This post was written on November 27th, and last updated on Jan 4, based on information available at the time. I am linking to primary sources: virologists, epidemiologists, researchers.
I’d also recommend reading a great writeup of the current state (as of Dec 17) by Derek Lowe at Science.org. He links to primary sources.
This post is written in a question-and-answer (Q&A) format.
Caveat - I am not a doctor, virologist, epidemiologist, public health expert. I spend a lot of time listening to them, trying to make informed + thoughtful choices.
Q - How much faster does Omicron spread compared to Delta?
A - Best guess, 4-6X faster. So far, when it’s not the dominant strain, it doubles the number of people infected every 1.3-2 days. We know this from several different sources:
Omicron could be spreading faster due to being more transmissible, and/or being able to evade antibodies (immune escape). We don’t know which yet. Dr. Trevor Bedford goes into detail about this.
This leads to truly crazy spread, like 1 in 10 people in London having Covid on December 19th
Q - What will this winter (winter 2021->2022) wave look like?
A - Best guess, this could be the biggest wave yet. An IHME model](https://www.healthdata.org/covid/video/insights-ihmes-latest-covid-19-model-run) projects more COVID-19 cases in the next 60-90 days than there have been in the last 2 years combined, over 3 billion.
This will put immense strain on already stressed/breaking health care systems. If there was ever a time to ‘flatten the curve’, it is now.
Q - Why does Omicron spread faster?
Recall that the original Covid strain was confusing, because most people weren’t highly contagious. So the spread was mostly due to a small percentage of super-spreaders.
Omicron appears to have a large percentage of super-spreaders.
Q - What does it mean if my city/county has ‘high’ transmission? What’s the practical difference between 100 cases per 100K people and 1000 cases per 100K people (over 14 days)?
A - The short version? The higher the number, the higher the chance of your friends & family getting infected, all else being equal.
For example, the difference between 100 cases/100K and 1000 cases/100K is that in the latter, you are 10 times more likely to get infected doing the same things. That means your risk at the grocery store, in the office, at a restaurant, is ten times higher than it would be otherwise. The odds are 10 tens worse.
The other factor to consider is the ‘attack rate’, a.k.a the test positivity ratio. If more than 5% of tests are coming back positive, that means the spread is even higher than the case numbers indicate, because there’s not enough testing going on.
To measure your personal risk, I’d recommend a risk calculator. The best one I’ve found is microCOVID. A ‘micro-covid’ is a 1-in-a-million chance of getting infected with Covid-19.
Q - If I’m exposed to Covid, how long before I test positive? How long before I’m infectious?
Based on that knowledge, the best time to get tested for Covid is 48-72 hours after exposure (if you know you’re exposed).
Q - Will Omicron cause worse symptoms than Delta? A higher fatality rate?
A - The latest study finds Omicron isn’t quite as severe as Delta. However, there are some things that make that number misleading (Simpson’s paradox, if you’re curious)
Worse, Omicron is far more transmissible. That will cause higher fatality rates. It will strain hospitals even further. Hospital staff will have to do triage, give less care per person. A higher fatality rate becomes inevitable.
The fact that ‘most cases are mild’ doesn’t mean much because that’s true of all Covid variants so far. When a small percentage of a large population gets sick, the numbers are still large.
Oh, and the idea that viruses become less deadly over time? It’s a myth.
Q - What is Omicron going to do to the number of hospitalized patients?
A - Bad news. It depends on three things: a) how many people get infected at once, b) how severe their cases are, and c) how quickly their cases become severe.
A) We already know Omicron is far more transmissible, so a lot of people are getting infected all at once.
B) The latest studies show Omicron cases become just as severe as Delta.
Q - How will we know if our local hospitals are getting full?
A - There are several ways. One indicator is when hospitals cancel/suspend elective surgeries, like the UW on January 1.
Another is when you see reports of hospitals going on ‘diversion’, meaning they can’t accept ambulance patients. What’s worse is when multiple hospitals go on diversion, meaning patients in ambulances have to be driven farther, or sent to beyond-capacity ERs.
Long waiting times in the ER are another clue.
You can look at the number of available ICU beds, though that data may be a little old/out of date.
Q - Will rapid tests & PCR tests detect Omicron?
FYI, 3 PCR tests don’t work for Omicron, meaning they return a negative result even if you’re positive. However, by this point I expect they’re mostly not used.
Q - I’m vaccinated. Can I catch Covid from the Omicron variant? Can I pass it along to others?
A - Yes, you can catch Covid from Omicron, and you can pass it along to others. This was true even with Delta, and Omicron is even better at evading your antibodies.
Remember, Covid is an airborne disease. The 6-foot-distance rule is less useful now than it was before.
There is one report (from Hong Kong) showing vaccinated people (two doses of Pfizer) can get Omicron, and with relatively high viral loads. One person (from S Africa) infected another (from Canada) who was in an adjacent hotel room. This is clearly airborne transmission (no surprise there).
There are also reports of fully vaccinated (3 doses) people transmitting it to other 3 dose people, in Israel.
Q - I’m fully vaccinated (but not boosted). What’s my risk of getting sick (symptomatic) from the Omicron variant? What’s my risk of severe disease (hospitalization) or dying?
A - Bad news. 2 doses of Pfizer gives you 34-36% protection against symptomatic Covid for the first 15 weeks. That’s not great. AstraZeneca is worse (5.9%).
The latest research shows 2 doses of Moderna gives you better protection against Omicron than Pfizer protection. However, we don’t have a % number. I would guess Moderna is in the 40% rang, but I have no data for that.
Your protection against severe disease (hospitalization) and death is about 70% with 2 doses of Pfizer, and somewhat higher than that with Moderna.
Q - I’m fully vaccinated and boosted. What’s my risk of getting sick (symptomatic) from the Omicron variant? What’s my risk of severe disease (hospitalization) or dying?
A - Good(ish) news. With 2 doses of Pfizer + booster, you are 76% protected against getting symptomatic Omicron. Your protection against severe disease will be higher, but the numbers aren’t known yet.
3 doses of Moderna (2 + booster) gives you better protection than that. A study found 3x Moderna (boosted) had 6.5X lower antibodies against Omicron than 2x Moderna against Delta.
J&J, Sputnik, Sinopharm, and Convalescent plasma have effectivity of basically 0% - they don’t protect you at all.
Q - How long does booster efficacy last?
A - We don’t know for sure yet. 15 weeks (~4 months) at least seems likely, but a lot more research is needed here.
Some countries aren’t taking chances. Israel is moving towards giving high-risk people a 4th dose.
Q - What does a drop in antibody effectiveness mean for a greater risk of getting sick from Omicron?
A - That’s simple question with a complex answer. We don’t know yet. The studies being done right now (like the one above, by the Sigal Lab) looks at neutralizing antibodies, which are an important part of the human immune response, but it’s not the only thing.
Also important is the T-cell antibody response, which is much harder to study. I need to learn about CD8 and CD4 T-cells, which are apparently the relevant types.
Our best bet is to look at the spread of Omicron in a population, and see how people respond to its spread. That means our best information is going to come from South Africa, with its current Omicron wave and excellent public health system. Here’s an example, looking at preliminary Omicron impacts on the Tshwane District.
Q - What does a ‘mild’ case of Covid/Omicron look like?
A - Good question. The definition of ‘mild’ in the US means ‘not admitted to a hospital’. That can include pretty bad symptoms, including: emps up to 103, severe shaking racking chills, sweating enough to soak the sheets 1-2 times daily, severe coughing, vomiting their guts up, severe myalgias.
Q - What about Long Covid?
Among other things, a Covid infection can lead to long-lasting neurological damage, and can linger all over the body for months. It’s also quite common.
I’ve heard that being vaccinated reduces your risk of long covid, but I haven’t found the relevant studies yet. So for now I’m treating that as conjecture.
This is just as frightening as hospitalization to me. I’m boosted, so I’m not likely to end up in the hospital. I don’t know my risk of getting long covid.
Q - I previously caught COVID-19 and recovered from it. Am I immune to Omicron?
A - NO. Omicron is re-infecting people who are unvaccinated but have recovered from COVID-19. This includes people who have recovered from Delta. Some people are getting infected by Delta & Omicron at the same time.
Get vaccinated and boosted. Your disease-acquired antibodies provide little protection.
This is conclusive proof that the idea of ‘letting people get sick to achieve herd immunity’ won’t work, in addition to being highly unethical.
Q - What should I do if I test positive for Covid?
A - Several things.
Q - What should I do if a friend / family member / close contact has Covid?
A - Have you shared indoor air with them in the 4-5 days before they tested positive, or first had symptoms? If so, you’ve been ‘exposed’ and should quarantine.
Also, keep in mind your friend/family/contact is going to need support. Try and help them get it from other, non-quarantined people.
If they live with you (if you share air with them), read this, make a plan, and quarantine.
Q - What treatments exist if I get sick with Covid?
A - There aren’t as many as we’d hope. Pfizer’s new Paxlovid drug, a protease inhibitor, seems to do well. It was approved for use in the US (an EUA) on Dec 22. However, we won’t have enough supply to do much for the Omicron wave.
Many monoclonal antibody treatments don’t work against Omicron. Sotrovimab, from Vir/GSK, appears to be the exception. Note that it was designed to be a last resort against variants, and it was designed partially based on SARS-CoV-1 (the original SARS).
There is a new COVID-19 vaccine, SpFN, developed by Walter Reed, that apparently works against Omicron and all other variants. It just finished up a phase 1 clinical trial to prove efficacy. Given that phase 2 & 3 trials haven’t started, it’ll likely be 6-8 months minimum before it could get an EUA & thus be given to people.
The WHO page on therapeutics lists other known-good treatments, including certain monoclonal antibodies, IL-6 recepter blockers, and systemic corticosteroids. This depends on how severe your case is.
Q - How can I protect myself from Omicron?
A - There are several things you can do. Since no one step is perfect, I recommend doing multiple things: less shared air, masks, vaccines/boosting, reducing exposure, and prophylactic measures.
Less shared air
Vaccines + Boosting
Q - It’s been less than 6 months since I had my 2nd dose of Pfizer/Moderna. Can I get a booster? Is it safe? Will it help?
Personally, I would get boosted if it’s been 3+ months since my second dose. I’d be willing to deceive a vaccine clinic/doc to do that. Thankfully I didn’t have to.
Q - I have kids in school. What can I do to protect them, and myself, from getting Covid-Omicron?
A - Wear masks, and add ventilation to the schools. There’s a great Swiss study showing how better ventilation reduces kids+teachers’ risk of getting Covid.
Band together with other parents, your PTA, if you need to. Find some like-minded parents and build CR (Corsi-Rosenthal) boxes for all of the classrooms in your kids’ school.
Pediatric hospitalizations are at an all-time high.
More practically, prepare for your school to shut down with little notice. The level of spread is so high that large numbers of schools will have no choice but to close.
Q - I want to see loved ones this winter, and it’s too cold/wet/miserable outside. What can I do?
A - There are several things you can do. Since no one step is perfect, you need to do several things.
The World Health Network made a great guide for steps you can take to have a safe holiday.
Until there’s solid data on the impact of Omicron against vaccine-induced immunity, I am reducing my risk of potential exposure:
Q - What relevant lessons were learned earlier in this pandemic, and previous ones?
Q - What do we see about antibody level drops
We’re starting to get some useful lab data now. For blood from Pfizer-vaccinated people, an initial study shows a 41x (!) drop in antibodies against Omicron, from 1321 to 32. The study was done by the Sigal Lab - here’s their site & the associated paper.
Pfizer reports a 25x drop in antibodies…but they put out a press release, not a scientific paper, and not the data+methodology. I’ve spoken to a couple of virologists, and they’re pretty annoyed; this is the sort of thing that makes sensational headlines but obfuscates the underlying research. We don’t need more of that.
However, a 41x drop in neutralizing antibodies doesn’t mean the vaccine is 41x less effective. There’s more to a human’s immune response than neutralizing antibodies alone. For example, T-cells play an important role.
Moderna’s CEO suggests (without numbers) current-generation vaccines may not be as effective against Omicron. They’re planning on having updated vaccines in spring/summer.
Q - Is the Omicron variant in the United States right now?
A - Yes, all over the place. The first documented case was on a traveler who arrived in San Francisco on November 22 from South Africa. More cases have been found in NYC and Minnesota. The Minnesota case is domestic spread, from someone who went to the Anime NYC 2021 at the Javits Center, between November 19-21. That event had 53K attendees.
We’re seeing evidence of community transmission around November 20th. It has been circulating since before Thanksgiving.
Cases were identified in western Washington on Dec 4, for people who tested positive on November 29th.
The countries that have found Omicron cases (South Africa, Denmark, UK, Hong Kong, Israel) have highly competent quarantine + monitoring programs. They’re not unlucky, they’re the ones looking. It is everywhere already. Cases have been found in many other countries, including Australia, Austria, Germany, Brazil, the Czech Republic, and more.
Q - Will travel bans help?
A - At this point, they’re largely useless.
They can only buy time in the early stages, if done correctly. That ship has sailed.
Country-specific travel bans are useless. There are cases from people who haven’t been in sub-Saharan Africa, meaning it’s too late. You’d have to do what Israel just did, isolate from the world for a time.
Q - What’s happening with the push for at-home testing?
A - The idea is pretty simple; if tests were cheap ($1) or free, people could test themselves & their families more easily. At that point you can test everyone you meet socially, easily. It would be a good way for people to slow down transmission.
One downside - home test results usually aren’t reported to public health agencies, so published case numbers would become inaccurate.
Q - Are you scared?
A - Now and then. It helps to find primary sources and think through the implications. This isn’t the end of the world. We know a lot more, individually + collectively, than we did in March 2020.
Q - Does Omicron spread faster than Delta?
A - Yes, it spreads faster. We know this from many different sources:
Each year I make a plan. This year is off to a challenging, unstable start. Here are themes I see in society; each relates to the other in complex ways. I’ll mostly be talking about the United States, because it’s what I know best.
Let’s start with what Americans always do: money.
The 400 richest Americans have more wealth than the bottom 50%, 165 million people.
Society is becoming more competitive. Many industries are becoming monopolies or monopsonies, “winner take most”.
Lately, we’ve been talking about the immense power of tech companies and their lack of oversight. Another topic is the deadly impact of consolidated pharmaceutical companies. Oh, and larger companies are more likely to engage in fraud.
“It is difficult to get a person to understand something, when their salary depends on them not understanding it.” - Upton Sinclair
Incentives drive behavior. People are predictable when I think about their incentives. Morals don’t do that much. We are all skillful at rationalizing our behavior. No one sees themselves the villain, no matter what they do.
College students know a degree is more important to a middle-class lifestyle than knowledge. Cheating is becoming more widespread.
Insurance companies seek profit, and profit more if they pay fewer claims. They create barriers for the insured to get health care, car maintenance, home repairs. It’s telling that the “The percentage of insurance premiums we pay to peoples’ claims” is called the loss ratio.
Campaign money is critical to staying in power, so politicians reward donors.
Modern capitalism and politics: “Might makes right. Deny it”.
For 99.999% of us, this is bad. Higher minimum wages lead to lower suicide rates. Giving people money is better for mental health than therapy. Poverty hurts. Giving the homeless shelter is cheaper and better than dealing with the consequences of rough sleeping.
Inequality leads to more crime and low trust. There’s little reason to believe in fairness or justice when you’re living its absence. Social class shapes your behavior and worldview. Mistrust has a high price.
Heck, the secure, working-class lifestyle from “The Simpsons” is a fantasy now.
We are able to do amazing things, but not the basics. I call it “competence inequality”. A focused, small group of people can make staggering breakthroughs.
But widespread, basic competence? Delays, mismanagement, chaos.
“Government IT project fails, is over budget, and poorly designed”. This is so common a headline I don’t notice anymore. We need digital public infrastructure more than ever. And I don’t mean no-bid contracts to companies to build broken websites like VAMS for vaccines. The US federal government is more corrupt than it was in 2015.
Neoliberalism and “public-private partnerships” are code for “worse outcomes that cost more”.
The US would have far fewer COVID-19 hospitalizations and deaths if it built good systems. Effective technologists can build systems for contact tracing, unemployment benefits, and vaccine distribution. Other countries have done just that.
If anyone remembers the Affordable Care Act rollout, this isn’t surprising. Government systems keep doing the same thing. They don’t change with the times.
It doesn’t have to be this way.
“Might makes right. Deny it”.
Every large company/organization I’ve encountered obsesses over appearances, “Optics”. The facts are often inconvenient, embarrassing, or lead liability. Companies put out carefully worded statements to mollify their critics, and to make you think they care. Anything to avoid saying the quiet part out loud.
It’s stylized nonsense. The average person reads these and knows something is hidden, but not what.
Spin is about lying and deception, but somehow we all pretend it isn’t.
Let’s look at an example: the Boeing 737 Max. The root cause of the crash was the push for short-term profit. That pressure led to questionable design decisions, ethical failures, faulty software development, and compromised FAA regulators.
Since the two crashes, Boeing has a credibility problem. After the crashes and grounding, Boeing was still pushing to weaken safety testing, fire inspectors, minimize fixes, and outsource training pilots.
The public doesn’t believe what Boeing says about safety, because they’ve said it before.
Boeing can do one thing to convince people the 737 MAX is safe to fly. Promise that all of Boeing leadership will fly only on the 737 MAX for a year. All corporate executives at Boeing, and all managers at Boeing Commercial Airplanes.
I doubt it will happen. “We bet your life” is the company line when oligarchy meets rentier capitalism…
“Improvement Means Deterioration” - Hutber’s Law
“Rent-seeking behavior”: seeking to monopolize access to any kind of property, to extract profits without contributing to society.
“Crapification”: when everything becomes flawed, impermanent, and brittle.
I see this in 3 ways:
The rise of financial over industrial capitalism leads to…
We live in an age of expanding surveillance and vanishing privacy. Surveillance is so pervasive that undercover agents can’t hide. Recent events reinforce trends to increase surveillance. The remaining restrictions aren’t restrictions. Companies & agencies can buy location and license-plate tracking data.
Social media incentives encourage collection of horrifying amounts of personal information.
There’s no way to keep your information completely private, but there are ways to minimize your exposure. You can do gain a lot of privacy for less than $5/month, but you need to be technically savvy.
The best way to keep people hooked: feed them extreme, polarizing information. Algorithms that reward polarization are sowing division for profit. Social media companies are conflicted. They peddle lip service about removing/hiding toxic groups while funneling users to new ones. Madness ensues: ads for military gear showing up alongside groups organizing Capitol riots, thus rewarding extremist views. Social media companies have carefully minimized their role in the January 6 riots. The role of venture capital pushing a “engagement at any cost” model is even less well known.
The incentives of social media companies are ‘more attention = more money’. This leads to algorithms that prioritize attention (‘engagement’) above all else. This became so troubling that investors got scared, and that led to quick change.
I went looking for systemic causes of polarization and found one: winner-take-all voting. “A simple-majority single-ballot system favors the two-party system” - Duverger’s Law. Do you want more complex thought, less polarization, and more discussion? You need proportional representation.
Functional society needs the ‘paradox of tolerance’. It’s an old idea:
“We are not enemies, but friends. We must not be enemies. Though passion may have strained, it must not break our bonds of affection.” - Abraham Lincoln’s 1st Inaugural Address.
And yet, now people in powerful positions advocate for political violence, deceit, and broken elections. Other powerful people pretend to ignore them.
“All that is necessary for evil to succeed is that good people do nothing.” - Edmund Burke
People want power for many reasons: security, safety, or because their parents didn’t love them.
In the US, this often shows up as greed, a lust for money. The traits you need to become rich are psychopathic. This isn’t surprising: “I’ll fire people to bump up stock prices” and “I care about others” are contradictory.
Society exists so people can survive in large groups. Humans have needs. Beyond physical needs, we crave safety, security, and to belong.
Our social orientation around individualism doesn’t help.
We are in an epidemic of loneliness and instability. A huge number of people face a future with little chance of love, stability, or a sense of purpose. It’s creating another epidemic, despair. Given the history of drug use and addiction, that’s the root cause of the opioid crisis.
Loneliness is extremism fuel, and so this is a systemic problem.
These trends lead to division, manifesting as racism and sexism.
Police react more to left-wing protests than right-wing ones, often with violent tactics. The leadership of the Capitol Police failed days before January 6th, putting line officers in an untenable position. The plans for the January 6th insurrection were public months in the making, as white supremacists find each other online. It’s not a normal protest movement, and it’s not going away.
How do we as a society end racism & white supremacy without making things worse, causing a backlash, encouraging extremists to organize, polarize society further, or give domestic surveillance the same legal carte blance we did for foreign surveillance after 9/11?
The pandemic and sexism are leading to shocking numbers of women dropping out of the labor force. Domestic violence is on the rise, often a precursor to wide-scale violence.
This, at a time when women’s influence is growing.
Just when you thought you’ve had enough good news, there’s a pandemic going on…
Given the state of the United States before the COVID-19 pandemic broke out, what’s happened since January 2020 was predictable.
Given the precarious nature of most people’s finances, of course there is spread. There isn’t enough government/business support for people to stay home when they’re sick, or taking care of sick loved ones.
Given the political power of the affluent, an effective way to reduce COVID-19 spread isn’t talked about:
eviction and utility shut-off bans:
Study finds that uniform moratoria on evictions and utility shutoffs through November of last year could have saved 164,000 lives lost to COVID-19. “If real, that would make reducing housing precarity easily the best public health measure we’ve got.”
Given that ‘reopening’ decisions were done for political reasons (open bars, restaurants) rather than public safety (open parks, outdoor schooling), ‘reopening’ is inevitably followed by a spike in cases. States don’t follow the best available science. They’re losing their top health officials.
Given the incentives to polarize anything for profit, basic measures like mask-wearing have become politicized. Other policies (hand washing, social distancing) don’t have that divide. Effective policies like ventilation aren’t even talked about.
Given the disinformation and uneven competence of large institutions, we don’t have widespread access to better masks.
Given the every-country-for-itself approach to pandemic policies, vaccines are wrapped up in nationalism, even when it’s counterproductive for everyone.
Finally, we get to the elephant in the room: climate change.
Human-caused climate change destabilizes everything. You read about this in economic terms, because the established order revolves around money. For example, consumerism, a manufactured trend, is unsustainable.
Even ‘responsible’ companies like Apple have incentives countering sustainability. Easy-to-repair devices are more sustainable, but less profitable. Movements like the Right to Repair are good for your wallet and climate change.
A lot of the US may be uninhabitable by 2050, to say nothing of the rest of the world. Heat waves, wildfire, water shortages, sea-level rise, famine…it’s getting worse. Climate-change induced migration may destabilize entire regions; it’s happened before.
I learned to “expect the worst and hope for the best”. We are doing the opposite as a civilization.
Here are truisms I live by: