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“Why Omicron is scaring me”

Brian Leiter

Philosopher Gregory Pence, a leading bioethicist at the University of Alabama at Birmingham, gave permission to share these concerns:

The fact that cases of the Omicron variant are doubling every 2.5 days in England and Europe worries me, and the cases seem to be doubling despite 89% of the English having one “jab” and many others having natural immunity.

Yes, Omicron is less likely to hospitalize or kill you, but Pfizer-vaccinated people like me are 70% of the break-through infections, and who wants such an infection (and possible Long Covid)?

With 50+ million unvaccinated Americans, and break-through infections, 1000 cases in 25 days could create a million cases in America, and in another month, that’s potentially … well, you do the math.

What worries me is that folks like me who get infected will want anti-viral drugs or monoclonal antibodies all at the same time as millions get infected  in January/February and as burned-out staff at hospitals face a tsunami of hospitalized cases.

And what about all the people with “normal” problems like attacks of stroke, heart disease, cancer, and injuries?

I fear that we are going to need a triage system in place.

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Am I missing something here? Being too alarmist? I hope so.

British government data showed that two shots of Astra Zeneca, the primary vaccine in the UK, provides zero protection against infection by Omicron; two shots of Pfizer provides 35% protection.  However, Pfizer booster shots raise that to 75% (compared to 95% for Delta), at least for some period of time (we don't yet know how long the raised antibody levels last).  Of course, booster levels are low in the U.S.

I'm opening this for comments/links from readers about the issues raised by Professor Pence.

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18 responses to ““Why Omicron is scaring me””

  1. Roger Albin

    Well founded concerns. For an interesting and concise snapshot on the consequences of high caseloads, see – https://www.cdc.gov/mmwr/volumes/70/wr/mm7046a5.htm

    Reply
  2. Phil

    Professor Pence states a lot of valid concerns, but I think your summary is slightly alarmist. While it's true that two shots of AZ or Pfizer provide little (or no?) protection against becoming infected (and infectious) with Omicron, they are believed to provide significant protection against severe illness. (A friend of mine who tested positive experienced no symptoms at all for his whole ten days of isolation, and in fact had a negative test result on the fifth day.) But it's certainly looking as if the third shot should be seen as part 3 of 3, rather than an optional extra.

    As a Brit I regret that my government has bet the shop on vaccination; I suppose a robust public health response was a lot to expect from the laissez-faire individualists in the Cabinet, let alone the laissez-everything deadbeat we've got for PM. But at least the rollout of the boosters is proceeding at speed (43% of the over-12 population now vaccinated – nearly 25 million people, from a standing start at the beginning of October).

    I feel that we're still in the calm before the storm with Omicron, both in terms of spontaneous public reaction to it (which was already emptying the pubs and offices in the last waves before the government gave us any instructions) and in terms of its possible (still unproven) impact in the hospitals. But with the way the cases are growing, the storm's likely to hit sooner rather than later.

    Reply
  3. Jennifer Hornsby

    I have some understanding of why Prof Pence should be alarmed, having just heard a U.K. Press Conference, which makes clear the mounting crisis in the UK owed to Omicron. In London the doubling rate is less than 2 days.
    The c.8 minutes of the youtube video in which the Chief Medical Officer speaks with slides is informative: it starts c.26 minutes in.


    [Please ignore our Prime Minister who specializes in congratulating himself for the booster vaccine programme, which he should have got started a few days earlier than he did.]

    Reply
  4. A Sharon

    Question for any experts here. Would Omicron be detected as a positive covid result in tests prior to the variant being found in South Africa? In other words, was it only identified as a variant well after it could have been widely distributed in the population? Do current PCR tests generally find Covid but identifying the variance require a more sensitive analysis?

    Reply
  5. Jennifer Hornsby

    I'm far from an expert. But .. surely lateral flow tests find Delta and Omicron alike, but can't distinguish between the two variants of the virus. PCR tests(with a further analysis in the lab.) can distinguish them (even though an initial positive PCR test result says only you've got the virus.

    Reply
  6. Jeremy Fischer

    I share Professor Pence’s concerns. Even if Omicron’s hospitalization/death rates per infection were 8 times lower than Delta, that would buy us a mere 7.5 additional days at a doubling time of 2.5 days until we reach the number of hospitalizations/deaths that we’d expect with Delta’s H/D rates. [8 is three generations of doubling (8=2^3), and 7.5 days is three doubling generations of 2.5 days (7.5=3*2.5).] And, as Professor Pence emphasizes, the exponential growth is unlikely to stop there. Here are two graphical representations of the point: https://twitter.com/GosiaGasperoPhD/status/1469456805491138560. For that reason, the “likely” in “Omicron is less likely to hospitalize or kill you” is badly ambiguous between per infection likelihood and per capita likelihood. Even if an infected person’s odds of disaster are lower than with Delta, _your_ odds of disaster may soon be much higher!

    Moreover, and here I may be disagreeing with (and more pessimistic than) Professor Pence, I gather that it’s still too early to know whether Omicron’s hospitalization/deaths rates per infection are less than Delta’s. It’s my understanding that, given what we know, Omicron’s inherent virulence might even turn out to be equal to or greater than Delta’s, depending on its capacity for reinfection (https://twitter.com/nataliexdean/status/1468988174693289994) and other factors that we don’t yet fully grasp. I believe that epidemiologists expect to know Omicron’s virulence in a few weeks. (https://twitter.com/BillHanage/status/1469894127034814468)

    Turning to practical matters, now might be a good time for all higher ed institutions to consider (i) implementing universal mandatory rapid diagnostic testing, (ii) distributing (and even mandating) the indoor use of N95+ (FFP2/3) respirators, (iii) installing HEPA filters (or even DIY “Corsi/Rosenthal boxes,” as UCSD has done: https://twitter.com/CBSEveningNews/status/1445909400041017351) in classrooms and other shared spaces, and (iv) guaranteeing the academic freedom of instructors to choose whether to teach in person (https://www.inaaup.org/).

    Sadly, I fear that many higher ed institutions will again (for the second consecutive semester) decline to do (i)-(iv), in which case individual instructors, staff, and students will face some tough ethical questions (https://dailynous.com/2021/07/27/sounding-the-alarm-2021-2022-covid-risks-at-unprotected-colleges-and-universities-guest-post/). Such individuals might consider taking these matters into their own hands. For example, the non-profit organization, Project 95 (https://www.projectn95.org/) supplies free N95 masks and rapid diagnostic tests to organizations, especially those that serve especially vulnerable populations. (They recently donated 20,000 N95s for distribution to students at Bristol Community College in the Boston area: https://twitter.com/DrNataliaLinos/status/1470525144766590989) Perhaps consider organizing a mask distribution event. At a smaller scale, individuals might consider buying and bringing to class their own N95s and HEPA filters, and distributing N95s to any interested students. Finally, and especially if they work in relatively unprotected settings—like schools with low vaccination rates, no surveillance testing, and high community transmission rates—they might consider unilaterally moving some of their classes online.

    Like Professor Pence, I hope these concerns are misplaced. (Unlike him, I have no bioethics expertise. And, in case it's not obvious, I have no formal public health training either.)

    Reply
  7. Gregory Pence

    Here is a link that confirms Professor Honsby report that the doubling rate in the UK is now less than 2 days:
    https://www.bloomberg.com/news/articles/2021-12-15/u-k-covid-cases-hit-record-high-as-omicron-outbreak-accelerates

    Reply
  8. Gregory Pence

    Is Milder but More Infectious Better? Suppose that for every 1000 people that the Delta variant infects, it hospitalizes 50 and kills 25. Now it looks like the Omicron variant is milder than Delta and for triple-vaccinated people, less likely to hospitalize or kill them. But is that really such good news?

    No, because what matters is the Ro values: how many people the Delta and Omicron variants infect and how quickly.

    Suppose that for every 1000 people infected by Omicron, only 25 people get infected and only 12.5 die. Still, if Delta infects 1000 people on Monday, and for 3 days after, then in 3 days we have 4000 cases, 200 hospitalizations and 100 deaths. But if Omicron jumps from 1000 to 8000 in 3 days, then we have 400 hospitalizations and 200 deaths. So in 3 days, the “milder” variant has hospitalized and killed far more people than the Delta variant.

    And then for the next few weeks, the numbers of people Omicron hospitalizes or kills really jumps. With Omicron, if — on day 1 — we have 1000 infections, then in 10 days we could have 1,000,000 infections, 50,000 hospitalizations and 25,000 deaths.

    Reply
  9. Joseph Zepeda

    Surely by this point it is clear that one can't predict the course of the epidemic by just extrapolating doubling times into the future.

    Reply
  10. Stephan

    Thanks for the link. The informative slides start at 6:35 rather than 26 min in.

    Reply
  11. Jennifer Hornsby

    Thanks. Indeed. (When I saw it, there was c.20 mins of blank at the beginning: they'd started recording at the time the Press Conference was scheduled, rather than when it actually began.)

    Reply
  12. Jennifer Hornsby

    For sure. But even if one can't know how Ro values or doubling rates may change in the future, one can know that always a tiny percent of a huge number is a large number

    Reply
  13. A Sharon

    We are entering covid winter #3. Its reasonable to expect the response of societies will be different in winter #3 versus #1 and #2. I take note of the decision by the US Federal Reserve yesterday to begin winding down Covid-related economic stimuli. The Bank of England raised interest rates today. The stock market responded with big gains, signaling little fear of Omicron. Fear of inflation is trumping fear of covid, even with the new variant. It's doubtful a fresh round of government assistance will be offered to support the loss of jobs that would result from new lockdowns and severe restrictions of economic activity. Biden and the Democrats fear violent rebellion more than additional deaths from covid. Even authoritative Austria's full lockdown lasted only a few weeks for the vaccinated. The ruling classes are not likely to risk further erosion of their wealth and power derived from an unregulated global economy.

    Future measures to stop the spread of covid are likely to be fractured, localized and sector dependent. As Jeremy Fischer points out, those concerned about Omicron face "taking these matters into their own hands."

    Reply
  14. Rollo Burgess

    I'm in the UK and currently on day 2 since testing positive for covid. I had booster 2 weeks ago and whether for that reason or not I'm not really that ill; basically like a bad cold. In the old days I'd have gone into work in this state (I wouldn't now!) So on my mega unscientific assessment: omicron ain't too severe, and the boosters work. But while the rate of rollout is now very high, it seems too late to me. I am baffled by the acceleration of the programme – this implies it wasn't going at maximum pace before! Why on Earth not?

    The general tone of the piece quoted may be a bit alarmist but frankly we won't know until we start to see hospitalisation rates off the the current surge in cases. What is certainly clear is that, despite my personal view being that strictly enforced vaccine passports etc. would be a good thing, we'll not have this here. The government had a massive rebellion by their deranged backbenchers against even the feeble measures they have proposed; there is little chance of them proposing stricter ones.

    I suspect that the private polling that the rebels in the government have tells them that antivax morons are disproportionately likely to be their supporters (the same fools who supported Brexit).

    So hopefully omicron is mild… or we're screwed.

    Reply
  15. Jennifer Hornsby

    I regret having been imprecise in speaking of ‘further analysis in the lab’ of PCR tests. It is specifically genomic sequencing carried out on samples got in a PCR test that is used to distinguish between variants of the virus.
    I regret my imprecision, having learnt that certain sceptics claim that PCR tests fail to detect the virus in all of its variants. For sure, like almost any tests, PCR tests are not 100% reliable. But I suspect that the sceptics may rely (not only the support of fellow supporters of the former President of the USA, but also) upon conflating PCR testing and genomic sequencing.
    Rollo Burgess speaks of the deranged Conservatives in the UK Parliament. It could be that they join in this species of scepticism.

    Reply
  16. A Sharon

    No regret necessary. I assumed something opposite those skeptics. Its assuring PCR tests pick up all variants. Indeed, it's my belief Omicron has been in circulation for some time, certainly before it was "discovered" in South Africa in late November. It stands to reason countless positive PCR tests were not further screened for variation, meaning precise numbers on variation distribution are unknown.

    Reply
  17. Gregory Pence

    In 7 days, Omicron has jumped from 3% of new cases in USA to 73% of such cases:

    https://www.nbcchicago.com/news/local/omicron-could-become-dominant-strain-in-us-in-next-few-weeks-health-experts-say/2712039/

    Reply
  18. Gregory Pence

    Here is my op-ed essay expanding my original comments:

    https://www.al.com/opinion/2021/12/uab-bioethicist-why-omicron-scares-me.html

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