BACK IN 2019, it took a month for the warning to go out about a new respiratory disease in Wuhan; and another month for America to suspend flights from China. By this time, large amounts of the coronavirus had spread around the world. By contrast, the recent identification of a new and potentially dangerous strain of Covid-19 in South Africa took place within days. Travel bans followed within hours. Some were even announced before the World Health Organization even named the new variant Omicron (they tactfully overlooked the Greek letter Xi, which could have caused offense in China).
The admirable work of South African scientists and their exemplary openness, along with the swift recognition that Omicron poses a real threat, show that the world has learned a lot about dealing with pandemics over the past two years. The mere fact that Omicron was spotted early, using scant data, means its true nature will remain unclear without further investigation. The real test of pandemic preparedness will be how wisely the world uses the time gained.
One of the tasks is to answer some pressing questions. Most importantly, will Omicron supplant the Delta variant, which causes 2.5 million cases per week in Europe alone. Early evidence in South Africa suggests that it is indeed spreading very quickly. The possibility that it had already spread there may explain why sporadic cases have cropped up around the world, including 13 in the Netherlands, three in Britain, two in Denmark and Australia and more, along with more than 1,000 suspected infections.
But there are complicating factors. The level of immunization in South Africa is quite low and registered cases were until recently about 1% of their July peak. Perhaps that gave Omicron an edge, turbocharged through a series of super-dispersion events. Other variants, including Gamma and Lambda, looked dangerous for a while before fading. Yonatan Grad, a professor of immunology and infectious diseases at Harvard, has tweeted that transmissibility can last two to four weeks.
Another question is whether Omicron causes serious illness. Early reports of mild cases in South Africa are inconclusive. They may have described symptoms especially in young people, who are less vulnerable to all variants of Covid-19.
To make a comparison with other variants, scientists need to observe enough cases across ages and in people with secondary conditions, such as chronic kidney disease and diabetes, which are known to make catching Covid more dangerous. One thing to remember is that, if Omicron proves to be less virulent than Delta, but much more contagious, it could still lead to an increase in hospitalizations and deaths. dr. Grad thinks assessing Omicron’s severity could take one to two months.
A third question is how much protection vaccines, previous infections and drugs provide against Omicron. The reasons for concern are mostly theoretical. Omicron has about 30 mutations on the spike protein, some believed to help virus particles penetrate human cells and others believed to frustrate antibody attacks. There are about 20 more mutations elsewhere in the viral genome: some can also be dangerous.
There’s anecdotal evidence that fully vaccinated people contract the disease, but this isn’t surprising, because that’s a trick Delta is already pulling. It’s about how common such cases are, how easily they pass on the disease and, crucially, what proportion of it ends up in intensive care and in an early grave. dr. Grad thinks data on vaccines will be available in one to two weeks.
Perhaps Omicron will never yield much. Still, governments can use the time they have to prepare should that happen. Early travel bans and quarantines will slow the spread from South Africa by reducing the number of individual outbreaks of new arrivals. That, in turn, helps track-and-trace systems to keep up.
But Omicron may soon be so contagious that track-and-trace is flooded. If so, community transmission will quickly become more important than cases dispersed by the occasional international traveler. At that point, travel bans should be lifted immediately – after all, South Africa is currently being punished for its good citizenship.
A second task is for pharmaceutical companies to be able to make new vaccines. These target the spike protein and that of Omicron is highly mutated. In particular, the mRNA vaccines can be quickly processed, tested and then produced on a large scale using the genome of the new variant. They say that will take about 100 days. The other vaccines, where scaling is more difficult, may take longer. The work has already begun.
Whether administering these new vaccines really makes sense remains to be seen. Jeremy Farrar, head of the Wellcome Trust, a medical charity, points out that the ideal injection has been optimized to protect against a range of existing variants. Specializing in an exotic like Omicron may not be the best strategy.
Meanwhile, governments can accelerate strengthening programs, assuming current vaccines provide at least some protection against the new threat. Third shots like that make sense whether Omicron is going to dominate or not. Their primary job is to protect against Delta, which is currently rampaging through Europe and threatening the United States again.
If Omicron is going to spread, governments will have to fall back on non-pharmaceutical interventions. The least disturbing factors are wearing a mask, reaffirming the two meter rule, working from home where possible and better ventilation. If Omicron is really much more contagious than Delta, then the efforts required to stop its spread will have to be correspondingly more severe. Increasingly extensive lockdowns are, as always, a last resort to reserve when cases look like they are about to overwhelm the health system.
For all of this to work, governments need to know when to act. And that depends on understanding how the new variant spreads. By a stroke of luck, a common PCR test can’t detect one of its target genes when analyzing Omicron because the virus’ genome has a mutation. PCR testing is faster and less expensive than complete sequencing of the virus. They can therefore serve as a handy rough guide to Omicron’s status (although they are hardly fail safe, as some other variants behave the same way).
Governments are wrong at every stage of the pandemic. But their most consequential mistake was to act too late, when things are already spiraling out of control. With Omicron, South Africa bought them time. How well will they handle it?