Medical Examiner

Here’s One Reason to Be Hopeful About the Omicron Surge

It’s not just because this variant appears to be milder.

People wait in line on a sidewalk to receive a COVID-19 test
New York on Tuesday. Angela Weiss/AFP via Getty Images

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The omicron variant is surging in the U.S. By the Washington Post’s calculations, a month ago the U.S. was averaging about 100,000 cases per day. Now it’s about 500,000 cases per day. The seven-day rolling average hospitalization rate is nearly double. And even though omicron seems to be less severe than previous COVID surges, the fact that it’s more contagious means the mortality rate could still go up, fast. On Wednesday’s episode of What Next, I talked to Washington Post health reporter Dan Diamond about what to make of the omicron wave, why it’s important for hospitals to know which variant a patient has, and how the pandemic could end. This conversation has been condensed and edited for clarity.

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Mary Harris: Do we know that the surge in cases and hospitalizations is all omicron at this point?

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Dan Diamond: It’s not all omicron, and it depends where you are in the country. Parts of the U.S. were still dealing with a serious delta wave, this previous variant that was proven to be not only fast-moving but pretty severe. I was in the Midwest a few days ago, and hospitals say they are still seeing many patients coming in because of delta.

And are they testing? Trying to sort out who’s omicron, who isn’t?

They are testing, but it’s hard to do it in the moment. You can look back and do this genomic sequencing, and there are hospitals that I’ve talked to, Houston Methodist in Texas, which has done this really comprehensive tracking of, OK, this week we had 15 percent of patients were omicron, this week we have 30 percent, this week 50 percent—and I’m saying weeks, but really it was a matter of days. Omicron moved very, very quickly and is up over 90 percent of the cases now at this hospital system in Texas. But it’s also hard to know if you’re in the emergency room or you’re in the ICU, you’ve got this patient presenting with COVID who might need immediate help. You can’t tell if that person’s omicron or that person’s delta, and that makes a real difference when you’re trying to figure out what treatments to administer, because some things that work for delta don’t work for omicron, and there’s a limited supply of these things.

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Like what?

Like the monoclonal antibodies, which essentially you’re infusing, you’re giving someone antibodies immediately to fight off these infections. But the monoclonal antibody treatments that we’ve had for some time now, most of them don’t work for omicron. So if a patient’s showing up and needs monoclonal antibodies, it’s kind of a twofer of if you give an omicron patient these antibodies, you’re not making any difference in fighting omicron and you’re losing the opportunity to give it to someone who has a delta infection.

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This wave seems to be milder. Do we know if it’s milder just for people who’ve been vaccinated or vaccinated and boosted, or whether it’s milder for anybody who encounters this new variant?

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There’s evidence that it seems to be somewhat milder than previous variants for everybody, but “mild” is such a fraught word here. I’ve spoken to people who are vaccinated, who are boosted, who are young and healthy and they get omicron and they’re laid up in bed for days and it’s the worst sickness, cold, that they’ve had, certainly the past couple years, and in some cases one of the worst colds they ever remember having. And then they still feel bad for days or potentially weeks to come. So omicron is no picnic, and that’s for people with protection. People who aren’t vaccinated, who don’t have previous infections and don’t have some immunity built in to fend off omicron, it may be somewhat easier than delta, but that doesn’t mean that it’s going to be so easy that they’re not landing in the hospital.

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Over the last week or two, the CDC has released some guidance that I think has confused people, certainly generated a lot of controversy. It’s basically guidance that’s shortening isolation time after infection with COVID and saying, once symptoms have resolved, people can go back into the world while wearing a mask, even if they don’t have a negative test result. And I think a lot of people heard that and they just thought this is nuts. These guidelines—are they based on science? Do we know why they made these new recommendations?

They’re based on a mix of factors—science in part, but also economic considerations, real-world impact. The new guidance has been confusing, it’s been frustrating to lots of health workers I’ve spoken to. With omicron, it does move faster through the population, through your system. You develop symptoms faster, generally by the third day—opposed to delta, which was more like four or five days. Earlier COVID variants took even longer. So it does move up this timeline. And yes, to make that change abruptly has left not only workers confused, but other folks in the government confused. CDC sometimes is making these decisions in ways that come as a surprise even to other senior officials.

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So is that a CDC problem, like they messed up their process? Or is this just how it goes sometimes?

I think CDC has stumbled over its communication for a couple years in this pandemic. During the Trump administration, they stumbled in part because the Trump administration kept stepping on what CDC was trying to do, trying to influence what CDC was saying. That was obviously bad. The Biden administration in many ways has overcorrected. They’ve tried to let CDC have such a free hand that, as a result, the White House keeps getting surprised because it’s letting CDC do its thing. There’s probably a happy medium that the government has not figured out yet.

The Mayo Clinic and a number of other hospitals took out a full-page ad in a newspaper, basically begging folks to get vaccinated and take precautions. Why did they feel the need to do that?

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So they took out an ad, hospitals in Cleveland took out an ad, hospitals in the Chicago, Wisconsin, area have taken out ads. This is not just a Minnesota thing. This is a real problem across the Midwest, where the delta variant appears to still be landing people in hospitals. And now omicron is layering on top of that a new wave of demand. Hospitals are putting off procedures. They are canceling scheduled surgeries. And this isn’t just in the Midwest, it’s around the country: If you’re an ambulance with an emergency patient, you might be shopping around trying to find a hospital that will take you, because so many beds are taken up right now. And also, so many workers at hospitals are having their own omicron infections. They’re not coming in to work.

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Some of the shortage fears are overblown. There was a claim that circulated last month in the Atlantic magazine and elsewhere that 1 in 5 health workers have quit the industry during the pandemic. That does not appear to be true. But even if just 1 in 25 workers has left over the past year and wasn’t replaced, that means more work for the remaining 24. And that gets more noticeable when you’re already burned out, when you’re swamped with new patients, and when four or five of your colleagues are out sick with omicron.

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It’s also the fact that people are just stretched, and that has its own impact on how well they’re able to care for patients.

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Oh, yeah. We don’t have a national report on total procedures delayed for reasons of COVID. That’s just not something that’s tracked. But it is clear that hospitals are dealing with real shortages—that data is shared. And the number of hospitals that are reporting a critical staff shortage to the federal government, that I believe is at its highest level of the pandemic, on par with where we were a year ago, which was seen as the worst part of the pandemic to this point.

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I’ve heard that scientists are now saying omicron could peak as soon as this month. How will we know that this latest surge is making a turn?

We’ll see it in the data. We’ve seen the huge explosion in omicron cases overseas, in South Africa. We then saw the U-turn where it very quickly began to fall, too. So hopefully we’ll see something like that in America. I’m a little pessimistic that it will be as fast, only in that the U.S., it’s so much bigger than South Africa. It’s so much bigger than the U.K. And even if omicron is hitting everywhere, it still is going to take longer to make its way through this country than it did in a smaller place like South Africa.

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I want to ask about whether scientists you’re talking to are talking about omicron as a way that a pandemic could end. This seems to be a virus that is taking over delta, yet milder. Maybe this is how a pandemic fades away, where the virus evolves enough that it becomes something that’s less of a threat. Are doctors you’re talking to thinking about it that way? Or do they not want to say that out loud?

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They’re thinking about it, and some are definitely saying it out loud. That is the hope, that this tough omicron wave is going to pass and leave us with more immunity across the population. Omicron is challenging us because of its mutations, and it is evading the antibodies that would have been able to latch on and block earlier forms of COVID. But it does appear that if you are infected with omicron, you are left with now more protection against whatever next variant comes, including potentially delta, this earlier variant. So that is the hope, that if it’s going to tear through the population, if some people are going to have serious symptoms but many people have relatively mild symptoms, now there’s this new coat of armor around the world.

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And this is not our first bout with coronavirus. There have been coronaviruses plaguing the world for years, but we know them as common colds. There is a theory that those coronaviruses that circulate the world now, maybe they were pandemic strains once upon a time, centuries ago, and humanity evolved to have enough immune protection that when you get infected with one of these old coronaviruses, you might feel lousy for a day or two. You might have the sniffles. But could that be where COVID eventually heads, if we have enough general immunity and we have other treatments to defang it? Absolutely. So that is still the hope above all hopes.

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I wonder if part of the reason you’re optimistic is because of where we are with treatments, like there are a number of treatments coming down the pipeline, including monoclonal antibodies that could protect people for maybe six months at a go, that seemed to be about ready to come out in the next few months. Does that also make you think, OK, maybe we’re getting some traction here?

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I’m excited about the new interventions. I also am cautious because they’re coming generally in short supply. So the one that folks are most excited about is this Pfizer antiviral. It’s called a game changer because it appears to keep lots of people out of the hospital when you give it early in the course of infection. The challenge is there’s not a lot of Pfizer pill to go around right now. Tens of thousands of doses were distributed across the country last month, at a time when millions of people are getting sick. It just takes a long time to ramp this stuff up. It’s not in January of 2022 unfortunately.

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