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How omicron is changing the rules of the covid-19 pandemic

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The pandemic playbook is, once again, being torn up. In the course of just a few weeks, the omicron variant has upended recent calculations made about covid-19, prompting a return to travel restrictions and calls to stay home, as well as a new push for booster shots and a reevaluation of tactics such as vaccine passports.

The change is most acute now in Britain, where Prime Minister Boris Johnson’s plans for a normal Christmas have been upended, once again, by a fast-moving variant. On Wednesday, a top U.K. health official told parliament that omicron was “probably the most significant threat we’ve had since the start of the pandemic.” Similar scenarios could soon be playing out across the world.

Rich, vaccine-abundant nations that had once hoped the pandemic was over are now recalculating. Some worry they are overreacting. Speaking to Britain’s Sky News this week, the head of South Africa’s Medical Association warned that Britain created “hysteria” by overreacting to the threat of the variant.

“You need to take precautionary measures, you have to be prepared but don’t hype it up,” Angelique Coetzee said on Tuesday.

Others have even argued that the spread of omicron could signal the final days of the coronavirus outbreak, pointing to some signs that the variant may produce less serious illness than the current globally dominant variant, delta. Some even see hope in the sharp rise of cases: Conservative outlets like the National Review are wondering if omicron is “not that scary after all” while Wall Street analysts have said it “could accelerate the end of the pandemic.”

WHO Director General Tedros Adhanom Ghebreyesus said "vaccines alone will not get any country out of this crisis" during a news conference on Dec. 14. (Video: Reuters)

The argument rests on the theory that the coronavirus would become more transmissible and less deadly as it evolves, as was the case with the influenza virus that caused the 1918 flu pandemic. Are these positions fair? Are countries overreacting to omicron? It is still too early to say for sure, but consider these three points.

First, cases seem to be spreading fast. On Wednesday, Britain announced that it had recorded 78,610 new cases — a daily increase not seen at any point during the pandemic, even during the initial wave of delta. Hospitalizations have increased, too, though at a slower rate, while deaths are at worst flat. The number of confirmed omicron cases in Britain has increased to 10,017, though there are likely many more — Health Secretary Sajid Javid estimated on Monday that 200,000 may contract omicron cases that day.

Some experts have predicted that Britain could see as many as a million covid-19 cases a day by the end of December, potentially beyond the limits of its testing capability. “I’m sure for example the numbers that we see on data over the next few days will be quite staggering compared to the rate of growth that we’ve seen in cases for previous variants,” Jenny Harries, head of Britain’s Health Security Agency, told Parliament on Wednesday.

Another major study released from South Africa, where the variant was first recorded to be spreading widely, suggests a similarly rapid spread.

“The omicron-driven fourth wave has a significantly steeper trajectory of new infections relative to prior waves,” Ryan Noach, the head of Discovery Health, South Africa’s largest health insurer, said in a statement Tuesday. “National data show an exponential increase in both new infections and test positivity rates during the first three weeks of this wave, indicating a highly transmissible variant with rapid community spread of infection.”

Secondly, our current vaccination regimens may be less effective against omicron. In South Africa, Discovery Health found that the vaccine from U.S. pharmaceutical giant Pfizer and German partner BioNTech provided just 33 percent protection against infection from the omicron variant, though it still offered 70 percent protection against hospitalization.

Similar data came last week from the U.K. Health Security Agency, which reported that the standard two-dose regimen of either the AstraZeneca or Pfizer/BioNTech vaccine offered poor protection against symptomatic infection by omicron, with Pfizer’s protection falling to between 30 percent and 40 percent at 15 weeks after the second dose and AstraZeneca’s to zero.

Omicron has a wide variety of mutations that make it different from the original strain of the coronavirus. Some of these mutations appear to help it evade the disease-fighting antibodies that are created by vaccination or prior infection, hence why there seems to be a higher risk of re-infection with omicron for those who have recovered from the virus.

The good news is that vaccines do still have some potency against omicron, especially when used as extra “booster” shots for those already considered fully immunized. On Wednesday, Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, said that after reviewing data, the U.S. government did not feel that a new omicron-specific vaccine needed to be developed.

“Our booster vaccine regimens work against omicron. At this point, there is no need for a variant-specific booster,” Fauci said at a White House coronavirus briefing. “If you are unvaccinated, you are very vulnerable — not only to the existing delta surge we are experiencing but also to omicron.”

Finally, even if omicron proves milder than other variants, it could still upend current covid-19 strategies. Early data from South Africa suggests that omicron may cause less severe infection, especially compared with the devastating delta. But it is not clear to what extent this finding is related to high rates of immunity from vaccination and infection in South Africa or to the country’s relatively young population. It remains to be seen whether it will hold true in other nations with different demographic profiles.

If omicron does cause milder illness, its ability to spread fast and to defeat some of the protection provided by vaccines still worries doctors and public health experts. In an article in Time on Wednesday, Gavin Yamey, William Hanage and Tom Moultrie asked readers to imagine that the entire world caught the common cold, itself a less virulent coronavirus, at the same time.

“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 if only a small percentage of people get ill or die, a small percentage of a very large number would still be a large number,” the three global health experts write.

The need for boosters is also likely to further dash hopes for speeding up global vaccination. Covax, the only real effort to get vaccinations out around the world, struggled to get doses throughout 2021. The need for booster shots in wealthy nations could disrupt that further: The World Health Organization is already expecting a shortfall of 3 billion doses next year, partly because of that. And even if omicron does cause less serious disease, delta may still be raging in many countries for some time.

Omicron may have changed the rule book of the pandemic, but the game goes on. It’s far from certain that the coronavirus will become less deadly as it evolves and with much of the world still unvaccinated — leaving room for new variants to emerge — the alternative possibility is out there. Covid-19′s final days could still be a long, and painful, way off.

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