We need to be ready for Omicron, but let’s not assume the worst

Almost two years into the COVID-19 pandemic, patience and calm are in short supply.

But a stoic, nuanced response is exactly what we need as we digest the unwelcome news that yet another variant – B.1.1.529, or Omicron – has been unleashed on the world.

The World Health Organization has warned that Omicron poses a “very high risk” of fuelling the perilous and precarious pandemic, but its actual effect remains to be seen.

In other words, we need to prepare for the worst, but not assume the worst.

That’s an important distinction at a time when we actually know little about the latest COVID-19 variant and speculation is in overdrive.

We don’t yet know whether Omicron is more transmissible, or causes more severe disease, or is more likely to cause reinfection, or whether vaccines will be less effective as a result of its mutations.

It will take a few weeks of careful surveillance, enhanced genomic sequencing and epidemiological studies to unravel just how important this latest pandemic curveball will prove to be.

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What we do know, however, is that prevention is key, and that tried-and-true public-health measures such as vaccination, good ventilation, masking, physical distancing and limiting crowd sizes, are still effective ways to slow the spread of the virus in whatever variant form it appears.

Travel restrictions have a place too, but we have to use them deftly. Banning travellers from certain countries or regions is not effective. What can slow the spread of coronavirus (including the Omicron variant) is mandatory vaccination and testing for travellers, regardless of what passports they carry.

The current approach – slamming borders shut to citizens of southern African countries – will only discourage countries from reporting new variants. South Africa and its neighbours should not be punished for having excellent infectious-disease surveillance, which has given the world a head start in its response.

Despite its ominous moniker – Omicron, the 15th letter of the Greek alphabet, sounds like the name of a bad guy in a superhero movie – it’s not a given that the newest variant will be dramatically worse than previous ones, nor that it will displace Delta, the now-dominant variant.

The reason Omicron has scientists worried is its “Frankenstein mix” of mutations. Viruses mutate, but usually do so fairly slowly. The new variant has set off alarm bells because it has 32 mutations on its spike protein alone. The spike protein is what coronaviruses use to enter human cells, so that raises fears (at least theoretically) that Omicron could spread more easily and circumvent immune protections, both those from infection and vaccination.

But none of this is clear yet.

There are even early indications that symptoms may actually be less severe in those infected with the Omicron variant. It doesn’t seem to have caused a spike in hospitalization or death, but those are lagging indicators, so we have to keep close watch. We do know that PCR testing can still detect the new variant and that the few treatments we have seem to be effective.

We still don’t have enough information to answer the key question, “Is Omicron more transmissible?” The Gauteng province of South Africa, where the new variant seems commonplace, has seen a massive spike of infections recently. But there could be many reasons for that jump.

More concerning is that many of those infected with the Omicron variant have previously been sick and recovered from COVID-19. This suggests that the new variant can evade some antibodies and reinfect. This, in turn, calls into question the effectiveness of vaccines.

The good news here is that mRNA vaccines made by Pfizer and Moderna, which target the spike protein, can be modified relatively easily.

So far, five variants of concern have been identified: Alpha, Beta, Delta, Gamma and now Omicron, all with varying degrees of effect.

We will likely have to learn a few more letters of the Greek alphabet before the pandemic is over. The more COVID-19 spreads, the more likely mutations will occur.

Above all, the emergence of Omicron should make vaccinating the world more urgent.

A little more than half the population worldwide has been vaccinated. In wealthy countries such as Canada, an average of 158 doses have been administered for every 100 people; in low-income countries that number is seven for every 100.

The biggest pandemic challenge is not new variants such as Omicron. It is ending vaccine apartheid so these new threats stop emerging.

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