Omicron was the first to detect a highly mutated form of SARS-CoV-2 in South Africa. This has placed the global public health community on high alert. The evidence that this variant is transmissible has been mounting since then. The variant is more transmissible and in fact is becoming dominant over Delta. Omicron’s doubling time—how long it takes for the number of coronavirus cases to double—is just two to three days.
South Africa has shown that Omicron infection may be milder than other variants. This is especially true for vaccinated individuals. Despite some claims, it’s premature to conclude that Omicron will cause mild illness with few consequences. For example, in South Africa’s Omicron wave, infected people have tended to be younger than in previous waves, and we know that younger people are more likely to have more mild disease when infected with Any SARS-CoV-2 variant. It is too early for South Africa, given the time delay between deaths and hospitalisations. Omicron is fast approaching, but the full effects will only be apparent over time.
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The news made headlines in high income countries. How did they respond? Unfortunately, the response was a series of knee-jerk travel bans. This is not a coordinated public health response.
South Africa being punished for raising concern about Omicron is a wrong approach to dealing with it. Global action and solidarity are the only way to effectively respond. Since the outbreak, there have not been many examples of either. Omicron has been identified in 63 countries so far, with many others on the rise. Some preliminary evidence has been presented from South Africa, the United Kingdom and elsewhere that Omicron is less resistant to COVID-19 than Delta vaccines in terms of preventing disease. Positive news: Data suggest that boosters can increase vaccine effectiveness. However, many haven’t received vaccines at all. Global strategies will be needed to increase vaccine access and equity, and also to expand other protection measures. Early evidence also suggests that unvaccinated people who have been infected with the virus in the past are not well-protected against Omicron—re-infection appears to be common.
Given all of these initial data, the World Health Organization (WHO) calls Omicron a “high risk” variant that could lead to further surges worldwide with severe consequences. How could these surges appear?
An increase in Omicron cases could cause major disruptions and even lead to more deaths. Even though Omicron can cause mild illnesses, it is possible for severe consequences. For example, imagine if the whole world got a common cold simultaneously. There would be a rise in deaths among older, vulnerable people—such as those in nursing homes—and the mass absences from work would have major societal consequences. Even though a relatively small number of people become sick or are killed, this would still make it a substantial number. In many countries, such as the U.S. there are no gaps in their health care systems to cope with an additional surge in COVID-19 hospitalizations. The hospitals are already at full capacity, not only for COVID-19 (cases of Delta and their deaths are increasing in the U.S.), but also to catch up with the backlog of operations and other treatment delays or postponements caused by the pandemic.
Fatalism does not apply. Now, more than ever before the pandemic started, there are many scientific-based tools we have that can be and must be marshaled.
Omicron is a serious threat to human health. All countries must make it a priority to protect the vulnerable. This includes older people, those in the health care industry (including care home workers) and those with chronic health problems. As the WHO notes, “vaccines are likely to have some effectiveness against Omicron, particularly for severe disease, even if the performance is reduced compared with other variants.” Globally, the brunt of illness and death will fall on LMICs, where very few people have been vaccinated. Only 7.5% of Africa’s population are fully vaccinated.
Although the start was slow, vaccine supply to LMICs has improved in recent months. Some middle-income countries have seen an increase in vaccination coverage. But there’s still much to be done to expand vaccine access. It is urgent that rich nations donate vaccines to organizations like the African Vaccine Acquisition Trust or COVAX, which are vaccinating people in LMICs. These donations so far have been inconsistent, unreliable, and ad-hoc. Also, rich countries have purchased far more than they are able to use. They should immediately transfer the surplus vaccines to LMICs. LMICs should not be prevented from accessing vaccines by wealthy countries or vaccine corporations. Eigene doses. Omicron is expected to stimulate the rich world’s sharing of vaccine patents and manufacturing knowledge and the support for globalized production.
The United States has 3 out of 10 citizens who have never received a vaccine. The single biggest predictor for vaccination status is American political partisanship. Republicans tend to be less likely than Democrats to have their vaccines. We will therefore need Republican leaders to push to ensure that all Americans get their shot. The evidence is clear that boosters can improve the effectiveness of vaccines. It’s crucial to quickly get boosters to those at highest risk such as nurses and health care workers. These workers must be also vaccinated. Since nursing home staff can spread coronavirus to residents, and given that low vaccination rates among staff are linked with higher rates of infection and death among residents, there’s a strong case for mandatory staff vaccination in these settings and regular rapid tests to prevent the virus being introduced to them.
But a “vaccine only” strategy will not be enough to blunt the force of Omicron and prevent spikes in hospital admissions. We need “vaccine plus”: a surge of other evidence-based measures, alongside vaccines, to match the surge of SARS-CoV-2. It is essential to have a complete public health strategy.
All households should be able to receive free, non-invasive rapid antigen test (as it has in the UK) as well as high-filtration masks via mail. If you have a positive rapid test, it will show that you are infected to other people. This gives you the information you need to remain at home to help stop the cycle of transmission. High-risk environments such as nursing homes should have a quick test. If it is positive, visitors to these facilities must not go in. In addition, physical distancing, ventilating indoor spaces, hand hygiene, avoiding crowds, and reducing one’s number of social contacts can also help to control transmission of the more transmissible Omicron variant. The same political partisanship which has affected vaccination adoption in the U.S. is expected to influence the use of other preventive measures. We will therefore need Republican governors or mayors to protect their constituents. It is necessary to have a nonpartisan and collective public health solution. The virus doesn’t care how you vote.
It is impossible to know if Omicron will become the latest concern. One more could soon be on the horizon. There would be much less anxiety, however, about any new variant if we had a “joined up” global health program in place: preparation can allay panic.
We must aim to restore society without causing mass disease and death. SARS-CoV-2 cannot be eradicated. Therefore, we must plan and prepare to face the next Omicron wave. We can aim for a situation in which COVID-19 still circulates but there is much less transmission and much less severe illness, hospitalizations, and deaths, perhaps with seasonal peaks—a scenario akin to influenza. For that to happen, we’re going to need to vaccinate and boost the vast majority of people worldwide.
This is possible if Omicron, the global dominant Omicron variant, can be achieved. In most cases, mild to no symptoms would occur and you’d only need to take a day off work. Perhaps you’d wear a mask for a few days to protect others when you returned to the office. But in this scenario, one will be placing co-workers, and—indirectly—their families, at near-negligible risk of death. It is too soon to know whether three doses of vaccine will be enough to provide lasting immunity or whether, as with the influenza vaccine, we’ll need an annual shot (potentially tailored to specific strains). It is possible that there will be outbreaks in some areas, particularly those with low vaccination rates. These may require local protection using measures such as distancing and masks to slow transmission.
Omicron is on the horizon. While we wish it would cause only mild illnesses, the virus could still have significant health and societal consequences. Don’t forget the great majority of people infected in the pandemic to date have experienced mild illness, and yet the virus has already killed about 800,000 in the U.S. All by itself. Omicron is our lesson: We have to get rid of the pandemic through GlobalNot national action is needed to immunize, boost, or protect the health of others. Omicron will prove to be an unforgiving teacher. We will have to see if Omicron can be a good teacher.
