(2021-11-26) ZviM Omicron Variant Post 1 Were F-ed It's Never Over

Zvi Mowshowitz: Omicron Variant Post #1: We’re F***ed, It’s Never Over. The last day has seen the imposition of new travel restrictions and spreading alarm about the Omicron variant. It sure looks like a repeat of what happened with Alpha and Delta, as well as the original strain back in early 2020, and that we are probably doing this again. (covid-19)

The First Three Times

In early 2020, we got warnings about a new potential pandemic. Almost all reactions were too little too late

About a year ago, as the Alpha variant was spreading, it seemed like the same pattern was happening again

There was no big wave between March and May of 2021. Alpha wasn’t as additionally infectious as I expected, but it wasn’t that much less additionally infectious than I expected

Then, as it looked like things would have otherwise died down and normal life resumed, Delta variant arrived

Winter is now coming, and that winter wave is clearly already underway, except now we are likely to also face the Omicron variant.

If Omicron Is What We Think, We Cannot Stop It, Only Slow It Down

If Omicron is indeed substantially more infectious than Delta, it will become the dominant strain throughout the world

Once there are hundreds of detected cases, it is already far too late to successfully contain the new variant.

We lose

That doesn’t mean we can’t or shouldn’t do things that make us lose slower. We can absolutely slow down the pace at which Omicron displaces Delta. Whether or not that time is useful depends on what we do with that time

If buying time before a sufficiently large wave gets us better access to Paxlovid or other treatments, or allows us to get a lot more people booster shots that still work, or time to make a new version of the vaccine and roll it out, time can be quite valuable.

If you buy time and then it is wasted, then nothing is gained. If you pay a big price to buy time, it needs to be paired with a similarly big effort to make use of that time.

Travel restrictions are an excellent idea when the goal is to buy time. They can definitely slow down the rate at which the new variant spreads across borders.

The other issue with travel restrictions is they continue long, long past the time when they still make any sense. Once containment has generally been lost, the restrictions don’t do anything.

reason to reconsider existing lockdowns is that there are increasing marginal costs for lockdowns, and a limited capacity to impose them. The early efforts to stop the spread ‘used up’ a lot of that capacity. Lockdowns now, before the crunch time, could end up having little effect and also making it impossible or more expensive to lockdown again later when it matters most.

The best defense against prior waves and variants has been vaccination. Every time a new variant arrives, fears are stroked that the vaccines will stop working, or will be less effective.

So far, all talk of immune escape has mostly been exactly that, talk. That should make us wary of expecting it out of a new variant, or of updating too much from people’s concerns.

If a new variant comes along that does offer substantial escape from the vaccines, we will need to update the vaccines and get new versions out as quickly as possible. Will we be able to do that?

Biological Priors

We have explored various potential mutations a lot by now, so we should put a lot of weight on what those mutations imply about the variant’s likely behavior.

We should presume there will still be more ‘breakthrough’ infections but that this comes from the protection levels no longer being sufficient because the new variant is easier to catch in general, not because the particular protections you have stopped working.

What Do We Know About Omicron?

World Reaction

The financial markets are taking this seriously.

EDIT: The actual moment I hit the send button, we did in fact restrict travel:

Current Model

Chance that Omicron has a 100% or bigger transmission advantage in practice versus Delta: 30%.

Chance that Omicron will displace Delta: 70%.

Chance that Omicron is importantly more virulent than Delta: 25%.

Chance that Omicron is importantly immune erosive, reducing effectiveness of vaccines and natural immunity: 50%.

Chance that Omicron means the vaccinated and previously infected are no longer effectively protected against severe disease until they get an Omicron-targeted booster shot: 5%.

Chance we are broadly looking at a future crisis situation with widely overwhelmed American hospitals, new large American lockdowns and things like that: 20%.

My gut is something like: Even with a huge transmission advantage, we might not get to this point because of vaccinations and Paxlovid, if we have enough time for that, and because every wave ends up peaking on its own one way or another, and there’s a ton of immunity already even if it will be weakened somewhat.

Final Thoughts

The chances of things ever fully ‘returning to normal’ went down once again, except if we decide to return to normal and live our lives anyway. We need a plan to do that, now more than ever.