me is: What is strong and what is week about our response to Delta and other fairly well known variants. Strong: several vaccines that are effective at controlling Covid-19 in individuals that are free in the US and some other countries. Weak: 1) inadequate mfg capacity to produce enough jabs for most of world population; 2) 19th century level backwardness in IP law limiting an effort to produce adequate supplies and affordable jabs in many countries; 3) policies favoring medicine (drugs/vaccines) and undervaluing public health measures such as massive rapid testing, sequencing, contact tracing, improvement to ventilation, mask education and availability; and 4) failure to continually improve data collection methods and standards. The fourth in this list is probably first in importance. We are, in fact, still running blind as the gradual discovery of Omicron suggests. The rush of the CDC to drop masking as vaccines became available is characteristic of the impact of an unbalanced view of medicine vs public health. The delay in realizing the value of boosters is an example of not monitoring the evolution of the pandemic. The pressure to avoid boosters so that we can get more jabs world wide is an example of #1 above.
The timing of events in the past two weeks has made so clear the dysfunctional cadence of public health policy in the pandemic — obviously in the U.S. but also in the EU. Almost instantaneous clamping down on travel from SA (well, except for US citizens because apparently … well, no reason, really). When it became clear omicron is in many countries, and so many are pointing out the dangers of punishing transparent, fast alerts from SA? Silence. Nothing. Maybe a rollback in a week or two.
It’s like watching a chess player ignore Zugzwang. (Not sure that’s the right term but it’s the nearest ‘forced cadence’ term I know.)
Also: love the cartoon.
Thanks so much. What's particularly hard at this point is the lack of guidance on the holidays from people that seem like they actually believe that "hunkering down" for the holidays is an extremely high cost. For example, the author's "it's time to hunker down" article from about a year ago. At this point the commentators that are covid-cautious are advising caution and the ones that are more open are advising wait-and-see. But with Xmas 3 weeks away and Xmas travel 2 weeks ago, "wait and see" is kind of not an option. To a significant extent, a lot of folks need to decide today (really, two weeks ago or more) whether to forgo the in-person indoor mixing of the holidays for a second year in the row. Wait and see to some extent means "go forward with the holidays more or less like normal," which may be fine, but Omicron has come at a very awkward time for planning purposes.
Is there an existing conversation about our approach to broader evolutionary dynamics? Ie fitness landscapes, uh, 'islands' and how public health policies play a role? Thinking about birds in Papau New Guinea. Relevant also for creative adaptation among scientists and civic spirit.
See also: James Evans at University of Chicago