Omicron optimist, pessimist or fatalist – which are you?

20th January, 2022

Is this the point at which we should shrug our shoulders and give up? Omicron has prompted three kinds of reaction: optimism, pessimism and fatalism. The optimists argue that the variant is “nature’s vaccine”, a mild and transmissible virus that will quickly infect billions, triggering an immune response that will provide protection against deadlier variants such as Delta. The pandemic is over, and we won.

The pessimists believe that, while Omicron is probably less dangerous than Delta, attacking lung cells less aggressively, it may still be dangerous enough. It partially dodges vaccines, and many people have yet to have access to a vaccine anyway. If it does quickly infect billions, then hospitals across the world will be overwhelmed. The pandemic is over, and the virus won.

The fatalists argue that if everyone agrees that billions are about to be infected, then eat, drink and be merry. If it didn’t get you at Christmas, it will surely get you by Easter.

What’s confusing is that all three views may be right. Omicron is quite plausibly mild, catastrophic and inevitable all at once.

Fatalism is particularly understandable. Omicron seems to be one of the most transmissible viruses ever discovered. In the UK, the first cases were reported in late November. By the end of December, the Office for National Statistics estimated that one in 15 English residents were currently infected, presumably mostly with Omicron. In a highly vaccinated population, the variant went from nowhere to everywhere in a month.

This transmissibility does suggest that the vast majority of people will be experiencing an Omicron infection over the next few months, and whether or not you think it is mild, that suggests there is little point in hiding.

But there are several weak points in the fatalists’ argument. The most obvious is that you never really know with this virus; maybe Omicron will infect fewer people than we think.

There is also the familiar need to “flatten the curve”. Even if everyone is infected, it makes a big difference to hospitals if those infections can be spread out over months rather than weeks. And across the globe, 30 million vaccine doses are being administered every day. Whether first doses or boosters, they all help the body mount a defence. Each day that Omicron can be delayed adds to the wall of protection.

Then there’s the appearance of fresh therapies for Covid-19. The new drug Paxlovid seems to be an astonishingly effective treatment, but it will take months to scale up production from hundreds of thousands of doses to hundreds of millions. Meanwhile there is nothing foolish about playing for time.

But there is a subtler flaw in the case for fatalism, says Joshua Gans of the University of Toronto’s Rotman School. Implicit in the fatalists’ argument is that you’ll either get Covid-19 once now, or once later.

“If we were having this conversation about flu,” says Gans, “you wouldn’t be talking about whether to catch flu now or later. You could easily catch flu now and later. The same is possible with Covid.”

Flu mutates endlessly, which is why many people receive a flu vaccine every year. But Omicron has demonstrated that Sars-Cov-2 can also mutate more dramatically than we had hoped. There are no prizes for picking up an Omicron infection now if Pi, a new immunity-evading variant, will be with us this summer.

So what to do? I would not blame anyone for being extra careful at this point, but personally I have taken a few small steps towards the fatalists’ camp. I’m boosted, fit and under 50, and with three children at school I suspect that Omicron will come knocking soon enough. And while there is no guarantee that Omicron will be the final wave of the pandemic, it’s plausible that it might be.

What worries me is that governments might think in the same way. That could be disastrous. When we are confronted with a near miss, there are two possible responses: breathe a sigh of relief or treat it as a warning. Omicron is a near miss: vaccine-dodging, astonishingly transmissible, but probably not severe enough to kill tens of millions of people.

But what if the next variant combines Omicron’s transmissibility with greater capacity to dodge vaccines and cause more severe illness? The original Sars virus was fatal in 10 per cent of cases; something like a Sars-Omicron mash-up could kill a billion people.

Omicron might be “nature’s vaccine”, but it might also be the gateway to hell.

Is this likely? No. But it is more likely now than it seemed two months ago. While I am starting to relax, governments should be on high alert. The FT’s Martin Sandbu rightly argued that they should prepare contingency plans in case future lockdowns are needed, with clear rules and well-designed support for affected sectors.

Other preparations may be even more important. We punished South Africa for detecting Omicron early. That’s insane. We should be supporting strong viral surveillance systems. We should also be accelerating the development of vaccines that work against all coronaviruses and subsidising the capacity to produce and distribute future vaccines more quickly.

I am hopeful about 2022. Omicron may well be the last wave of the pandemic. It is quite understandable that individual citizens are starting to relax. But if governments become complacent, that is unforgivable.

Written for and first published in the Financial Times on 14 January 2022.

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