Getting Used to Omicron’s Impact – For Good and Ill

Here's the COVID-19 picture in early 2022, in the Omicron Era: There’s uncertainty, frustration, case numbers rising through the roof, and daily death statistics that are each an individual, life-altering tragedy for a family. In many ways, it feels like we’re back at the beginning of the pandemic in 2020.  

On January 10, 2022, the total number of COVID-19 cases in the United States exceeded 60 million—and incredibly, 1.4 million new cases were reported that day. In numerous regions of the country, the new Omicron variant of the SARS-CoV-2 virus has been dominant at least since Christmas. By late December, Omicron accounted for 60% of all SARS-CoV-2 variants circulating nationwide.  

But, even given the rapid proliferation and high transmissibility of Omicron, it’s not 2020 all over again. According to a growing number of epidemiologists, there is a decent chance we’ll see some light at the end of the tunnel.  

Game-changing vaccines 

Much of the good news centers on the fact that we have safe, highly effective vaccines that are widely available, at least in richer nations. A study led by the Ragon Institute at Massachusetts General Hospital released in early January 2022 revealed that people fully vaccinated and boosted should have strong protection against serious outcomes from the Omicron variant. 

The study confirmed emerging thought trends among epidemiologists: All three vaccines approved for use in the United States—the Johnson & Johnson vaccine, and the two mRNA vaccines made by Pfizer-BioNTech and Moderna—remain effective to a significant degree at preventing infection. But their main value lies in their ability to prevent devastating illness and death. 

The study also found that the protection afforded by a two-dose Pfizer or Moderna vaccine, followed by a booster at least six months later, is superior in terms of antibody production. People who received the Johnson & Johnson product, even after receiving a booster with one of the mRNA vaccines, still didn’t exhibit the breadth of immune response as those vaccinated exclusively with Pfizer and Moderna. 

The booster appears to be key. With all three vaccines, antibody production and immune response wane over time. But after an mRNA booster, people enjoy “substantially higher” levels of antibodies that help maintain protection against Omicron.  

A less-lethal mutation 

Omicron itself also appears to be less severe in its assault on the human body. It’s pretty clear by now that Omicron’s genetic structure directs it to target the nasal passages and upper airways, rather than the lungs. A report issued on December 31, 2021 in the United Kingdom comparing the effects of Omicron with those of the Delta variant noted that people infected with Omicron were only about one-half as likely to need emergency treatment or hospitalization. 

With Omicron, people may be entirely asymptomatic, or they may experience cold-like or flu-like symptoms that resolve quickly. The coughs and fevers that so distinguished previous variants are also less common with Omicron.  

But don’t call it “mild” 

As the World Health Organization noted in January 2022, a case of Omicron does tend to result in less severe disease, but it is not necessarily “mild.” The numbers show that, proportionally, far fewer people need hospital care. But this doesn’t mean that many people, even fully vaccinated ones who get “breakthrough” infections, won’t show symptoms. And as one American pulmonologist said, for individual patients who are elderly or immunocompromised, Omicron can be a “nasty” experience.  

Experts advise that, as with any coronavirus variant, an individual’s “absolute risk” is determined by a whole constellation of factors: general health and overall quality of immune function, vaccination and booster status, and their financial situation and access to healthcare services. 

Although the jury is still out on this aspect of Omicron, many researchers also believe that, even in quickly resolved cases, infection could still lead to long COVID, the persistence of sometimes disabling symptoms for months—or even years—after the acute illness has run its course. 

We’re still all in this together. 

It’s important to remember that, as with any public health emergency, risk is not just individual. It's collective and produces big ripple effects throughout healthcare systems and societies. Even a less-lethal virus with greater transmissibility can still devastate healthcare infrastructure and the economy.  

Even though fewer people are experiencing severe symptoms, the sheer numbers of those infected will necessarily result in case numbers and hospitalizations high enough to overwhelm existing resources. Turn on the news and see report after report of people being turned away from care for serious non-COVID illnesses due to lack of hospital beds and medical personnel.  

Make no mistake, we’re still in a pandemic. So, get vaccinated and boosted. Mask up and follow local safety ordinances. Avoid crowds when possible, and continue with good habits of hand-washing, physical distancing, and checking for excellent ventilation and air filtration in shared spaces. Omicron may be "milder," but that's in relative terms—you still definitely don’t want to get COVID. 

Some good news, taken with caution 

We could still see any number of new variants and other curveballs, of course. But for many researchers, the rapid spread and transmissibility of Omicron could very well push what was a “pandemic” into a new status quo in which COVID becomes simply “endemic.” In this scenario, although COVID will be ever-present, most of us will be able to live with it and society will be able to manage it, thanks to increasing vaccination rates and some degree of natural immunity from previous infection. Regular booster shots may become a fact of life if this scenario plays out.  

There’s a central fact often forgotten in overheated media coverage of the pandemic: the vaccines are holding up. Granted, Omicron is considerably more infectious than Delta, and hence results in a larger number of cases, even among the vaccinated. But none of the vaccines ever guaranteed absolute, 100% protection against becoming infected in the first place. What they are best at is protecting us from serious illness, hospitalization, and death.  

As the Omicron wave passes its peak in one part of the world after another, a number of researchers think this will make the latter part of 2022 look a whole lot better.