Market wraps were awash with “Omicron optimism” Thursday.
The body of evidence to support the contention that the variant causes less severe disease is growing. Three studies now suggest the risk of hospitalization is materially lower for Omicron, although research also continues to show an elevated risk of reinfection and breakthrough infection.
“[E]arly national data suggest that Omicron is associated with a two-thirds reduction in the risk of COVID-19 hospitalization when compared to Delta,” researchers in Scotland wrote, in a working paper published Wednesday. “Whilst offering the greatest protection against Delta, the third/booster dose of vaccination offers substantial additional protection against the risk of symptomatic COVID-19 for Omicron,” the same paper said.
Similarly, an Imperial College London report said estimates “suggest that Omicron cases have, on average, a 15-20% reduced risk of any hospitalization and an approximately 40-45% reduced risk of a hospitalization resulting in a stay of one or more nights.” Further, the study noted that “reinfection is associated with approximately a 50-60% reduction in hospitalization risk compared with primary infections.”
Those findings appear to confirm the results of a study in South Africa, which suggested Omicron was associated with a 70% reduction in the chances of severe disease development and an 80% decrease in the likelihood of hospitalization. The research contained the usual caveat associated with studies conducted in the country. “Some of this reduction is likely a result of high population immunity,” the paper said.
As ever, I encourage those interested to read the study abstracts for themselves. That’s why I provide links, and also why I lean more heavily on direct quotes when documenting COVID research as opposed to paraphrasing and editorializing.
With those obligatory caveats, I think it’s fair to say that one doesn’t have to be an infectious disease expert to come to the conclusion that preliminary reports suggesting Omicron is associated with less severe disease have proven to be at least a semblance of accurate. The problem, of course, is that the combination of higher transmissibility and vaccine hesitancy could still mean strained health care systems. You don’t have to be a virologist to come to that conclusion either, but just in case, Anthony Fauci summed it up in a few simple words. “The fact that you have so many more cases might actually obviate the effect of it being less severe,” he said Wednesday. Assuming you know what “obviate” means, you’re in a pretty good position to understand why the variant is still concerning.
For markets, though, the combination of reduced severity and relatively upbeat news on the effectiveness of booster shots is… well, it’s a shot in the arm. Although it’s somewhat disconcerting that three doses of Sinovac’s widely-distributed vaccine don’t appear sufficient to produce adequate levels of neutralizing antibodies against Omicron, boosters from Western vaccines are generally effective at guarding against severe disease, despite the elevated risk of breakthrough infection.
On Thursday, AstraZeneca said antibodies against Omicron following a third-dose booster were higher compared to those found in individuals previously infected and naturally recovered from the virus. “It is very encouraging to see that current vaccines have the potential to protect against Omicron following a third-dose booster,” John Bell, a professor of medicine at Oxford and a study investigator said, adding that the “results support the use of third-dose boosters as part of national vaccine strategies, especially to limit the spread of variants of concern, including Omicron.”
Additionally, AstraZeneca said its long-acting antibody combination for the prevention of COVID retained neutralization activity against Omicron in “new authentic ‘live’ virus neutralization data.”
When taken in conjunction with FDA authorization for Pfizer’s Paxlovid (the oral treatment for mild-to-moderate cases in individuals assessed to be at high risk for developing severe disease), the public health outlook for the Omicron wave looks nothing like the situation witnessed in March of 2020.
Obviously, that’s not to suggest the new wave won’t lead to soaring cases and overburdened hospitals. It already has. Nor is to suggest that restrictions and various containment protocols won’t serve as a drag on growth. Again, they already have. Finally, I’m not suggesting Omicron won’t exacerbate inflation by prolonging supply chain disruptions and adding to the labor market frictions pushing up wages.
Rather, the point is that the cautious optimism voiced by some two weeks back does appear warranted, notwithstanding the self-evident fact that disease and, more to the point, suffering, are everywhere and always lamentable, irrespective of the severity or cause.
Relatedly, but more broadly, I encourage folks to remember that if you’re a sentient being able to live your life largely free of suffering, that makes you an anomaly in a world which, in so many ways, is defined by suffering.
Perfect summation. Nothing is peer reviewed yet but it’s going to be impossible to really have clear ideas when everything is such a mishmash of previously infected, partially vaccinated, vaccinated, vaccinated and booster.
As odd as it is for me to think this way. I have Moderna and Moderna booster four weeks ago. I had bloodwork two weeks ago that showed my immune response is very good. Breathing in some Omni may actually do me a bit of good. But alas, a breath of Delta may do me very bad.
Apples-to-apples (i.e. comparing persons of similar vulneraibiltiy) Omicron appears less likely to result in hospitalization, supplO2, death than Delta. It is unclear how much less likely. It is also unclear why that is, but some hints that Omicron may replicate faster in upper respiratory tissue and slower in lung tissue (in vitro).
In actual populations, Omicron is attacking countries that are less vulnerable than Delta found them. Higher vaccination rates and higher prior Covid rates mean the average person has more protection against severe disease, if not against asymptomatic or mild disease.
Combine these two and you get the reduced hospitalization rates H refers to. But a smaller hosp % of a larger number of cases can be an equivalent or larger number of hosp.
What we are actually seeing in DM countries is very early and I am not sure a clear pattern is emerging. In Netherlands, Germany, Denmark, new hosp are either approaching, or have approached, prior peak levels. In UK, new hosp is still well below prior peak (although SE England #s are starting to pick up momentum). If there is a possible pattern, it may have to do with prior infection rate + vax rate, the inverse of which is the number of “naive” wholly unprotected persons. The hypothesis is that where % naive is low, large case numbers will result in moderate hosp #s.
In the US, the big surge so far is in the NorthEast e.g. New York, which must have the lowest % naive in the country. So we may see only moderate hosp #s in the NorthEast. Extrapolating that to other parts of the country is likely unjustified.
On the therapeutics from Pfizer, Merck, and GSK/Vir, I think those are immaterial unless you are very lucky – or a VIP. The supply right now is miniscule and will likely remain so through the Omicron surge.
Final thought, for most of us – vaccinated and boosted – the economic disruption of Omicron is far more important than the health risk. As long as confirmed infections require quarantine / off-work and businesses / people change behavior in response to virus threats, case count remains an economically relevant metric. And I see few grounds for cheer there.
“if you’re a sentient being able to live your life largely free of suffering, that makes you an anomaly in a world which, in so many ways, is defined by suffering.” As always, appreciate your putting things in perspective.