There’s good reason to be optimistic about Omicron

In the past few weeks I started noticing stings of a feeling that I have not become accustomed to. I thought it was indigestion at first, but I’m starting to think it’s actually cautious optimism. That’s because the recent surge in Omicron underlined how well our COVID-19 vaccines work.

Omicron was first documented in Botswana and South Africa in late November 2021 and quickly spread around the world. However, this time there was something different. Compared to the Delta variant, the Omicron infection resulted in significantly lower hospitalizations and death rates in South Africa and elsewhere.
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There has been a rush to declare Omicron “milder” than Delta, and before we even consider whether or not it is, remember that this “mild” virus was responsible for more than 15,000 deaths in the past week alone. in the U.S. † And a virus that is so transmissible does collateral damage by infecting health workers who must then isolate.

That said, at the peak of Omicron, the US reported about ten times more daily infections than in mid-November, when Delta was the only variant in the city. However, the Omicron peak resulted in about twice as many deaths as we saw in mid-November. Obviously, if we saw so many infections with Delta, things would be much, much worse than they are.

Three explanations are plausible: first, Omicron causes an inherently less severe disease, the vaccines work, or a combination of both. It’s hard to tell them apart because the Omicron wave in South Africa was chasing the Delta wave at a time when a significant portion of the population was vaccinated. As a result, the variant emerged in a population with the benefit of greater immunity than at any earlier stage of the pandemic.

Since Omicron is somewhat able to evade previous immunity, there have been significant numbers of reinfections in people with previous SARS-CoV-2 infections, as well as breakthrough cases in vaccinated and boosted people. Looking closely at the data from South Africa, a colleague and I determined that at least part of Omicron’s apparently mild nature is indeed due to immunity that keeps people out of the hospital. That’s consistent with another study, showing that the risk of a vaccinated person being hospitalized for an Omicron infection is reduced by 70% compared to an unvaccinated person.

Second, side-by-side comparisons of people infected with each variant in recent months suggest that Omicron is slightly less inherently dangerous than Delta. Whether this holds up in older age groups remains to be seen, but again, the data is more reassuring than might have been feared.

Third, people who have been vaccinated are also less likely to spread SARS-CoV-2, including the recently isolated BA.2 subvariant of Omicron, which appears to be even more contagious than the original BA.1 Omicron subvariant identified last November. BA.2 is also better able to escape vaccination coverage than BA.1, but according to a recent study in Denmark, those who were vaccinated were less likely to infect the people in the same household.

The importance of vaccination is underlined by a comparison of the cumulative death rates for the pandemic and the increase in Omicron in the US and other high-income countries. Rich countries with high vaccination rates are significantly outperforming the US, where our vaccination and booster rates are alarmingly low. This stark juxtaposition shows how powerful vaccination can be in protecting our neighbors and loved ones. Remember that an 80% vaccination rate is not “almost as good” as 90%; on the contrary, it is twice as bad because it leaves 20% instead of 10% without the benefit of vaccination. And in a country the size of the US, that 10% equates to about 20 million adults.

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The success of the vaccines is indeed great news. And yet, getting a vaccination can still be a difficult task. Colleagues at Ariadne Labs have created a tool that shows on a map how far someone has to travel to get vaccinated. According to their analysis, the US is pockmarked with areas where people who want to get vaccinated have to drive 30 minutes or more to a vaccination site. If someone is dependent on public transport or is trying to vaccinate a child or teenager, large parts of the country must travel at least 30 minutes to access vaccinations. For those dealing with multiple jobs, limited physical mobility, childcare, aged care or other responsibilities, such a journey can be too difficult to make. Vaccination should be easily and readily available to everyone.

And as we all know, SARS-CoV-2 is a skilled and agile adversary. As I write this, the virus is currently infecting more than 2.8 million people worldwide, and each of those infections represents an opportunity for the virus to mutate into a more or less contagious or deadly variant. This sheer number of active infections practically guarantees that we will see more SARS-CoV-2 variants. Our best hope is that by immunizing everyone as possible, the consequences won’t get any worse. We may not be so lucky with the next variant.

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