After about two weeks of news about the omicron variant of the coronavirus, when it’s been tracked like some impending hurricane or escaped murderer, the story has become no less cryptic and confused. Taken together, the many important and accurate reports have led to a sense of conflict, even chaos. In the process, we’ve lost the point.
First there was the unprecedented alarm about mutations in the newly identified strain, B.1.1.529, which were far more extensive than experts expected to find. For the first time, the World Health Organization abandoned its methodical system of categorizing variants by threat level. Barely more than a week after it was identified, this one went straight to the top.
Until then, only four other variants of SARS-CoV-2 — out of trillions of mutated iterations — had risen to the level of “variant of concern.” This meant there was evidence that a variant was spreading or sickening people in significant new ways. The only other one at this level is delta (which had replaced both the other two). Suddenly, we had another — based on genetics alone — dubbed omicron.
Official messages were cautious: It remained to be seen if this variant was more transmissible or virulent. But that was at odds with the sheer speed with which the WHO raised alarms. Though experts couldn’t say how concerning it was, they wanted countries to know that this variant warranted serious attention. Microbiologists warned that it would take weeks, even months, to see if and how its mutations might translate into a material difference in the disease.
The world did not wait to see. Despite all the hedging, the effects of the variant became suddenly concrete. Stock markets plummeted. World leaders scrambled. Politicians who had sworn to take decisive action to end the pandemic — to “follow the science” — found themselves surrounded by scientists shrugging in genuine uncertainty. Nonetheless, in many places, political pressures err on the side of protectionism; within days, countries including the United States had issued international travel bans. Some local leaders have cited the variant in justifying actions like New York City’s vaccine mandate for private employers: On MSNBC on Monday, Mayor Bill de Blasio said, “Omicron is here, and it looks like it’s very transmissible.”
The conflicting messages from officials have amplified an already roiling mix of anxiety, fatalism, ennui and distrust. The public has been alerted to a potentially catastrophic threat, while also being told not to do anything differently — and that it may not be a threat at all. The overall effect is like that of a doctor telling you she saw some abnormalities on your brain scan and doesn’t know what they are. It could be meaningless. But don’t panic. The world’s best experts are convening to figure out what’s happening in your head. We’ll know more at some indefinite point in the future. In the meantime, don’t travel internationally. Even for those who aren’t left feeling anxious — or by now are barely able to care — practical considerations cast vague shadows over previously certain plans. Does this mean we shouldn’t get together with grandparents over the holidays? Should I still get that booster if you’re not sure it’ll help with this mystery variant? Are schools going to close again? If they do, I swear to God …
But we already know the most important answers to questions about this virus. There is a more cogent, straightforward way to think about the challenges before us and how to meet them. It does not involve waiting to learn if and how some mutations in a viral genome will determine our fates.
For most people, any variant of the coronavirus is going to cause a mild illness. That has always been the case. It’s also what makes this virus so difficult to contain or to get people to care about: The pandemic has always been a problem of scale.
For now, SARS-CoV-2 is far from the most deadly virus in the world. Based on average fatality rates, any person should choose it over getting Ebola or rabies. Yet at a population level, this coronavirus has already killed many millions more people than those other viruses do each year. Covid-19 is a disease whose overall deadliness has more to do with us — our willingness and capacity to spread it — than with anything baked into its RNA.
Now, as with prior variants, as the public awaits news of “just how dangerous” this one is, we are again missing that point.
Covid is a leading cause of death in the United States. Every day, more than 1,000 Americans are dying of it, as are countless thousands more globally. We do not need to wait to learn more about omicron to know that an extremely transmissible, deadly respiratory virus is spreading widely around the world. If 1,000 deaths each day did not constitute a crisis sufficient to animate the best possible response from everyone, I hesitate to ask what would.
And yet in many places, people are taking zero preventive measures. Especially in states with Republican leadership, the pandemic has effectively been declared over. Lawmakers are largely dedicating their time and energy to fighting measures aimed at increasing vaccination and decreasing transmission. As a result, cases have been surging around the country, even more so in red states, and our national demand for vaccines has stagnated. Relatively slow uptake of boosters may amount to a backslide in progress. Whatever additional evolutionary advantages omicron and future variants may develop, their impact will be extremely difficult to differentiate from the effects of so many people forgoing even basic preventive measures.
We cannot stop this virus from mutating, and each new variant should be expected to have a slightly better ability to attach to our cells and replicate within us, and to be somewhat better at evading our vaccine-educated immune systems. Immunity of any sort creates pressure on the virus to do just that. The net effects of these shifts across populations, over time, are absolutely critical for officials to monitor.
The expectation is that, eventually, the arc of the disease becomes milder — at an individual level. But a somewhat-less-deadly variant can do more damage if it spreads to more people.
Forecasting the course of a pandemic is not like predicting the path of a hurricane or tsunami. Mutations may be inevitable, and variants will arise, but their practical effects also depend on us. Viruses cannot spread on their own. If someone gets infected and is able to test, stay home and effectively quarantine, the transmissibility of the virus — no matter how many mutations it bears — drops to zero. If that same person began to feel sick, but didn’t have a rapid test on hand and decided to go to choir practice, he could infect 10 people. A new variant may mean the number was instead, say, 11 or 14. Each of them could infect a few more, and so on, until that one infection becomes thousands. The effect of the new variant globally would be massive. And it would appear that this new variant is simply unstoppable. When a virus is spreading as widely as this, even a tiny increase in its transmissibility or virulence can become catastrophic.
But that lets our leaders defer blame for their inaction. To say we must wait for microbiologists to study variants and make a forecast is based on a false premise, and it has real consequences if it makes people feel like they have no agency in this.
In fact, any new variant will most likely lead to only a subtle or imperceptible difference for most of us as individuals. The prognosis for any given person who contracts covid-19 via any new variant is unlikely to be radically different from that with previous variants. And the recommendations for how to prevent transmission almost certainly will remain the same.
If we want to minimize the impact of this variant, we already know what to do, and what to expect, as individuals. Advice on what types of masks to wear, and when, and what types of air purifiers and ventilation systems are most effective, will not change. Omicron and other variants may one day warrant updates to things like vaccines and treatments. But we need not live in fear that our tools will suddenly become useless. An update to a vaccine, if and when that happens, is likely to be more similar to the update between the iPhone 13 and the iPhone 12 than between the iPhone 13 and a ham radio. Good vaccines are not likely to be rendered obsolete as improvements are made.
If and when updates become valuable in certain populations, guidance can be revised accordingly. But it’s not the case that every individual or family or schoolteacher or anyone else must be directly concerned about each new variant.
The solutions are the same for each variant, and they are systemic. The United States and other wealthy countries have been warned — many times — that a failure to comprehensively vaccinate the world will continually put everyone at risk. As long as the coronavirus is spreading widely, its capacity to evolve is vast, and difficult if not impossible to stay ahead of. By the time we can identify a concerning variant, it will already have traveled far.
Leaving it up to individuals to figure out responses to systemic failures is dangerous. Patience and good faith have worn razor thin, in places where they’re not already gone. It isn’t sustainable to ask people to live in constant uncertainty about whether some new variant is shifting the risk calculus of any given social scenario. People are exhausted by that, justifiably, and those who remain vigilant are misled if they think there will be a day when everything is suddenly declared safe. The virus will be with us indefinitely, and we need to think about its risks in more sustainable ways.
If we treat variants as novel threats that must be addressed in new ways each time, and attempt to precisely adjust recommendations to account for each specific mutation, then the road ahead will be one of endless updates and changes, confusion and weariness. It will also lead us into the trap of being complacent about any threat that is not novel. We have already seen this with diseases like HIV, influenza and every other variant of SARS-CoV-2.
The sustainable path forward involves a long-term focus on creating a world equipped to deal with respiratory viruses. This begins with more comprehensive monitoring systems that can identify patterns in mutations and new viruses more readily, and determine their meaning for individuals as quickly as possible. A global system of collaborative, open-source vaccine development should follow, along with a plan for strategic and equitable international vaccination programs that would give any virus far less opportunity to mutate.
At an individual level, behaviors will always matter. But the more we can do to make basic safety into common practice, the less thought need be given to new variants or new viruses. Governments will benefit from doing everything possible to make these habits easy to develop: offering ubiquitous rapid tests, free masks, hand sanitizer, high standards for ventilation in public spaces. Things like wearing a mask on a crowded subway, or asking people to do a rapid test before a gathering, may be worth maintaining as norms without quibbling over whether a particular variant will necessitate them.
When we simply make a habit of a safety practice, like wearing a seatbelt or washing our hands after using the restroom, we make our lives simpler. These habits mean we don’t have to rely on some elaborate and constantly changing risk-benefit calculation. We perform them even though the danger of any given car ride without wearing a seatbelt is actually small, as is the likelihood of getting cancer from any given cigarette, or of contracting covid from any given interaction. And yet the net effect can be enormous.
We are not waiting to see how dangerous this new variant is. We’re already determining it.
James Hamblin is a journalist and physician specializing in public health and general preventive medicine. He is a lecturer at Yale School of Public Health and writes a free weekly newsletter called The Body.