Jen Gerson: What if Omicron is the Really Big Bad?

Would we be able to cope?

I've spent the last few days struggling to gauge how nervous I should be about the Omicron variant and I've settled on an unsatisfying answer: heightened state of alert pending more data. I haven't cancelled Christmas, but I have advised my mother to keep the fridge well stocked. 

As Line readers can attest, during this pandemic, I've generally been on the side of "take reasonable precautions and get vaccinated, but don't panic." There are a number of reasons for this approach: I believe that an abundance of caution has to be weighed against the consequences of overreaction. Lost schooling, lockdowns, vaccine mandates, travel bans — all of these measures may be necessary, but they each present serious risks to long-term health and well being. We shouldn't make a habit of cheering for more draconian state-imposed restrictions without showing due respect for the consequences — and not just the easily quantified economic consequences. There is a price to be paid in physical and mental health, social cohesion, time spent away from loved ones, and lost opportunities for children and other vulnerable people living in precarious circumstances. 

Chronic fear is, itself, maladaptive and addictive. Scaring the hell out of everyone works until it doesn't: this is why we ought to have shifted to a risk-management-based communications approach — one that allows individuals to craft sustainable lives for themselves in the face of a long-term endemic disease according to their personal circumstances. Dosing us all with exponential COVID-19 case models that, more often than not, proved wrong, has left too many of us shell shocked and skeptical. 

But my statements to this effect have always been predicated on one major caveat — that we wouldn't be confronted with a truly vicious COVID mutation — a possibility made all the more likely by a scenario in which the rich world hogged the vaccines while the poorer half struggled to achieve double-digit vaccination rates. 

Whoops!

And so we find ourselves facing Omicron. 

It will be several weeks before we understand how dangerous this variant is — or isn't. As reported elsewhere, there are a number of mutations that have scientists worried about increased transmissibility. We are also watching how well vaccines prevent serious illness. Moderna's CEO has already conceded that the vaccines may have decreased effectiveness against this strain. 

The World Health Organization says: "It is not yet clear whether infection with Omicron causes more severe disease compared to infections with other variants, including Delta." 

There is some hope that this variant is milder than previous strains, which may be a weird blessing. If this turns out to be a more transmissible version of a very mild illness, there could be some hope that Omicron could supplant the more dangerous Delta. So while I do have my Costco membership card at the ready, I'm not yet heading to the aisles to stock up on garbanzo beans and cut-rate SSRIs. 

The data just ain't there yet. 

That said, this is a dark timeline and I am in a mood. All I can think about right now is how our reaction to previous strains of COVID-19 have left us all in a sorry state if Omicron does turn out to be the Big One. 

Yes, I know that many people believe that the last 20 months was The Big Bad but — with apologies for ruining your day — that is ahistoric nonsense. By any historic standard, COVID is comparatively tame. In 1918, the Spanish Flu’s mortality rate was so bad that Red Cross nurses attended flu-ravaged homes to find bodies next to sick patients. Families stuffed corpses with ice and stored them in bedrooms. Coffin makers and grave diggers literally could not keep up with the sudden influx of the dead. 

You can rank COVID on absolute number of deaths and it looks impressive — as long as you ignore relative tolls. Five million deaths in a world with a population of 7 billion is a different ballgame than what we saw only a century ago: as many as 50 million global deaths in a population of 1.8 billion. Our tally for COVID’s toll is likely underreported, but you can double it — hell, you can quadruple it — and we’re still in rounding error territory relative to 1918 (adjusted for population growth, of course).

Absolute numbers aside, the comforts and advances of modern life have also supplied us with an historically unprecedented pool of elderly, overweight, and immunocompromised people; in other words, the subpopulations disproportionately most vulnerable to death by COVID.  

Now, I'm in no way devaluing the lives of those people most vulnerable to COVID — nor ignoring the otherwise healthy and young individuals who also died of the virus, of which there were many. I bless modernity in all its forms. I eat well and haven’t lost half of my 14 children to sickness. I have elderly, overweight, and immunocompromised people in my life, and I'd like to keep them here as long as possible. What I'm pointing out is that this is a parallel to the faulty logic of Goop fans who look at our skyrocketing rates of cancer and assume that our corrupt modern lifestyles must be exposing us all to toxins and carcinogens. Never mind the real answer — modern life has allowed us to live long enough to get cancer. Historically, vast swathes of the population would have been wiped out by infectious disease and misadventure well before the faults in our genes fomented lethal tumours. 

What can I say, here? Human history is a charnel house. 

Regardless, it doesn't take a lot of imaginative tweaking to turn COVID-19 from the merely bad pandemic it was into a truly catastrophic one it easily could have been (and could theoretically still become). What if the natural fatality rate were closer to 5 per cent? Or 10 per cent? Or 20? What if it were as transmissible as the measles? What if its rate of mutation radically outpaced our ability to keep up via vaccine technology or natural immunity? What if it targeted children and young adults with the same ruthless lethality it reserved for the elderly and infirm? 

In each of these plausible scenarios, we would be dealing with a much more dangerous virus that would be much more difficult to bounce back from as a society. COVID-19 v.1 is bad to us because we live in a modern, medically advanced civilization totally unaccustomed to mass death. We’re used to things being good.

And now I'm going to credit writer Dani Paradis for injecting some sorely needed optimism into my gloomy mood. 

Dani Paradis @DaniParadis

@maxfawcett @TejSwatch @jengerson Alsooo the only way we are now prepared for something worse was the steps taken to get where we are. We now have vaccines and drug treatments that can be adapted and actual pandemic emergency experience. We are amazing adaptable creatures!

She's entirely correct. Alpha and Delta have given us an edge in a few key areas. A pandemic drug treatment is on the immediate horizon. Vaccine makers now believe we could get an Omicron-specific vaccine in as little as 100 days. And, yes, we now have almost two years of pandemic experience to draw from. If Omicron is worse, we would not be facing March 2020 yet again. We would not be back to square one.

I note that we moved very quickly to impose travel bans in this round, and nobody is seriously debating the merits of border closures. (In fact, Nature ranked border restrictions as one of the most effective Non-Pharmaceutical Interventions in stopping previous waves of COVID.) 

If Omicron is truly more transmissible, travel bans won't keep it out of the country. But it will slow it down, and when we're measuring vaccine and drug production in days rather than years, time bought matters. 

But then my pessimistic voice creeps back in. We have exhausted our population with two years of fear-driven messaging and highly intrusive public-health measures. A sizeable portion of the population has either tuned out, or worse, no longer trusts authorities enough to listen to warnings of imminent danger. We're flirting with a serious inflationary cycle, both due to COVID-induced supply chain problems and — possibly — due to the monetary measures we had to introduce to keep everyone fed and functional during the pandemic. We seem perilously close to maxing out our financial capacity to cope with another major crisis. 

Even if we could get updated Omicron-busting vaccines into arms within 100 days, how many people would take them? How many would rank the expert and media proclamations highly enough to heed the warnings? And even if they did consent to a new round of restrictive health measures, would we be able to implement another round of CERB long enough to get the next vaccine sorted? In the last two years, how much actual hospital capacity have we built to manage the possibility of a much more deadly strain, should we be faced with one? 

If this truly were the darkest timeline, this is how the pandemic would unfold. It would spend two years exhausting us socially, psychologically, and materially with a middling-bad virus before totally creaming us with something much, much worse. These are the unhinged thoughts that keep me up at night.

I sincerely hope, and almost expect, Omicron to be a false alarm, but pondering those questions leaves me feeling grim. I think we're dancing closer to the line than we like to admit. 

But, like I said, I’m in a mood.

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