The big picture: The data showed nearly a six-fold increase in Omicron’s share of COVID-19 infections in just one week.
The variant was only detected in the U.S. a few weeks ago. Still, the strain has spread rapidly throughout the country and threatens to overturn the new normal.
What they’re saying: “These numbers are stark, but they’re not surprising,” said Rochelle Walensky, the CDC’s director, adding that the growing infections reflect what has been seen in other countries.
While the Delta variant still drives up a lot of new infections, Walensky told AP she anticipates “that over time that Delta will be crowded out by Omicron.”
What’s next: President Biden on Tuesday will deliver a speech outlining new steps the administration will take to address the rapid spread of the new variant.
America was not prepared for COVID-19 when it arrived. It was not prepared for last winter’s surge. It was not prepared for Delta’s arrival in the summer or its current winter assault. More than 1,000 Americans are still dying of COVID every day, and more have died this year than last. Hospitalizations are rising in 42 states. The University of Nebraska Medical Center in Omaha, which entered the pandemic as arguably the best-prepared hospital in the country, recently went from 70 COVID patients to 110 in four days, leaving its staff “grasping for resolve,” the virologist John Lowe told me. And now comes Omicron.
Will the new and rapidly spreading variant overwhelm the U.S. health-care system? The question is moot because the system is already overwhelmed, in a way that is affecting all patients, COVID or otherwise. “The level of care that we’ve come to expect in our hospitals no longer exists,” Lowe said.
The real unknown is what an Omicron cross will do when it follows a Delta hook. Given what scientists have learned in the three weeks since Omicron’s discovery, “some of the absolute worst-case scenarios that were possible when we saw its genome are off the table, but so are some of the most hopeful scenarios,” Dylan Morris, an evolutionary biologist at UCLA, told me. In any case, America is not prepared for Omicron. The variant’s threat is far greater at the societal level than at the personal one, and policy makers have already cut themselves off from the tools needed to protect the populations they serve. Like the variants that preceded it, Omicron requires individuals to think and act for the collective good—which is to say, it poses a heightened version of the same challenge that the U.S. has failed for two straight years, in bipartisan fashion.
The coronavirus is a microscopic ball studded with specially shaped spikes that it uses to recognize and infect our cells. Antibodies can thwart such infections by glomming onto the spikes, like gum messing up a key. But Omicron has a crucial advantage: 30-plus mutations that change the shape of its spike and disable many antibodies that would have stuck to other variants. One early study suggests that antibodies in vaccinated people are about 40 times worse at neutralizing Omicron than the original virus, and the experts I talked with expect that, as more data arrive, that number will stay in the same range. The implications of that decline are still uncertain, but three simple principles should likely hold.
First, the bad news: In terms of catching the virus, everyone should assume that they are less protected than they were two months ago. As a crude shorthand, assume that Omicron negates one previous immunizing event—either an infection or a vaccine dose. Someone who considered themselves fully vaccinated in September would be just partially vaccinated now (and the official definition may change imminently). But someone who’s been boosted has the same ballpark level of protection against Omicron infection as a vaccinated-but-unboosted person did against Delta. The extra dose not only raises a recipient’s level of antibodies but also broadens their range, giving them better odds of recognizing the shape of even Omicron’s altered spike.In a small British study, a booster effectively doubled the level of protection that two Pfizer doses provided against Omicron infection.
Second, some worse news: Boosting isn’t a foolproof shield against Omicron. In South Africa, the variant managed to infect a cluster of seven people who were all boosted. And according to a CDC report, boosted Americans made up a third of the first known Omicron cases in the U.S. “People who thought that they wouldn’t have to worry about infection this winter if they had their booster do still have to worry about infection with Omicron,” Trevor Bedford, a virologist at Fred Hutchinson Cancer Research Center, told me. “I’ve been going to restaurants and movies, and now with Omicron, that will change.”
Third, some better news: Even if Omicron has an easier time infecting vaccinated individuals, it should still have more trouble causing severe disease. The vaccines were always intended to disconnect infection from dangerous illness, turning a life-threatening event into something closer to a cold. Whether they’ll fulfill that promise for Omicron is a major uncertainty, but we can reasonably expect that they will. The variant might sneak past the initial antibody blockade, but slower-acting branches of the immune system (such as T cells) should eventually mobilize to clear it before it wreaks too much havoc.
To see how these principles play out in practice, Dylan Morris suggests watching highly boosted places, such as Israel, and countries where severe epidemics and successful vaccination campaigns have given people layers of immunity, such as Brazil and Chile. In the meantime, it’s reasonable to treat Omicron as a setback but not a catastrophe for most vaccinated people. It will evade some of our hard-won immune defenses, without obliterating them entirely. “It was better than I expected, given the mutational profile,” Alex Sigal of the Africa Health Research Institute, who led the South African antibody study, told me. “It’s not going to be a common cold, but neither do I think it will be a tremendous monster.”
That’s for individuals, though. At a societal level, the outlook is bleaker.
Omicron’s main threat is its shocking speed, as my colleague Sarah Zhang has reported. In South Africa, every infected person has been passing the virus on to 3–3.5 other people—at least twice the pace at which Delta spread in the summer. Similarly, British data suggest that Omicron is twice as good at spreading within households as Delta. That might be because the new variant is inherently more transmissible than its predecessors, or because it is specifically better at moving through vaccinated populations. Either way, it has already overtaken Delta as the dominant variant in South Africa. Soon, it will likely do the same in Scotland and Denmark. Even the U.S., which has much poorer genomic surveillance than those other countries, has detected Omicron in 35 states. “I think that a large Omicron wave is baked in,” Bedford told me. “That’s going to happen.”
More positively, Omicron cases have thus far been relatively mild. This pattern has fueled the widespread claim that the variant might be less severe, or even that its rapid spread could be a welcome development. “People are saying ‘Let it rip’ and ‘It’ll help us build more immunity,’ that this is the exit wave and everything’s going to be fine and rosy after,” Richard Lessells, an infectious-disease physician at the University of KwaZulu-Natal, in South Africa, told me. “I have no confidence in that.”
To begin with, as he and others told me, that argument overlooks a key dynamic: Omicron might not actually be intrinsically milder. In South Africa and the United Kingdom, it has mostly infected younger people, whose bouts of COVID-19 tend to be less severe. And in places with lots of prior immunity, it might have caused few hospitalizations or deaths simply because it has mostly infected hosts with some protection, as Natalie Dean, a biostatistician at Emory University, explained in a Twitter thread. That pattern could change once it reaches more vulnerable communities. (The widespread notion that viruses naturally evolve to become less virulent is mistaken, as the virologist Andrew Pekosz of Johns Hopkins University clarified in The New York Times.) Also, deaths and hospitalizations are not the only fates that matter. Supposedly “mild” bouts of COVID-19 have led to cases of long COVID, in which people struggle with debilitating symptoms for months (or even years), while struggling to get care or disability benefits.
And even if Omicron is milder, greater transmissibility will likely trump that reduced virulence. Omicron is spreading so quickly that a small proportion of severe cases could still flood hospitals. To avert that scenario, the variant would need to be substantially milder than Delta—especially because hospitals are already at a breaking point. Two years of trauma have pushed droves of health-care workers, including many of the most experienced and committed, to quit their job. The remaining staff is ever more exhausted and demoralized, and “exceptionally high numbers” can’t work because they got breakthrough Delta infections and had to be separated from vulnerable patients, John Lowe told me. This pattern will only worsen as Omicron spreads, if the large clusters among South African health-care workers are any indication. “In the West, we’ve painted ourselves into a corner because most countries have huge Delta waves and most of them are stretched to the limit of their health-care systems,” Emma Hodcroft, an epidemiologist at the University of Bern, in Switzerland, told me. “What happens if those waves get even bigger with Omicron?”
The Omicron wave won’t completely topple America’s wall of immunity but will seep into its many cracks and weaknesses. It will find the 39 percent of Americans who are still not fully vaccinated (including 28 percent of adults and 13 percent of over-65s). It will find other biologically vulnerable people, including elderly and immunocompromised individuals whose immune systems weren’t sufficiently girded by the vaccines. It will find the socially vulnerable people who face repeated exposures, either because their “essential” jobs leave them with no choice or because they live in epidemic-prone settings, such as prisons and nursing homes. Omicron is poised to speedily recap all the inequities that the U.S. has experienced in the pandemic thus far.
Here, then, is the problem: People who are unlikely to be hospitalized by Omicron might still feel reasonably protected, but they can spread the virus to those who are more vulnerable, quickly enough to seriously batter an already collapsing health-care system that will then struggle to care for anyone—vaccinated, boosted, or otherwise. The collective threat is substantially greater than the individual one. And the U.S. is ill-poised to meet it.
America’s policy choices have left it with few tangible options for averting an Omicron wave. Boosters can still offer decent protection against infection, but just 17 percent of Americans have had those shots. Many are now struggling to make appointments, and people from rural, low-income, and minority communities will likely experience the greatest delays, “mirroring the inequities we saw with the first two shots,” Arrianna Marie Planey, a medical geographer at the University of North Carolina at Chapel Hill, told me. With a little time, the mRNA vaccines from Pfizer and Moderna could be updated, but “my suspicion is that once we have an Omicron-specific booster, the wave will be past,” Trevor Bedford, the virologist, said.
Two antiviral drugs now exist that could effectively keep people out of the hospital, but neither has been authorized and both are expensive. Both must also be administered within five days of the first symptoms, which means that people need to realize they’re sick and swiftly confirm as much with a test. But instead of distributing rapid tests en masse, the Biden administration opted to merely make them reimbursable through health insurance. “That doesn’t address the need where it is greatest,” Planey told me. Low-wage workers, who face high risk of infection, “are the least able to afford tests up front and the least likely to have insurance,” she said. And testing, rapid or otherwise, is about to get harder, as Omicron’s global spread strains both the supply of reagents and the capacity of laboratories.
Omicron may also be especially difficult to catch before it spreads to others, because its incubation period—the window between infection and symptoms—seems to be very short. At an Oslo Christmas party, almost three-quarters of attendees were infected even though all reported a negative test result one to three days before. That will make Omicron “harder to contain,” Lowe told me. “It’s really going to put a lot of pressure on the prevention measures that are still in place—or rather, the complete lack of prevention that’s still in place.”
The various measures that controlled the spread of other variants—masks, better ventilation, contact tracing, quarantine, and restrictions on gatherings—should all theoretically work for Omicron too. But the U.S. has either failed to invest in these tools or has actively made it harder to use them. Republican legislators in at least 26 states have passed laws that curtail the very possibility of quarantines and mask mandates. In September, Alexandra Phelan of Georgetown University told me that when the next variant comes, such measures could create “the worst of all worlds” by “removing emergency actions, without the preventive care that would allow people to protect their own health.” Omicron will test her prediction in the coming weeks.
The longer-term future is uncertain. After Delta’s emergence, it became clear that the coronavirus was too transmissible to fully eradicate. Omicron could potentially shunt us more quickly toward a different endgame—endemicity, the point when humanity has gained enough immunity to hold the virus in a tenuous stalemate—albeit at significant cost. But more complicated futures are also plausible. For example, if Omicron and Delta are so different that each can escape the immunity that the other induces, the two variants could co-circulate. (That’s what happened with the viruses behind polio and influenza B.)
Omicron also reminds us that more variants can still arise—and stranger ones than we might expect. Most scientists I talked with figured the next one to emerge would be a descendant of Delta, featuring a few more mutational bells and whistles. Omicron, however, is “dramatically different,” Shane Crotty, from the La Jolla Institute for Immunology, told me. “It showed a lot more evolutionary potential than I or others had hoped for.” It evolved not from Delta but from older lineages of SARS-CoV-2, and seems to have acquired its smorgasbord of mutations in some hidden setting: perhaps a part of the world that does very little sequencing, or an animal species that was infected by humans and then transmitted the virus back to us, or the body of an immunocompromised patient who was chronically infected with the virus. All of these options are possible, but the people I spoke with felt that the third—the chronically ill patient—was most likely. And if that’s the case, with millions of immunocompromised people in the U.S. alone, many of whom feel overlooked in the vaccine era, will more weird variants keep arising? Omicron “doesn’t look like the end of it,” Crotty told me. One cause for concern: For all the mutations in Omicron’s spike, it actually has fewer mutations in the rest of its proteins than Delta did. The virus might still have many new forms to take.
Vaccinating the world can curtail those possibilities, and is now an even greater matter of moral urgency, given Omicron’s speed. And yet, people in rich countries are getting their booster six times faster than those in low-income countries are getting their first shot. Unless the former seriously commits to vaccinating the world—not just donating doses, but allowing other countries to manufacture and disseminate their own supplies—“it’s going to be a very expensive wild-goose chase until the next variant,” Planey said.
Vaccines can’t be the only strategy, either. The rest of the pandemic playbook remains unchanged and necessary: paid sick leave and other policies that protect essential workers, better masks, improved ventilation, rapid tests, places where sick people can easily isolate, social distancing, a stronger public-health system, and ways of retaining the frayed health-care workforce. The U.S. has consistently dropped the ball on many of these, betting that vaccines alone could get us out of the pandemic. Rather than trying to beat the coronavirus one booster at a time, the country needs to do what it has always needed to do—build systems and enact policies that protect the health of entire communities, especially the most vulnerable ones.
1. While “vaccination” briefly appeared onscreen in a list of options, it didn’t merit a mention in the video.
2. The surgeon general listed guidance on “emerging” treatments that was … remarkably on point.
The absence of focus on vaccines in the video is unfortunate, if entirely in keeping with the GOP’s willingness to play to its anti-vax base. That’s bad, but not surprising.
What was surprising was No. 2. The information Ladapo shared about treatments was fairly accurate. In the video, he told Floridians to ask their doctor about monoclonal antibodies, fluvoxamine, and inhaled budesonide should they come down with Covid-19.
I’ve been reporting on the Covid-19 treatment beat for much of this year, and I’ve uncovered a massively confusing pile of contradictory information. But those are the top three treatments I’d recommend sick loved ones talk to doctors about, and while there’s much we still don’t know, solid science suggests they have real promise.
That said, the fact that such important (and accurate) information stood out in a government PSA indicates just how dismal the state of public communications on treatments is — and just how much misinformation and distrust are hampering the fight against Covid-19.
What should you take if you get Covid-19?
There’s been little public health communication about which treatments to pursue if you get Covid-19, perhaps because for much of the pandemic, it’s been unclear what options are better for mild Covid than just resting at home. While in 2021 the best treatment recommendations have gotten clearer, public health messaging over the last year has rightly been focused on vaccination.
The official CDC page on what to do if you get sick with Covid-19 advises you to wear a mask, wash your hands, and clean high-touch surfaces to avoid infecting those around you. If your breathing deteriorates or you show signs of severe illness like confusion or an inability to stay awake, the CDC advises you to go to the hospital.
All sound guidance — but what it doesn’t offer is advice on a question that patients who aren’t sick enough for hospitalization might desperately need to know: What medication should I take if I come down with Covid-19?
Meanwhile, large, high-quality, peer-reviewed, and published randomized controlled trials (RCTs) have found promise for cheap therapies that are already FDA approved for other purposes and have an established safety profile.
Research underway will help provide a better understanding of both of these therapies, but there’s enough evidence that some doctors are already prescribing them to patients. If you have the opportunity to enroll in an ongoing clinical trial of these medications, you can get access to a potentially promising treatment and help contribute to our scientific understanding of whether these treatments really work.
Another exciting treatment in the pipeline is Paxlovid, an antiviral developed by Pfizer that showed impressive 90 percent efficacy in preventing hospitalization — so effective that in November, the clinical trial stopped enrolling new participants because investigators concluded it’d be unethical to put them in the control group. It has not yet been approved by the FDA, but it might be a game changer if, as is expected, it’s approved in January.
Why is it so hard to find good guidance about treatments?
The US government has communicated little about Covid-19 treatment options. NIH guidelines about treatments like fluvoxamine haven’t been updated since this past spring, meaning results from recent high-quality studies haven’t been incorporated into that guidance. Without it, physicians considering whether to prescribe these medications can’t turn to official public health resources for help.
From a certain perspective, that reticence is understandable. Learning which Covid-19 treatments work is very hard. While large-scale RCTs found promising evidence for fluvoxamine and inhaled budesonide, “promising” is still the most we can say — it could absolutely turn out that the real-world effects are much smaller than hoped for, or even fail to materialize altogether.
But it’s precisely because this area is so difficult to navigate for doctors and patients that the CDC, FDA, and NIHcould play an important role in pointing out good treatments — yet it’s a role they have been puzzlingly reluctant to play.
Perhaps because of the dearth of formal federal government guidance on treatments — and because of politically driven crazes over drugs like hydroxychloroquine and ivermectin, which evidence thus far suggests do little to fight Covid-19 — Florida media hasbeencritical of Ladapo’s PSA and its recommendations.
But that justified irritation shouldn’t get in the way of a needed conversation about the possible benefits and drawbacks of monoclonal antibodies, fluvoxamine, and budesonide. As the US braces for an omicron surge that is likely to hit even vaccinated people, effective treatment is going to be essential for saving lives. Yes, promoting vaccines is a must, but tens of thousands of Americans are getting sick each day, which makes clear, accurate communication about which treatments to ask your doctor about extremely important.
The more society and public health get aligned on what works, the better off we’ll be in confronting omicron and other future variants.
Nurse Katie Sefton never thought Covid-19 could get this bad — and certainly not this late in the pandemic. “I was really hoping that we’d (all) get vaccinated and things would be back to normal,” said Sefton, an assistant manager at Sparrow Hospital in Lansing, Michigan. But this week Michigan had more patients hospitalized for Covid-19 than ever before. Covid-19 hospitalizations jumped 88% in the past month, according to the Michigan Health & Hospital Association.
“We have more patients than we’ve ever had at any point, and we’re seeing more people die at a rate we’ve never seen die before,” said Jim Dover, president and CEO of Sparrow Health System.
“Since January, we’ve had about 289 deaths; 75% are unvaccinated people,” Dover said. “And the very few (vaccinated people) who passed away all were more than 6 months out from their shot. So we’ve not had a single person who has had a booster shot die from Covid.”
Among the new Covid-19 victims, Sefton said she’s noticed a disturbing trend.
“We’re seeing a lot of younger people. And I think that is a bit challenging,” said Sefton, a 20-year nursing veteran.She recalls helping the family of a young adult say goodbye to their loved one. “It was an awful night,” she said. “That was one of the days I went home and just cried.”
‘We haven’t peaked yet’
It’s not just Michigan that’s facing an arduous winter with Covid-19. Nationwide, Covid-19 hospitalizations have increased 40% compared to a month ago, according to data from the US Department of Health and Human Services. This is the first holiday season with the relentless spread of the Delta variant — a strain far more contagious than those Americans faced last winter.
Sparrow Hospital nurse Danielle Williams said the vast majority of her Covid-19 patients are not vaccinated — and had no idea they could get pummeled so hard by Covid-19.“Before they walked in the door, they had a normal life. They were healthy people. They were out celebrating Thanksgiving,” Williams said. “And now they’re here, with a mask on their face, teary eyed, staring at me, asking me if they’re going to live or not.”
‘The next few weeks look hard’
Dover said he’s saddened but not surprised that his state is getting walloped with Covid-19.“Michigan is not one of the highest vaccination states in the nation. So it continues to have variant after variant grow and expand across the state,” he said.
“The next few weeks look hard. We’re over 100% capacity right now,” Dover said.”Most hospitals and health systems in the state of Michigan have gone to code-red triage, which means they won’t accept transfers. And as we go into the holidays, if the current growth rate that we’re at today, we would expect to see 200 in-patient Covid patients by the end of the month — on a daily basis.”And that would mean “absolutely stretching us to the breaking point,” Dover said.”We’ve already discontinued in-patient elective surgeries,” he said. “In order to create capacity, we took our post-anesthesia recovery care unit and converted it into another critical care unit.”
‘There’s a lot of frustration’
Nurse Leah Rasch is exhausted. She’s worked with Covid-19 patients since the beginning of the pandemic and was stunned to see so many people still unvaccinated enter the Covid unit.
“I did not think we’d be here. I truly thought that people would be vaccinated,” the Sparrow Hospital nurse said.”I don’t remember the last time we did not have a full Covid floor.”The relentless onslaught of Covid-19 patients has impacted Rasch’s own health. “There’s a lot of frustration,” she said. “The other day, I had my first panic attack … I drove to work and I couldn’t get out of the car.”
‘We need everybody to get vaccinated’
Dover said many people have asked how they can support health care workers.”If you really want to support your staff, and you really want to support health care heroes, get vaccinated,” he said. “It’s not political. We need everybody to get vaccinated.”
He’s also urging those who previously had Covid-19 to get vaccinated, as some people can get reinfected.”My daughter’s a good example. She had Covid twice before she was eligible for a vaccine,” Dover said. “She still got a vaccine because we know that if you don’t get the vaccine, just merely having contracted Covid is not enough to protect you from getting it again. And I know that from personal experience. “And those who are unvaccinated shouldn’t underestimate the pandemic right now, Dover said.
“The problem is, it’s not over yet. I don’t know if people realize just how critical it still is,” he said.”But they do realize it when they come into the ER, and they have to wait three days for a bed. And at that point, they realize it.”
COVID-19-related hospitalizations have been on an upward trend in New York state since last month, but there appears to be a drastic divide between the Big Apple and some of the state’s more rural areas, health data shows.
In New York City, the seven-day average of new COVID-19 hospitalizations per 100,000 people rose from 0.5 on Nov. 10 to 1.1 on Dec. 7, the New York State Department of Health said.
The story is different in several counties hundreds of miles north, where new COVID-19 hospitalizations are rising at a higher rate. In the Finger Lakes region, officials in several counties declared a state of emergency after the seven-day average of new COVID-19 hospitalizations per 100,000 people went from 2.9 on Nov. 10 to 4.9 on Dec. 7.
David Larsen, an associate professor of public health at Syracuse University, told ABC News that there are several factors behind this divide, but the most important one is the lower vaccination rates in certain counties upstate.
“At the end of the day, you’re more likely to get severe COVID-19 symptoms and go to the hospital if you’re not vaccinated,” Larsen said.
Health experts and state officials predict the situation upstate is only going to get worse during the holidays and colder months, but the tide can be turned if more people get their shots and heed health warnings.
As of Dec. 8, 74.9% of all New York state residents have at least one COVID-19 vaccine dose, but those numbers vary by region, according to state health data.
New York City and Long Island had over 78% of their populations with at least one shot, the state data showed. Further north, the rates for at least one dose in the Mohawk Valley, the Finger Lakes and North Country sections were 60.6%, 68.5%, and 63% respectively.
There is even more division within the regions when it comes to vaccination, the data shows; for example, counties that are along the Interstate 87 corridor, such as Hamilton, Schenectady and Saratoga, all have rate of at least one dose above 75% of their populations.
Counties directly west of those locations, Schoharie, Fulton and Montgomery, have one-dose vaccination rates under 65%, the state data showed.
New York Gov. Kathy Hochul has repeatedly highlighted that the unvaccinated are the ones suffering and being hospitalized.
“It is a conscious decision not to be vaccinated. And the direct result is a higher rate of individuals in those regions upstate as well as it has a direct correlation to the number of hospitalizations,” she said during a Dec. 2 news conference.
Dr. Isaac Weisfuse, an adjunct professor of public health at Cornell University, told ABC News that there are fewer options for upstate residents to turn to for medical help and fewer hospitals in the area are handling patients from more locations.
Weisfuse, a former deputy health commissioner for New York City’s Health Department, noted that New York City residents have much closer access to amenities like free testing sites and medical clinics than their upstate counterparts.
“If you live in a rural county in New York state and it takes a while to get to a doctor, you may put it off. So when you do eventually go get care, you may be sicker versus someone who lives closer and gets a quicker diagnosis,” he said.
Larsen added that there has been pandemic fatigue across the country, and many Americans have scaled back on mitigation measures, especially mask-wearing indoors.
“We’re doing less mask wearing. What that does is it increases transmission, which is fine for the vaccinated people but it does go to the unvaccinated people and they are higher risk,” he said.
Weisfuse said the hospitalizations are likely to grow upstate and have ripple effects for those regions. The governor has ordered elective surgeries to be postponed at 32 hospitals upstate that have seen their available beds decrease.
State officials said they are beefing up their marketing efforts to encourage eligible New Yorkers to get their shots.
Weisfuse said this outreach needs to be done meticulously if upstate officials want to avoid more overcrowded emergency rooms this winter.
“The state needs to take a good look at the pockets of non-vaccination,” he said. “They need to make some targeted intervention in those neighborhoods.”
Anyone who needs help scheduling a free vaccine appointment can log onto vaccines.gov.
Top US scientist Anthony Fauci said Tuesday that while it would take weeks to judge the severity of the new Covid-19 variant Omicron, early indications suggested it was not worse than prior strains, and possibly milder.
Speaking to AFP, President Joe Biden’s chief medical advisor broke down the knowns and unknowns about Omicron into three major areas: transmissibility, how well it evades immunity from prior infection and vaccines, and severity of illness.
The new variant is “clearly highly transmissible,” very likely more so than Delta, the current dominant global strain, Fauci said.
Accumulating epidemiological data from around the world also indicates re-infections are higher with Omicron.
Fauci, the long-time director of the National Institute of Allergies and Infectious Diseases (NIAID), said lab experiments that tested the potency of antibodies from current vaccines against Omicron should come in the “next few days to a week.”
On the question of severity, “it almost certainly is not more severe than Delta,” said Fauci.
“There is some suggestion that it might even be less severe, because when you look at some of the cohorts that are being followed in South Africa, the ratio between the number of infections and the number of hospitalizations seems to be less than with Delta.”
But he added it was important to not over-interpret this data because the populations being followed skewed young, and were less likely to become hospitalized.
“I think that’s going to take another couple of weeks at least in South Africa,” where the variant was first reported in November, he said.
“As we get more infections throughout the rest of the world, it might take longer to see what’s the level of severity.”
Fauci said a more transmissible virus that doesn’t cause more severe illness and doesn’t lead to a surge of hospitalizations and deaths was the “best case scenario.”
“The worst case scenario is that it is not only highly transmissible, but it also causes severe disease and then you have another wave of infections that are not necessarily blunted by the vaccine or by people’s prior infections,” he added.
“I don’t think that worst case scenario is going to come about, but you never know.”
Preliminary laboratory studies demonstrate that three doses of the Pfizer-BioNTech COVID-19 Vaccine neutralize the Omicron variant (B.1.1.529 lineage) while two doses show significantly reduced neutralization titers
Data indicate that a third dose of BNT162b2 increases the neutralizing antibody titers by 25-fold compared to two doses against the Omicron variant; titers after the booster dose are comparable to titers observed after two doses against the wild-type virus which are associated with high levels of protection
As 80% of epitopes in the spike protein recognized by CD8+ T cells are not affected by the mutations in the Omicron variant, two doses may still induce protection against severe disease
The companies continue to advance the development of a variant-specific vaccine for Omicron and expect to have it available by March in the event that an adaption is needed to further increase the level and duration of protection – with no change expected to the companies’ four billion dose capacity for 2022
NEW YORK & MAINZ, Germany–(BUSINESS WIRE)– Pfizer Inc. (NYSE: PFE) and BioNTech SE (Nasdaq: BNTX) today announced results from an initial laboratory study demonstrating that serum antibodies induced by the Pfizer-BioNTech COVID-19 Vaccine (BNT162b2) neutralize the SARS-CoV-2 Omicron variant after three doses. Sera obtained from vaccinees one month after receiving the booster vaccination (third dose of BNT162b2 vaccine) neutralized the Omicron variant to levels that are comparable to thoseobserved for the wild-type SARS-CoV-2 spike protein after two doses.
Sera from individuals who received two doses of the current COVID-19 vaccine did exhibit, on average, more than a 25-fold reduction in neutralization titers against the Omicron variant compared to wild-type, indicating that two doses of BNT162b2 may not be sufficient to protect against infection with the Omicron variant. However, as the vast majority of epitopes targeted by vaccine-induced T cells are not affected by the mutations in Omicron, the companies believe that vaccinated individuals may still be protected against severe forms of the disease and are closely monitoring real world effectiveness against Omicron, globally.
A more robust protection may be achieved by a third dose as data from additional studies of the companies indicate that a booster with the current COVID-19 vaccine from Pfizer and BioNTech increases the antibody titers by 25-fold. According to the companies’ preliminary data, a third dose provides a similar level of neutralizing antibodies to Omicron as is observed after two doses against wild-type and other variants that emerged before Omicron. These antibody levels are associated with high efficacy against both the wild-type virus and these variants. A third dose also strongly increases CD8+ T cell levels against multiple spike protein epitopes which are considered to correlate with the protection against severe disease. Compared to the wild-type virus, the vast majority of these epitopes remain unchanged in the Omicron spike variant.
“Although two doses of the vaccine may still offer protection against severe disease caused by the Omicron strain, it’s clear from these preliminary data that protection is improved with a third dose of our vaccine,” said Albert Bourla, Chairman and Chief Executive Officer, Pfizer. “Ensuring as many people as possible are fully vaccinated with the first two dose series and a booster remains the best course of action to prevent the spread of COVID-19.”
“Our preliminary, first dataset indicate that a third dose could still offer a sufficient level of protection from disease of any severity caused by the Omicron variant,” said Ugur Sahin, M.D., CEO and Co-Founder of BioNTech. “Broad vaccination and booster campaigns around the world could help us to better protect people everywhere and to get through the winter season. We continue to work on an adapted vaccine which, we believe, will help to induce a high level of protection against Omicron-induced COVID-19 disease as well as a prolonged protection compared to the current vaccine.”
While these results are preliminary, the companies will continue to collect more laboratory data and evaluate real-world effectiveness to assess and confirm protection against Omicron and inform the most effective path forward. On November 25, the companies started to develop an Omicron-specific COVID-19 vaccine. The development will continue as planned in the event that a vaccine adaption is needed to increase the level and duration of protection against Omicron. First batches of the Omicron-based vaccine can be produced and are planned to be ready for deliveries within 100 days, pending regulatory approval. Pfizer and BioNTech have tested other variant-specific vaccines as well, which have produced very strong neutralization titers and a tolerable safety profile. Based on this experience the companies have high confidence that if needed they can deliver an Omicron-based vaccine in March 2022. The companies have also previously initiated clinical trials with variant-specific vaccines (Alpha, Beta, Delta & Alpha/Delta Mix) and data from these studies will be submitted to regulatory agencies around the world to help accelerate the process of adapting the vaccine and gaining regulatory authorization or approval of an Omicron-specific vaccine, if needed. The companies have previously announced that they expect to produce four billion doses of BNT162b2 in 2022, and this capacity is not expected to change if an adapted vaccine is required.
About the Pfizer-BioNTech Laboratory Studies
To evaluate the effectiveness of BNT162b2 against the Omicron variant, Pfizer and BioNTech immediately tested a panel of human immune sera obtained from the blood of individuals that received two or three 30-µg doses of the current Pfizer-BioNTech COVID-19 vaccine, using a pseudovirus neutralization test (pVNT). The sera were collected from subjects 3 weeks after receiving the second dose or one month after receiving the third dose of the Pfizer-BioNTech COVID-19 vaccine. Each serum was tested simultaneously for its neutralizing antibody titer against the wild-type SARS-Cov-2 spike protein, and the Omicron spike variant. The third dose significantly increased the neutralizing antibody titers against the Omicron strain spike by 25-fold. Neutralization against the Omicron variant after three doses of the Pfizer-BioNTech COVID-19 vaccine was comparable to the neutralization against the wild-type strain observed in sera from individuals who received two doses of the companies’ COVID-19 vaccine: The geometric mean titer (GMT) of neutralizing antibody against the Omicron variant measured in the samples was 154 (after three doses), compared to 398 against the Delta variant (after three doses) and 155 against the ancestral strain (after two doses). Data on the persistence of neutralizing titers over time after a booster dose of BNT162b2 against the Omicron variant will be collected.
The Pfizer-BioNTech COVID-19 vaccine, which is based on BioNTech’s proprietary mRNA technology, was developed by both BioNTech and Pfizer. BioNTech is the Marketing Authorization Holder in the United States, the European Union, the United Kingdom, Canada and other countries and the holder of emergency use authorizations or equivalents in the United States (jointly with Pfizer) and other countries. Submissions to pursue regulatory approvals in those countries where emergency use authorizations or equivalent were initially granted are planned.
That’s what we felt when news broke about a new coronavirus variant, named omicron, being designated as a “variant of concern.” It’s been nearly two years since Covid-19 was declared a global pandemic, and we’re yet again wondering what the future holds.
Once again, there are no clear answers. But we do know enough to begin mapping out the space of possibilities.
We know enough to ask, as we have at pastmoments in the pandemic: What are the (relatively) “good,” “bad,” and “ugly” scenarios?
Full disclosure: Even in the day it took us to draft this post, we’ve had to rethink our beliefs in light of emerging information. Still, even if these predictions are shaky, we believe there’s value in reflecting on the futures that could arise—and how health care stakeholders can prepare for each one.
The (relatively) ‘good’ scenario: Our existing vaccines and treatments still work, and omicron doesn’t cause worse disease.
It would be misguided to label any outcome as truly “good” in a pandemic that has already killed more than 775,000 Americans and more than 5 million people worldwide.
Still, some possible futures are clearly better than others—and the best-case scenarios are those in which the omicron variant doesn’t fundamentally change the course of the pandemic.
America has already given 74% of people aged 5+ at least one vaccine dose. If those vaccines are as effective against omicron as other variants, that will be a promising sign for the pandemic’s future.
It’s even possible that omicron’s emergence could drive increased vaccine and booster uptake, as happened in the initial weeks of the delta surge. It could even advance efforts to vaccinate the world, a task that President Biden deemed a “moral obligation” in his early remarks on the omicron variant.
So how likely are current vaccines to work against the omicron variant? One reason for optimism is that most early cases and hospitalizations in South Africa appear to have occurred in unvaccinated individuals. Another is that vaccines have worked well against all past variants, including delta. Still, experts caution that omicron carries more mutations than past variants, and many of those mutations exist in areas associated in lab experiments with immune escape. In the coming weeks, we’ll have more data on whether the vaccines protect against the variant.
Another “good” possibility would that omicron doesn’t make people as sick as other variants (or, put more formally, that it’s not especially virulent). Here, too, there’s reason for optimism. Early reports out of South Africa indicate that most infected individuals have suffered only minor or asymptomatic illnesses.
But there’s also reason for caution: Because the variant has emerged so recently, it’s possible that most cases simply haven’t had time to progress to hospitalization and death. According to WHO, there’s simply no evidence to suggest that omicron’s symptoms are any better or worse than those caused by past variants.
On the whole, we think a relatively good scenario remains plausible, especially in highly vaccinated regions. Additionally, our current preparedness measures—like increased testing and vaccinations, as well as even renewed calls from Dr. Francis Collins from the NIH for mask wearing indoors—may help us get ahead of omicron’s spread, at least in the U.S. But there’s also a risk that things will turn worse.
The ‘bad’ scenario: Omicron is highly transmissible and slightly more virulent than previous variants, but existing vaccines and treatments still work well.
In the “bad” scenario, the omicron variant’s course could look very similar to that taken by the delta variant in the summer. It could rapidly spread throughout the nation and world, with the most severe impacts on unvaccinated populations.
Transmissibility could be a key factor in this scenario, and data on the variant’s basic reproduction ratio (R0) a metric used to describe the contagiousness or transmissibility of infectious agents, will help us further understand potential impact. The original coronavirus had a R0 of 2.79, and the delta variant had a R0 of 5.08. If the omicron variant’s R0 exceeds this number (and is more virulent), we may find ourselves in a “bad” scenario. Experts have speculated that omicron is likely highly transmissible since it carries mutations found on the very contagious delta variant, as well as other mutations hypothesized to increase transmissibility. The variant’s apparently rapid rise in South Africa also suggests it spreads easily, although experts warn we don’t yet know for sure.
If omicron turns out to be the most transmissible variant yet, we should expect another wave of cases among the unvaccinated, likely accompanied by an increase in breakthrough infections. However, so long as our vaccines still are effective, most breakthrough infections will be mild, as was the case during the delta surge.
Even in this “bad” scenario, we’re still much better off than in past coronavirus waves. In just the last several weeks, we’ve seen the emergence of new, promising treatments—notably, oral antivirals that reduce the risk of hospitalization and severe illness. Pfizer’s antiviral, Paxlovid, was shown to provide an 89% risk reduction in outpatients. Merck’s antiviral, molnupiravir, was recently shown to reduce the risk of hospitalization and death from Covid-19 by 30%.
Because of the way these treatments work in the body, experts feel confident they’ll remain effective against the omicron variant. It’s possible that, at least at first, they could be reserved for unvaccinated people or high-risk groups or sent to areas with the greatest prevalence of the variant. It’s likely that FDA will discuss these possibilities as it reviews these drugs’ applications for emergency use authorization. It will also be essential that we can overcome some of the big obstacles for anti-viral treatments, such as access, rapid testing, and sufficient tracking.
Still, while post-exposure drugs will play an important role in a “bad” scenario, the key to preventing a truly “ugly” outcome will be vaccines. The World Health Organization and the Biden administration both echoed this message, recently urging people to get vaccinated and boosted to prevent further spread. Additionally, CDC just strengthened its booster recommendations, saying all eligible adults “should” get boosted (where previous guidance said they “may” get boosted) and Pfizer announced it is seeking approval of boosters for people ages 16 and 17.
The sooner vaccines are distributed throughout America and the world, the better the outcome will be—at least so long as the vaccines themselves remain effective.
The ‘ugly’ scenario: Vaccines falter, and omicron’s virulence is dangerously high.
The biggest question, then, is: What happens if our current vaccines falter?
Here’s where we want to be cautious. Most experts say omicron is extremely unlikely to fully evade existing vaccines. Scott Gottlieb, former FDA commissioner, recently said that “… if you talk to people in vaccine circles… they have a pretty good degree of confidence that a booster vaccine so three full doses of vaccine is going to be fairly protective against this new variant.” It would be irresponsible, and unhelpful, for us to speculate—in absence of any evidence, and against scientists’ best predictions—that vaccines could simply stop working.
But it’s possible that omicron will show a degree of immune escape.
If so, then many people who are vaccinated could fall ill. They in turn could pass the virus to others. And if omicron proves to be as virulent as or worse than past variants, many of those infected—especially those who are unvaccinated—will suffer and die.
This would render the next 100 days truly “ugly,” as manufacturers race to develop new vaccines and boosters against the new variant, and an already exhausted health care system copes with yet another devastating wave of cases.
In this scenario, health care leaders, policymakers, and public health officials will need to re-evaluate preventive strategies. We could once again see draconian measures such as lockdowns and sustained capacity mandates. However, President Biden recently announced that the U.S. will not resort to lockdowns or shutdowns as a result of omicron, making this possibility unlikely.
Even this scary scenario wouldn’t quite bring us back to March 2020. We know dramatically more than we did then about how to detect, contain, and treat Covid-19, and manufacturers stand ready to adapt their vaccines with all due haste.
But this scenario would be horrific, and the next few months would feel all too much like déjà vu.
Parting thoughts
When we’ve written these predictions about the pandemic in the past, we struggled to see how our individual actions could meaningfully inflect our trajectory toward a good, bad, or ugly outcome.
But whether one or none of these scenarios play out, it is important to step back and consider how we can rely on lessons we’ve learned over the past two years. Lessons such as encouraging vaccine uptake by going into the community, combatting structural inequities by acknowledging and acting, helping out vulnerable countries around the world, supporting the health care workforce, and much more.
If you are feeling overwhelmed after reading through these various scenarios, stuck in the treacherous mental waters of the unknown, you are not alone. It is okay to acknowledge the confusion of constantly emerging data as we learn how to proceed. But this is also true: these unknowns will not be the end of us. Somehow, amid the chaos of constant pandemic updates and new death tolls, we continue to move forward as a collective—doing our best to stay prepared, protected, and proactive.
The new omicron variant is “more of a Frankenstein” than previous virus coronavirus variants, according to one virologist, and vaccine experts are at odds over how well current vaccines will provide protection against it.
A ‘Frankenstein’ variant
According to Alex Sigal, a virologist heading a team of researchers at the Africa Health Research Institute, the new variant is “probably the most mutated virus we’d ever seen.” However, Sigal added that he believes existing Covid-19 vaccines will continue to protect people against severe disease and hospitalization.
Similarly, Ugur Sahin, BioNTech co-founder, said that the Pfizer-BioNTechvaccine not only creates antibodies that prevent infection from occurring, but also creates T lymphocytes that attack cells after the body has been infected. Sahin argued that, even if omicron can evade antibodies, it would likely be vulnerable to T lymphocytes.
“Our message is: Don’t freak out, the plan remains the same: Speed up the administration of a third booster shot,” Sahin said.
Luke O’Neill, an immunologist and chair of biochemistry at Trinity College Dublin, said Sahin’s assumption makes sense from an immunological perspective. “There is optimism that the T-cells will hold the line—they are very good at stopping severe disease,” O’Neill said.
However, Stanley Plotkin, a scientist who has developed many vaccines, said Sahin’s assumptions were “gratuitous and without any proof.” Plotkin said so far there’s little evidence to suggest T-cells could fully protect against severe symptoms if a virus evades antibodies.
Further, Stéphane Bancel, CEO of Moderna, said, “There is no world, I think, where [the effectiveness] is the same level … we had with [the] Delta [variant] … I think it’s going to be a material drop. I just don’t know how much because we need to wait for the data. But all the scientists I’ve talked to … are like, ‘This is not going to be good.'”
However, former FDA commissioner Scott Gottlieb on Monday said, “There’s a reasonable degree of confidence in vaccine circles that [with] at least three doses … the patient is going to have fairly good protection against this variant.”
Angelique Coetzee, national chair of the South African Medical Association, said that so far, vaccinated patients who have tested positive for omicron “have no complication.” She noted that the nation’s hospitals were not overwhelmed by omicron patients, and most of those hospitalized were not fully vaccinated. Additionally, most patients she had seen did not lose their sense of taste and smell, and had only a slight cough, the New York Times reports.
“I have seen vaccinated people and not really very sick,” Coetzee said. “That might change going forward, as we say, this is early days. And this is maybe what makes us hopeful.”
Could omicron ‘outcompete’ delta?
Separately, Adrian Puren, acting executive director of South Africa’s National Institute for Communicable Diseases, said he believes omicron could become more pervasive than the delta variant. “We thought what will outcompete delta? That has always been the question, in terms of transmissibility at least … perhaps this particular variant is the variant,” Puren said.
William Schaffner, a professor of preventive medicine at Vanderbilt University School of Medicine, said that while nothing is certain yet, “it looks as though [omicron] will be as infectious as delta.”
As for how long it will take to answer questions about omicron, including its transmissibility and virulence, Tara Smith, an epidemiologist at Kent State University, said at minimum “it will take a month to get some preliminary data, and quite possibly longer to really know the fuller picture. We also won’t know about real-world experience in vaccine breakthroughs until that time.”
The first known U.S. case of the Omicron variant was detected in California, the Centers for Disease Control and Prevention confirmed Wednesday.
Driving the news: The confirmed case was detected in a traveler returning from South Africa who was fully vaccinated and has mild symptoms, according to the CDC.
Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, had previously cautioned that the Omicron would “inevitably” be found in the U.S.
What they’re saying: “The recent emergence of the Omicron variant … further emphasizes the importance of vaccination, boosters and general prevention strategies,” the CDC said in a statement.
“We know what we need to do to protect people,” Fauci said following the announcement. “Get vaccinated if you’re not already vaccinated.”
HENRY KOTULA 