Hi,
It felt like a revelatory week for a lot of people. Not just in the numbers, but in the emotions and frame of mind.
As you've surely read, cases of SARS-CoV-2 infection are beyond surging. There's a "tidal wave" across the U.S., and hospitalizations are up 45 percent over last month, per Reuters. And perhaps it's because the waves are blanketing New York and DC that there's a particular sobriety in news media. An abstract academic understanding of omicron's transmissibility became concrete: everyone knows someone who's sick.
Lots of people seemed to accept, finally, that they are going to get infected with this virus. A few readers have surfaced a story I wrote in February of 2020 in The Atlantic with the headline "You're Likely to Get the Coronavirus." It posited that roughly 40 to 70 percent of the world would get infected. Which was a big claim at the time when there were a dozen or so known cases in the U.S.
If anything, in hindsight, that was understatement. The prediction was based on a basic model of herd immunity thresholds for a respiratory virus—but not one that managed to evolve and re-infect people as quickly as SARS-CoV-2 has. The model assumed that immunity would be more durable than it has proven to be, and that immune people wouldn't spread the virus. It also assumed that politicians wouldn't tell people bizarre lies like that there was no second wave, or devote themselves to fighting not the virus but the safety measures.
Even still, many dismissed the idea as hyperbole or fear-mongering back then. Which was always the opposite of what I tried to convey. And which is a problem because we really should be frank about what lies ahead, and what we're trying to accomplish here. It feels like now, finally, may be the time for that.
So: Yes. We’re all very likely getting infected by this virus at some point(s).
But infection is not the same as sickness. And not all sickness is the same, as you know. This disease can feel like almost nothing, or it can send you to the ICU for weeks, only to leave with permanent organ damage. The goal is to have more people's experience be as close as possible to the former.
Accepting that you're likely to get infected by this virus isn't the same thing as fatalism. It doesn't mean throwing up your hands and doing nothing. We’re also likely to get in car accidents at some point(s). That doesn’t mean we close our eyes and let go of the wheel.
The months ahead will see many thousands of preventable deaths in the U.S. They will often nominally be attributed to omicron. Most will more accurately be the result of people declining vaccination.
We are living in an ongoing tragedy whose scale is impossible to comprehend. Two years ago I couldn't bring myself to say aloud that a million people would die. Now the number, globally, is probably somewhere around 20 million. And the death toll far from captures the effects on the living.
At the same time, the emerging evidence on omicron seems to be reminding us that herd immunity is underway; it just isn't working as simply as many people expected. It's not so black-and-white as it would be if every person who'd been infected or vaccinated were 100-percent protected indefinitely. That's the perfect textbook model. But it's never exactly so simple. And this case is especially complicated, given the many ways this virus has evolved, many different levels of immunity across populations, and different ways the virus affects different groups.
Still, populations with high levels of vaccination will be less affected by omicron. Early evidence from South Africa suggests that omicron caused—on average—a "milder" disease than did prior strains, in that a surge in cases was not followed by a predictably overwhelming surge in hospitalizations and deaths. Part of that may be due to specific mutations in this strain; but part is certainly due to ambient levels of immune memory in the population. If that effect holds true elsewhere, we should be reminded that our preventive efforts do matter. We are effectively making this disease milder. We are beating this virus in ways not reflected by case numbers.
There are dark days ahead. But unlike last December, we have the tools we need. The rise of omicron is cause for anything but fatalism. It should serve to remind us that there is enormous purpose in continuing to make efforts to prevent transmission and minimize exposure. Every small act buys time to continue vaccinating people and building our collective protection, such that when we do get exposed to the virus, we're as prepared as possible. We might even hope that the strain(s) we encounter down the road are somewhat less deadly in themselves. As the health reporter Helen Branswell put it in an interview this week, "I think we all have a date with COVID at some point. I just want to make sure that mine occurs when I have enough immunity on board that it's just an inconvenience and not a serious health threat."
I've been trying to say the same, but she put it more eloquently than I probably yet have. Point being, this is an ongoing process of building protection and beating the virus as a group, not a binary for individuals. Small things matter, and can affect everyone else in endless ripples, or outright waves. Some experts posit that Omicron evolved in one immune-compromised person, whose infection may have been preventable by a single vaccine or one momentary decision. We do not know which individual case could cause the next global panic and disaster, nor which small act might prevent it. Those that do never make news.
If you're absorbing the ambient fatalism, direct any and all weariness, anger, and frustration at the systems that could have kept us safer; that should have and still could do things like help make rapid tests widely available; now could invoke the Defense Production Act to march in and take over the rights to Pfizer's new antiviral drug that the company claims will cut the chances of hospitalization or death by 89 percent but can't produce fast enough to meet this omicron tidal wave. And on and on.
In short, there's reason to care, and to keep doing your best. There is purpose in your efforts. They matter, and you matter.
Take care,
Jim
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