Omicron panic: Let’s take it down a notch

Panic and outrage seem to drive most of our conversations today. The discovery of a highly mutated SARS-CoV-2 coronavirus variant dubbed Omicron fits right in with this pattern.

Everybody needs to calm down.

You might think this is an entirely new virus, an emergent threat like COVID-19 was in January 2020. You might think vaccines are pointless, or that your vaccination is helpless in the face of this new foe. You might think, omicron changes everything.

You would be wrong.

Variants happen

Viruses, like all living things, evolve. Random mutations can lead to variants that reproduce more easily. Through natural selection, such variants can become dominant (as Delta showed last summer).

Omicron seems be more contagious even than Delta. This is a bad thing. But it doesn’t change the rules of the game. Omicron is a variant. It is not a new virus. For the immune system, that matters a lot.

Stop freaking out about COVID variants. No variant of the SARS-CoV-2 coronavirus will be as dangerous as the original version that came out of Wuhan—because we had no defenses against it. Even if a variant is more contagious, or more deadly, or evades the vaccines, we have a lot of pre-existing immunity in the population, and we have tools to deal with it.

In early 2020, we had neither.

If you want to obsess about viral threats, worry about the next pandemic. Completely new viruses are always the most dangerous ones. And they will emerge again and again.

You should expect to hear about COVID variants for a long time. There will be more. But there’s a limit to how much the spike protein can be mutated before it simply does not work any more for the virus. Immunized people will always have at least some protection.

Furthermore, the Delta variant is already so contagious that virtually every human will at some point be exposed to the coronavirus. So even if more infectious variants circulate, that only changes the timeline, not the end result.

Everything is quantitative

We are story-driven creatures. We’re attracted to narratives with clear distinctions between “good” and “bad”. We have a hard time thinking in terms of how much good or how much bad. At this stage of the pandemic, everything should be a question of how much.

The American vaccines all use the spike protein to train the immune system to recognize SARS-CoV-2. The vaccines are based on the spike protein of the original Wuhan virus from January 2020. The spike protein of Omicron has 37 changes from that amino acid sequence; Delta has nine (source). So obviously some of the antibodies we make against the vaccine version will not work against Omicron. The key word here is some. We are likely to see some immune evasion by Omicron. But how much?

We don’t have data yet, so reports are full of rampant speculation–most of it inflammatory because it’s not quantitative.

As I have emphasized repeatedly, the Pfizer and Moderna mRNA vaccines were stunningly, shockingly effective when they first came out: in the range of 90% effective at preventing symptomatic illness, and virtually 100% protective against death (in small-scale trials of tens of thousands of people). For perspective, in 2020 the FDA was prepared to give a green light to vaccines that were only 50% effective. That leaves a lot of room for immune evasion .

In reality, I would speculate that Omicron reduces the effectiveness of existing vaccines by much less than that, mostly because antibodies are only one arm of the immune response. So-called cellular immunity by T cells is the main part of what prevents severe disease, and it should be less affected by the mutations in Omicron.

Still don’t like the odds? Then get a booster dose of an existing vaccine. The CDC now recommends boosters for every adult (source) because a ton of mediocre antibodies can do the job of a smaller number of strong ones.

If Omicron seems to materially change the epidemiology, we have a fix: just change the sequence of the mRNA vaccines and boost with that. In the grand scheme of things, that’s not a big deal. At the start of the pandemic it was far from certain that we would ever have a safe and effective vaccine against COVID. Now we have several, and mRNA technology makes them easy to tweak.

I’m not being glib. I know such actions would be costly. I’m trying to emphasize how in comparison to the start of the pandemic, we are in a vastly better position.

We even have some pretty decent new antiviral drugs that should be available soon. (link) Frankly, I call that miraculous.

I know people are still dying of COVID (an average of more than 1,200 every day in the US this week source). But the risk of dying is highly skewed by vaccination status. For example, data from King County (Seattle, Washington) show people who are not fully vaccinated are 36 times more likely to be hospitalized for COVID-19 and 28 times more likely to die of COVID-related illness. (source) Data from Minnesota also show risk of hospitalization and death is overwhelmingly concentrated in people who are not fully vaccinated (see figure; source).

If every American over age 65 were fully vaccinated, the number of COVID deaths would collapse. In the US, we have the tools to manage this. Even with variants.

Amy Rogers, MD, PhD, is a Harvard-educated scientist, novelist, journalist, and educator. Learn more about Amy’s science thriller novels at AmyRogers.com.