I wish you all a Happy New Year. I also wish it wasn’t a year that kicks off with the rise of Omicron. Here’s hoping 2022 gets better as we move towards spring.
A month ago, when I sent out my last issue of Friday’s Elk for 2021, Omicron was still a deep mystery. It was surging in South Africa, but it wasn’t clear if Omicron would perform the same way elsewhere. Things are very different now. By mid-December, early surges in Denmark and Norway hinted that Omicron was on its way to a global explosion. Before long, it was the dominant form across much of the world. A major source of Omicron’s success is its evasiveness. It can dodge antibodies–produced either by infections or vaccines–that would stop earlier variants. Omicron may also have adaptations that allow it to get from one person to the next more reliably than other variants, but that has yet to be determined.
As cases skyrocketed, hospitalizations rose at a slower pace. That decoupling suggested that Omicron might cause fewer cases of severe diseases. While Omicron may evade antibodies, T cells and other immune defenses–either from vaccines or previous infections–lower the risk of getting a really bad case of Covid. On top of that, Omicron is fundamentally different than other variants. It uses a different method to get into cells, one that works very well in the upper airway, but not so well deep in the lungs.
All this adds up to a good-news/bad-news picture. It means that lots of people–both vaccinated and unvaccinated–will get infected. Some of them will end up in the hospital, the vast majority whom will be unvaccinated. The rate of daily cases, already breaking records, will continue to skyrocket through much of January before falling. Hospitalizations may increase as well. With hospital staffs hollowed out by sick staff in isolation, Omicron could push health care systems once more towards the breaking point.
The surge may also change the immune landscape. Preliminary studies suggest that Omicron infections create a strong immunity against Delta, but not vice versa. As Omicron surges, Delta–a variant that causes more severe disease–is vanishing. Immunity from Omicron infections may drive down that chances that people get sick in the future. It’s like spraying water on kindling. Flare-ups may become less likely in the months to come.
The uncertain state of medicine makes it even harder to predict our Omicron future. Boosters reduce the odds of infection and strongly reduce the risk of severe disease. But only 22 percent of Americans have gotten boosters yet. If that number rises quickly, fewer people will end up in hospitals. Many people could be kept out of the hospital if they can get two newly authorized antiviral pills—Paxlovid and molnupiravir. But they’re in desperately short supply. Meanwhile, Omicron resists the two leading authorized monoclonal antibody treatments, from Regeneron and Eli Lilly. It can still be treated with a third, called sotrovimab, but that too is in short supply.
I stepped away from pandemic reporting briefly to report on some sad news. The evolutionary biologist Edward O. Wilson died on December. Here is the the obituary I wrote for him for the New York Times. I’m grateful that my editors let me write in depth about Wilson’s remarkable, controversial career. I went back through my own numerous interviews with him over the years and also talked to a number of scientists about their view on his legacy. That’s not something that can fit in a few hundred words.
That’s all for now. Stay safe!
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Originally published January 7, 2022. Copyright 2022 Carl Zimmer.