New Year, New Variant

What we know about omicron so far, and what to do about it.

Omicron has officially swept the nation. In early December, scientists in South Africa reported that they had found a new variant with a remarkable 36 mutations to the spike protein, resulting in the most contagious variant yet. As one might expect from the most transmissible variant COVID-19 has produced, it now makes up the majority of cases in the U.S. As of December 20, omicron made up 73% of cases in the United States, and we have now seen the highest average daily COVID positive cases at an astounding 355,990 average daily infections reported this past week.

To complicate matters, many studies have shown that the vaccine is fairly ineffective against contracting this variant. While it seems that all the vaccines offer some level of protection against severe illness—Moderna and Pfizer are the most effective—when it comes to mitigating infection, these shots with the booster are the only vaccines that help. According to Dr. Fauci, the two doses from Pfizer offer significantly lower protection from infection, only 33% compared to its previous 80%. The vaccine does, however, still offer 70% effectiveness at preventing hospitalization. Pfizer’s preliminary research shows that its booster shot increased antibodies by 25x, and estimates point to 75% effectiveness in preventing symptoms. Estimates of efficacy for Moderna’s vaccine are similar. Many medical professionals have been quick to recommend the booster shot, with Fauci urging, “The message remains clear. If you are unvaccinated, get vaccinated, and particularly in the arena of omicron if you are fully vaccinated, get your booster shot.” 

Companies have signaled that they are already preparing to make new vaccines and are studying the effectiveness of current vaccines on omicron. Moderna CEO Stéphane Bancel believes that it could have a higher dose booster shot available very quickly, but that an omicron specific vaccine “could take months to develop and ship.” Pfizer’s CEO Albert Bourla set out a similar timeline urging that “We have made multiple times clear that we would be able to have the vaccine in less than 100 days.” Fauci, however, doesn’t think it’s necessary. “Our booster vaccine regimens work against omicron. At this point, there is no need for a variant-specific booster,” he has said. 

In addition to booster shots and vaccines, the FDA has recently approved use of Pfizer’s antiviral pill Paxlovid for use in patients 12 years and up who test positive and are at risk of severe illness. It is effective for reducing the risk of hospitalization and death by 88%. The FDA also approved use of Merck’s antiviral pill, molnupiravir, however it is only available to those who are 18 and older, have tested positive, are at risk of developing severe symptoms, and do not have access to other treatments. This pill is only 30% effective at reducing the chance of hospitalization or death. While this is a huge step in the fight against COVID, it has also been difficult to ramp up production. The Biden administration has ordered 20 million courses of Pfizer’s pill and 3.1 million of Merck’s, which will hopefully become available in the near future. The FDA makes clear that “Paxlovid is not a substitute for vaccination in individuals for whom COVID-19 vaccination and a booster dose are recommended.” The FDA goes on to recommend that those who are eligible for vaccines and boosters receive them.

The Biden administration, while assuring the public that this is not what we experienced in March 2020 and that we will not be shutting down again, noted that “For the unvaccinated, you’re looking at a winter of severe illness and death for yourselves, your families, and the hospitals you may soon overwhelm.”

Others aren’t so sure that this variant will be that severe. Dr. Iwasaki has made clear a silver lining, “I suspect, and I’m hopeful, that these aren’t all going to result in severe disease,” adding, “Maybe there are lots of infections, but they may be milder.” Dr. Angelique Coetzee, a member of the South African Medical Association and the first doctor to identify the new variant, reported that omicron “presents mild disease with symptoms being sore muscles and tiredness for a day or two not feeling well. So far, we have detected that those infected do not suffer the loss of taste or smell. They might have a slight cough. There are no prominent symptoms.” Coetzee’s findings are especially noteworthy, considering only 24% of South Africans are fully vaccinated (at least two shots). One study in South Africa suggested that omicron was 80% less likely to cause hospitalization.

At the time of writing, the surge of omicron in South Africa seems to have passed, with the South African government noting that “the country had passed its omicron peak without a major spike in deaths.” They also took note of the precipitous rise and fall of the variant, Fareed Abdullah of the South African Medical Research Council remarked that “It was a flash flood more than a wave.” This seems to match what is being seen in the United States. While case numbers have climbed to their seven day moving average all time high, the United States has seen little rise in deaths. Wall Street Journal notes that “The seven-day average of hospitalizations, though increasing, is below both the pandemic peak of 137,510 on Jan. 10, 2021, and the smaller peak of 102,967 on Sept. 4, 2021, during the Delta surge,” and in Ohio “more than 90% of the patients [were] unvaccinated.” 

Fauci predicts that omicron could peak by the end of January, with other scientists seeming to echo the likelihood of omicron peaking in mid to late January. 

Graph by The New York Times

In an interview with The Dispatch, Dr. Monica Gandhi, an infectious disease specialist at the University of California-San Francisco, noted the Spanish flu’s evolution into obscurity. “It’s really hard for a variant to become more transmissible and more virulent,” she said. “For it to be more mild, that would be an amazing hope, because in a way, that’s how the 1918 influenza pandemic ended. It just became more mild and burned out.” Gandhi has added that case counts “are causing a lot of panic and fear, but they don’t reflect what they used to, which was that hospitalizations would track with cases.” Future breakouts surrounding COVID, until proven otherwise, are likely to be widespread yet inconsequential.

As the threat of COVID dissipates, it would reason that the associated restrictions would subside along with the pandemic. Yet, at our own Connecticut College, mandatory twice per week testing, indoor mask mandates, and dorm room capacity limits are still in-place despite a full vaccination plus booster mandate. The Administration continues to defend these policies, saying they are necessary to keep the campus community safe. Fortunately, the campus community was quite unharmed during the fall semester; despite a massive 100+ case breakout in September, Dean of Students Victor Arcelus stated that no students were hospitalized due to the coronavirus. Conditions of infected students were consistent with nearly all college-aged vaccinated students in which they, at worst, resemble harsh symptoms of a seasonal flu.

While Connecticut College’s Administration seems determined to impose strict rules on its students, it is clear that students are among those the least affected by the virus. In most places in the United States, mask mandates are absent and the public may enter indoor spaces without them. The public also need not worry about testing at all; while many schools have implemented testing regiments, the general public only ever needs to get tested of their own volition. It is clear that schools have some of the most extensive measures in place to prevent spread and track this disease, despite this demographic being largely unaffected by the virus. Those aged 50 and above make up about 93% of all deaths from COVID. 

It is true that this virus has been devastating and that restrictions have been helpful in a few circumstances, particularly in flattening the curve so as to not overwhelm hospitals in the early stages of this pandemic. However useful these restrictions have been, they have not been without consequences themselves. On average, kids have fallen behind 5 months in math and 4 months in English, which has had the largest impact on lower income families and increased disparities in education, although hybrid learning has significantly improved this deficiency. Kids are also more likely to drop out of high school, miss classes, and not enroll in college, demonstrating that the impact on education may be felt long after this pandemic is over. In addition, mental health has been seriously negatively impacted since the beginning of this pandemic. 35% of parents are very or extremely worried about their children’s mental health, and 80% are somewhat worried about their children’s mental health. 

Masks and isolation have contributed to decreased social stimulation that could be potentially damaging for developing children. According to Dr. Michael Nagel, “Human faces convey a great deal of information and are one of the most important aspects of communication and development for children.” It is true that masks can inhibit these social interactions and may hurt children’s social development. Isolation is also impactful, considering that social interaction early in life is a contributing factor to learning how to interact with other people and gaining social skills. Social stimulation has many positive effects and reducing this stimulation through masks and isolation can be harmful to developing children, especially when it is for prolonged periods of time. 

While masks can offer some levels of protection in certain situations, its detriments seem to outweigh its benefits, especially considering certain masks and mandates are ineffective. A study conducted by the CDC during the 2020-2021 school year found that “schools that required mask use among students was not statistically significant compared with schools where mask use was optional.” Mask efficiency depends largely on the type of mask that is used. N-95 and KN-95 masks are nearly entirely effective and offer the most protection, while surgical masks offer slightly less protection but are still largely effective. However, cloth masks, which most students use on a daily basis, offer significantly lower levels of protection as they are an ineffective barrier for air particles and water droplets. A study recorded in Bangladesh found that surgical masks have a 95% filtration efficiency, while cloth masks are only 37% effective. 

It has nearly been two years since COVID initially made its serious debut in the United States, and at the time restrictions were a reasonable precaution to confront a virus that much was unknown about. The coronavirus’s high contagion was a cause for concern to hospitals that needed to give those affected their full attention, and would not be able to do so if the virus spread uninhibited. These mitigation efforts were initially useful, but as time went on and treatments improved, vaccines were released, boosters were released, antiviral pills were created, viruses mutated to be less harmful, and the percentage of COVID cases that produced severe symptoms declined, the question arises of whether we are still using the right metric to track this disease. The more prolonged these restrictions are the larger impact they have on mental health and social interaction, and they seem to be heavily applied to those most vulnerable to these effects. 

With vaccines vastly available and vaccinated individuals protected from conditions worse than the seasonal flu, the virus and variants may remain, but the pandemic has ended. Because the risk of fatality for those vaccinated has subsided, cases no longer serve as a reliable basis for the severity of our situation and the mitigation efforts cause a larger negative impact than positive impact. In some cases of course, it is wise to be cautious and it is always prudent to be wary of the immunocompromised, but for those students who are among the least vulnerable demographic for COVID and most severely impacted by restrictions, it is time to reconsider our mitigation efforts.