The Omicron variant of SARS CoV2 has quickly upended at least three facts we thought we had established about the COVID-19 pandemic.
First, the transmissibility of Omicron has shattered all previous records, including those set by the Delta variant, which briefly had been considered just about worst-in-class due its extreme contagiousness. Second, it has shown us that COVID-19 can be a mild disease—if one considers a three- or four-day bout of fatigue, aches, and fever to be mild.
But it is the third revelation that’s the most alarming. Omicron has scrambled a great deal of what we thought we knew about immunity to the infection in the first place. Witness the ease with which it has infected those with one or two—or even three—vaccinations, a phenomenon referred to as vaccine evasion, or VE. Thankfully, the current vaccines still prevent most lethal infections, despite being less effective at preventing infection itself.
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However, it is not vaccinated people with breakthrough infections who comprise the most unsettling part of the immunity story, even as that makes headlines and dominates social media. Rather, it is the ease with which Omicron has evaded the immunity provoked by previous infection with the Delta or the Alpha (aka the British or B-117) variants that has ominous implications for what’s ahead—and raises the specter of more mass death.
For those willing to accept vaccines, this type of evasion less than a year after the mRNA products entered widespread use is a serious but surmountable scientific challenge. We have long known we may need to develop just-in-time vaccines for a newly—and suddenly—dominant variant. MRNA technology lends itself to exactly that. The technology is available, and though the product will always lag behind the latest pandemic variants, tricks (like third doses and fourth doses of the old, less-finely tuned vaccine) to buy time or innovative technologic shortcuts surely will be developed.
Vaccinated people will—sooner or later—be able to keep up with the always-changing virus.
But the implacable millions for whom vaccination represents some intolerable intrusion on their personal space—call them the Never Vaxxers—represent a very different problem, one that science, persuasion, or even harsh threats seem unable to resolve. We knew there were anti-vaxxers, and we knew the pandemic would not end easily, but these people will not stop dying any time soon.
The unvaccinated are the ones who will continue to receive the brunt of whatever is next. Such is the case with the Omicron variant: Despite the fact that the majority of people in the U.S. are vaccinated, the unvaccinated are still filling hospital beds most often. In New York City, for example, the hospitalization rate this week is at least 8 times higher for the unvaccinated.
This is just the start, though. Among viral pathogens that affect the airways, the coronavirus family is a bunch of bad hombres, well known to re-infect year after year without major genetic shifts. (Though it may be that the genetic profiling developed during COVID-19 will, when applied to old-school viruses, show much more variation than we have previously been able to discern.)
In the Before Times, pre-SARS, MERS, and COVID, we knew of four main types of coronavirus that caused human infection. Using then-modern techniques, scientists established that though one of the four dominated every year, last year’s bad cold from coronavirus gave you no predictable protection against this year’s model. Given that coronavirus causes up to a third of “common colds” each year, no wonder adults, no matter how buffed their immune system might be, still get two to three “colds” a year.
Despite the coronavirus pedigree, many are already proclaiming (again) that the end of the pandemic is in sight. To prove their point, they are drawing a connection between the milder disease and the increasing immunity of the human herd provided by vaccine or by actual infection (or both). The concept is based on real science relating to the two main arms of human immunity: that provided by antibodies, which are first responders but not reliable variant to variant, and that provided by the slower-moving but more thorough T-cells that maintain substantial punch regardless of the variant du jour.
It is a great and plausible story, but also smacks of a morality tale; a hard-fought battle has been won at tremendous cost, but redemption is just ahead. Somehow, the moral arc of the universe is assumed to bend towards pandemic control.
Viruses—and especially coronaviruses and especially, especially the one that causes COVID-19—surely have no moral compass, however, and almost never proceed according to the playbook. Rather, they jump around inexplicably and without particular concern to the human consequences.
More likely than a gratifying fade of the pandemic is an increasing burden of disease for anti-vaxxers. Whereas the rest of the world will have regular vaccination and the occasional infection to keep their immune systems primed and ready, anti-vaxxers will rely only on the much less frequent and equally imperfect infection-provoked immunity to see them through the next infection. And as we are seeing again with Omicron, the result is a rapidly divergent rate of serious disease and death between the vaccinated and unvaccinated groups. Though only an anecdote, it is memorable that the first death in the U.S. from Omicron is believed to have occurred in an unvaccinated man with a history of previous COVID-19 infection.
The universal—and increasingly well-known—hazard posed by a large, recalcitrant pool of Never Vaxxers is its impact on public health, as millions of willingly unvaccinated persons move trillions of viral particles through their immune systems. Application of this massive and unpredictable evolutionary pressure may produce a doomsday variant this year, or a wimp; we cannot predict what comes next. The point is that the Never Vaxxers are supplying the virus with endless chances to break bad.
My guess is that our current Groundhog Day of variants every four or five months will continue indefinitely. Sometimes, we will meet a seemingly mild one such as Omicron, and perhaps a very mild one like an old-school coronavirus. But given the uneven immunity against COVID-19 in the world’s 7.8 billion humans, all we know is that the pandemic will not go gentle into that good night.
