What happens next with Omicron? That’s up to us

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We just don’t know. Not yet.

That is, for now, the best answer to most questions about what happens next with the fast-rising wave of Omicron. Is it as likely as earlier variants of COVID-19 to lead to severe illness? What about for the nearly nine out of 10 Canadian adults who are vaccinated but got their shots months ago? Compared with Delta, will the number of hospitalizations for every infection be lower, higher or no different?

We just don’t know. Not yet.

Over the coming days, the picture will become clearer. We’ll also learn to what degree our vaccination efforts – the 31.6 million Canadians with at least one shot, the 29.3 million with two doses, the 5.3 million with a booster and the hundreds of thousands getting boosted daily – have built a barrier against severe illness, at least for the vaccinated, and especially for those not yet boosted. But Omicron’s exceptional degree of infectiousness, and the fact that roughly one in 10 Canadian adults are unvaccinated, may almost guarantee a tidal wave of hospital admissions.

There’s lots of evidence to suggest that we are heading for a bad outcome. Very bad? Less bad? We can’t say for certain. Not yet. And so, while hoping for the best, Canada has to prepare for the worst. The more Canadians do to prepare for the worst, the more we raise our chances of avoiding it.

Our fate is in our hands. It always has been. Since March of 2020, Canada’s death rate from COVID-19 is less than one-third the American rate. We did that. All of us, together.

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There is one certainty about Omicron: It is highly infectious. If each of the rapidly rising number of infections is as likely as previous variants to lead to hospitalization, the math crushes the health care system. However, there are things we can do to prevent that.

First, there are public-health measures – masking, capacity limits, opening windows, improving ventilation and even temporarily closing crowded indoor settings. Then there’s vaccination. People who’ve had a booster shot are well protected against infection and severe illness. They’re exceptionally unlikely to end up being hospitalized by Omicron.

What we don’t know is how well protected are the vast majority of Canadians who aren’t boosted but have had only two shots, the second around six months ago.

The evidence is that their protection against infection has weakened because of Omicron. Ontario’s Science Table data show Omicron has reduced protection against infection for the double-vaccinated from near 90 per cent to around 40 per cent. Breakthrough infections are now widespread – but breakthrough hospitalizations are not. The science table’s latest data show, for the double-vaccinated, protection against ending up in hospital from COVID-19 is holding at more than 90 per cent.

That information comes with a huge caveat: Most Omicron cases developed in the past few days. It takes time for an exposure to become an infection, an infection to become an illness, and someone seriously ill to go to hospital. What’s more, the earliest cases of Omicron were concentrated among the young, the group least likely to become severely ill. Which is why, to return to where we started, it’s still too soon to say.

But the results of a just-released, non-peer reviewed Scottish study suggest that the average Omicron infection may lead to less severe symptoms than Delta.

Peter Juni, scientific director of Ontario’s science table, told us on Wednesday that the Scottish data, though it is preliminary, “might be the first glimmer of hope.”

It opens the door to the possibility that the vaccinated, even the unboosted, may be relatively well-protected against hospitalization from Omicron. But it suggests a somewhat different story for the one in 10 Canadian adults who are not vaccinated.

When Delta was dominant, unvaccinated people were far more likely than the vaccinated to become severely ill. The Scottish study suggests that Omicron lowers the risk of severe illness for both groups – but the wide gap between them remains. Each infection among the unvaccinated is still far more likely to lead to a bad outcome.

Given how superinfectious Omicron is, compared to Delta, there are going to be far more infections, and likely far more hospital and ICU admissions, among the unvaccinated. Things still don’t look great for them – or the hospitals that will have to care for them.

So where does that leave us?

The worst-case Omicron scenario is that, over the coming weeks, Canada will be hit with an exceptionally large number of hospitalizations.

However, if the preliminary Scottish data proves to be right, and Omicron is milder than Delta, then the coming weeks could be somewhat less bad. The number of hospitalizations would rise, though not by as much. And the next wave of serious illness would be, overwhelmingly, a pandemic of the unvaccinated. Again.

Editor’s note and correction: The Scottish study on Omicron reached conclusions about outcomes for both vaccinated and unvaccinated people. A previous version of the editorial suggested otherwise, and Dr. Juni’s statement about a “glimmer of hope” was mistakenly described by us as applying solely to the vaccinated. The editorial has been updated to correct this.

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