Looking Ahead to Omicron

Delta provided a foretaste of what's coming...

Before considering the implications of the coming wave of Omicron infections, it’s probably useful to look at how the Delta variant has changed the COVID pandemic.

Buried deep within the BC Government’s latest Data Summary is the following graphic:

Each of those little circles shows you what percentage of COVID patients were unvaccinated, partly vaccinated, fully vaccinated or booster vaccinated for each of the four conditions shown.

I would like to draw your attention to the circle on the right marked Deaths. If we convert the given percentages on that circle to numerical values, that circle tells us that of the 164 British Columbians who died of COVID last month 74 were fully vaccinated, 8 were partially vaccinated, and 2 died despite having had booster shots. In other words, more than half of the people in BC who died of COVID last month were vaccinated in some way.

This chart of COVID deaths by age and vaccination status, is buried deep in that same document:

Do you see the tallest bar on the chart? That represents fully-vaccinated people age 70 and older dying of COVID. The single biggest group of British Columbians dying of COVID is now fully-vaccinated individuals over the age of 70. Delta is proving to be much more able to infect the fully vaccinated than previous variants. The older a person becomes, the less effective vaccines are in creating an immune response strong enough to prevent a Delta breakthrough infection from being fatal.

In presenting this information I am not saying that vaccines are without value. Unvaccinated seniors have been dying at a far higher rate than vaccinated seniors. My intent here is to identify the limits Delta has put on what vaccines can do.

There’s a second area where Delta has put limits on what we can hope to accomplish with vaccines. I suspect many people are still clinging to the hope that if everyone would just get vaccinated, COVID infections and any resulting deaths would fade away to nothing. Does the evidence support this view? No, it does not. In fact, there’s considerable evidence that as BC vaccinates more and more people, case numbers may even go up.

That’s certainly the global trend. Back in September, a Harvard University study looked at vaccination rates versus COVID cases in 68 countries, and found a measurable correlation: the higher the rate of vaccination, the higher number of COVID cases that country would see.

Since then, that pattern has played out across a number of jurisdictions: First in Israel, then in Guam and Vermont. Then Ireland – 91% fully-vaccinated – saw it’s highest level of COVID hospitalizations in seven months. Then Gibraltar, with more than 99% of its population fully vaccinated, had to start cancelling Christmas events because of a surge in breakthrough Delta cases. More recently Norway, Denmark and Germany have had big spikes in Delta numbers despite very high levels of vaccination.

How can it be that higher rates of vaccination are now leading so often to more COVID cases?

The fundamental issue once again is that Delta is much more prone to causing breakthrough cases among the vaccinated than previous variants. Research data also indicates that vaccinated individuals with breakthrough cases of Delta can spread the virus as effectively as the unvaccinated.

Oftentimes, breakthrough cases in the vaccinated are either asymptomatic or so mild the person doesn’t know they have Delta. I’ve talked to a surprising number of vaccinated individuals in recent months who reported staying home for a day with “just the flu.” They said it in a way that told me they hadn’t gone for a COVID test. The problem is that mild flu-like symptoms are usually the only symptoms a younger vaccinated person will have with a breakthrough infection of Delta.

Then there’s the issue that the vaccinated have a greater risk of exposure to the virus. If I have a bit of a sniffle but think it can’t be COVID because I’ve been fully vaccinated, and I go to a concert, or a restaurant, or hop on a plane, who am I going to infect? It won’t be the unvaccinated because the various vaccine mandates forbid them those activities.

When large numbers of undiagnosed Delta breakthrough cases are spreading the virus it makes the job of contract tracing immeasurably harder.

The upshot of all this is the spread of Delta in BC is likely now being driven more by the vaccinated than by the unvaccinated, if only because there are way more of the former than the latter.

My intent here is not to blame the vaccinated for the spread of Delta. My intent is to ask that huge group of people who want to blame the unvaccinated for the spread of Delta to notice that that belief is not supported by the available evidence. There is even less evidence for the position that vaccinating everyone in BC would significantly slow the spread of Delta going forward.

The new patterns we are seeing with Delta – significant deaths among the vaccinated elderly, and virus spread driven primarily by the vaccinated – should be seen as a foretaste of the even larger changes Omicron will bring.

Globally, Omicron case numbers have been doubling roughly every three days. At that rate, BC will rocket from 10 cases to 10,000 cases over the next month, and hit a million cases three weeks after that.

What’s particularly worrying is that all the evidence to date suggests that, to an even greater extent than Delta, vaccination doesn’t prevent people from getting and spreading the Omicron Variant. (Given current travel restrictions, we can safely assume that fully-vaccinated travellers brought Omicron to the 63 countries now dealing with Omicron outbreaks.)

In less than a month, Omicron has replaced Delta as the main variant circulating in South Africa. At this point, our best guess is it will fairly quickly do the same in BC.

The main risk of Omicron is not to the vaccinated, or even the unvaccinated. All the evidence to date suggests infections with Omicron are mild compared to previous variants. The vaccinated may only barely get sick. The unvaccinated likely won’t die.

The primary risk will be to the frail and elderly. With hundreds of thousands of cases Omicron circulating, it will become more and more difficult to prevent the elderly from becoming infected.

Describing Omicron as ‘mild’ makes Omicron seem innocuous. But ‘mild’ is a relative term. If you’re 85 and frail, even a ‘mild’ version of coronavirus is likely to make you sick, perhaps even kill you.

If seven weeks from now we have a million cases of Omicron in the Province, it will become very hard to prevent large numbers of BC seniors from becoming infected. Though we can hope the death rate from Omicron in seniors will be much lower than it was with Delta, if enough seniors become infected, they could still overwhelm hospitals and create a new wave of deaths.

It’s still early days with Omicron. Maybe it will prove to be less infectious than the early evidence suggests. Maybe Omicron will be even milder than early data indicates.

That said, even in the best case scenario we will likely be facing a big new wave of COVID soon. We can assume that the large majority of those catching and spreading Omicron in this new wave will be fully vaccinated. We can expect that most of those who die will be elderly, and fully vaccinated.

How will our COVID-control strategies need to change to deal with Omicron?

I would humbly suggest that with Omicron on the near horizon, our current strategies are already obsolete.

Vaccinating more people will have almost no impact slowing the spread of Omicron, and only a minimal impact on reducing the number of deaths.

In particular, the case for vaccinating children with an experimental, outdated vaccine with serious side-effects is looking extremely weak.

The case for extending the vaccine mandates will be similarly weak if the majority of those spreading Omicron and dying of Omicron are fully vaccinated. (Most recent stats from Denmark are that 76% of Omicron cases are fully vaccinated and a further 7% had booster shots.)

With a new wave of infections coming, it would probably be wise to think about hiring back all those unvaccinated doctors and nurses who were terminated. The simple truth is that they will be only marginally more likely to infect a patient with Omicron than fully vaccinated medical personnel. If the Omicron wave peaks quickly, it will be crucially important to have our hospitals fully staffed.

It’s not even clear that traditional social-distancing techniques will be very useful in preventing the spread of Omicron, although we can expect authorities to have knee-jerk reactions in that direction. (If you’ve had your fill of lock-downs, now would be a good time to let your MLA know that.)

Medical bureaucracies, like army generals, have a tendency to fight the last war. Let’s not do that with Omicron. If our goal is to bring this pandemic to a rapid conclusion with minimal loss of life, new strategies will be needed.

Omicron requires a thorough re-think of all of our pandemic-control strategies. Immediately.