In trying to hide that I’m getting a little repetitive and simply providing the third omicron variant update in three weeks, I’ve been thinking of clever movie-related headlines for this article. Back to the Coronavirus, Part III? Lord of the Variants: Return of the ‘Cron? The Dark Variant Rises? Harry Potter and the Prisoner of Omicron?
Nevertheless, once again, there is compelling news to report on the omicron variant that is going to make a difference here in Utah soon. The variant already makes up 2.9% of sequenced cases in the U.S., a number that undoubtedly will grow to a majority in the weeks to come. Due to its spread, we also have population-level data in a way that we didn’t before. It’s one thing to study omicron in a lab; it’s another to see its impact on multiple countries.
So we may have written about this subject recently, but we have learned much in the past week on omicron’s characteristics, and a better idea of how much it will impact our lives. Here is the latest — the Good, the Bad and the Ugly — of what scientists have discovered about omicron.
Transmissibility
It’s probably no longer graphically accurate to say that omicron is causing a fourth wave of cases in South Africa — the graph looks more like a brick wall.
South Africa's coronavirus cases. In recent weeks, nearly all are due to the omicron variant.
We also see that same size of rapid growth in other countries with the disease, including the United States in some areas. It’s now responsible for about 13% of cases in New York and New Jersey.
Why? Well, it appears to be a combination of increased transmissibility and immune escape. In particular, United Kingdom scientists found that when one member of a household was infected with omicron, it was about twice as likely to spread to another member of the house than delta was. Eek.
Vaccine efficacy
Thanks to populationwide data, we have much better estimates of how well vaccines are working against omicron in the real world. In particular, South Africa’s largest insurance company, Discovery, insures 3.7 million people. It found that two doses of the Pfizer vaccine was 80% effective against infection against the delta variant — but just 33% effective against omicron.
That’s a big drop. People who haven’t gotten a booster should consider themselves likely to be unprotected against omicron infection.
Not many people in South Africa have received boosters, but more in the U.K. have. Researchers there found that people who had received a booster after two doses of Pfizer — three doses in all — had about 70% to 75% efficacy against infection. That’s obviously much better.
What about against hospitalization? As always, the vaccines are more adept at preventing severe disease than they are against disease in general. Discovery’s data showed that two doses of Pfizer were preventing 70% of hospitalizations. (They found that Pfizer was preventing 93% of hospitalizations against delta.) You could expect three-dose vaccines to be much higher.
Worryingly, though, they found that the vaccine was more adept in preventing hospitalization in young people than it was in older people when compared to delta. That might be because older folks were vaccinated first, and therefore the antibodies have had more time to wane — or it could be because the antibodies generated were less effective in fighting omicron in the elderly.
Regardless, it highlights the urgency for the elderly to be boosted before omicron comes to be the biggest player locally. Many pharmacies and grocery store booster appointments are busy right now — but county health department booster appointments are still widely available in Utah.
Previous infection efficacy
All of us know some people who haven’t gotten vaccinated, and are instead relying on their previous bout with COVID to prevent their infection. So how well does a previous infection with an earlier variant prevent omicron?
Not super well. A New York study took the blood plasma of people infected with various variants (alpha, beta and gamma), and saw how well it neutralized the omicron virus. Unfortunately, it’s not great news.
Blood plasma taken from people with infected other variants is significantly less effective in fighting omicron. (https://drive.google.com/file/d/1zjJWsybGaa3egiyn5nQqTzBtl0kmvMUu/view)
There’s some protection remaining there, but it’s definitely significantly reduced. The U.K. found that the risk of reinfection was about five times greater for omicron than other variants in its initial data, while South Africa found a rate that was 2.4 times greater for omicron.
I’ll be interested to see data as to what degree these reinfections are significantly protected from hospitalization. Reinfections were significantly less likely to be severe for other variants, so I expect that trend will continue, but we just don’t have the sample size to indicate to what degree.
Those with so-called hybrid immunity — previous infection plus vaccination — are in really good shape, though.
Severity
And here’s our one silver lining, again: Omicron has, so far, led to fewer hospitalizations and deaths than previous variants.
The Discovery data in South Africa found that omicron was 29% less likely to send adults to the hospital than the first form of the coronavirus. That number adjusts for age, sex, risk factors, vaccination status, and documented previous infection.
What it can’t adjust for is undocumented prior infection, of which there certainly is a lot of everywhere. One hypothesis is that omicron isn’t necessarily less severe on its own but just running into people who have more immune protection than previous waves, even if they don’t know it.
But those who were hospitalized were also less likely to see the intensive care unit — and less likely to go their deathbeds. Among those who were unfortunate enough to make it to the ICU, only 16% were vaccinated.
Denmark’s data has a smaller sample size but came to similar conclusions. There, 0.6% of cases of the omicron variant led to hospitalization in recent weeks, compared to 0.8% of other variants.
It’s a drop in severity, but a smaller drop than I hoped.
So what happens next?
Given all this data, I think it’s actually possible to make an informed guess at how this will all play out. Though I wouldn’t dare to venture an estimate on numerical impact, in just general terms, here’s what I expect.
1. A lot of people are going to get sick. The unvaccinated, those with vaccinations but no boosters, and people relying on last year’s previous infection will get sick at high rates. Given the lack of emphasis on government COVID-19 testing compared to last year, case counts won’t reflect the true burden of illness as closely as they did before — but wastewater surveillance should provide a more accurate picture.
Sometimes we forget this simple fact: Being sick sucks.
2. As a result of this, industries with strict COVID protocols and testing are going to be significantly hampered by this: sports leagues, international travel, health care, and so on. I predict more frequent event cancellations or postponements. Supply issues have smoothed slightly recently; I don’t know if that positive trend will continue.
3. Hospitals are going to be burdened. The good news is that Utah’s normal hospital beds are 57% full at the moment — there’s some room to take some surge. Unfortunately, Utah’s ICU beds in referral centers are 99.3% full as of this writing. In other words, there are only three ICU beds open in referral centers in Utah.
Even though omicron looks less likely to send people to the ICU than delta, thousands of people being infected per day is going to mean that those three beds are going to fill up pretty quickly.
So we’re going to have to deal with that, somehow. I suspect we will see some combination of interventions familiar from last winter reintroduced — maybe longer or more shifts for doctors and nurses, elective surgeries delayed, wards at hospitals changing to meet needs, and so on. The unfortunate truth is that this will impact the level of care for even non-COVID hospital patients.
4. Fewer people will die than in previous waves. The coming availability of antiviral pills specifically to deal with COVID — Paxlovid and molnupiravir — will help immensely. We’re going to see lower fatality rates.
5. The coming wave will hammer home a reality: COVID isn’t going away. Like other viruses do, it will mutate occasionally, causing peaks and valleys of infection. We will be able to mitigate those disease with pills for the hospitalized and likely regular vaccine treatments for the public as a whole, just like the flu, but the burden will still be significant.
COVID will remain with us forever, a new cross to bear on top of the other illnesses we have. There will be times when the stress is particularly painful for health care systems and society as a whole. To deal with the added threat, we’ll need to focus on training more nurses and doctors than before. We’ll need more medical scientists to study the evolution of our diseases — and to identify the new ones that could start pandemics before they spread.
Too often, public health hasn’t been a priority. I wish, I hope, and I pray that our experience with COVID changes that.
Andy Larsen is a data columnist for The Salt Lake Tribune. You can reach him at alarsen@sltrib.com.
