Is Omicron Showing Us the Path Ahead?

The Omicron variant of the COVID-19 virus is wreaking havoc around the world. In South Africa, where it was first identified, it resulted in an unprecedented surge in the number of cases. The travel bans that soon followed against several Southern African countries were futile gestures, as the new variant was undoubtedly already circulating in the countries that rushed to put the bans in place. This quickly became clear as surges in cases were noted in several European countries and in the United States, resulting in case numbers never seen before.^[1] As they did during the initial surges, health systems across the globe fell quickly under enormous stress. In the case of the Omicron variant, this is mostly because of the large number of health providers who had to either isolate because of infection or quarantine after COVID-19 exposure rather than because of a higher risk of severe disease.^[2,3] Similarly, high worker absenteeism has affected organizations and businesses, undermining already weakened economies around the world.

Yet, despite the tremendous challenges it is presenting, the Omicron variant may actually be paving a new path toward coexistence with COVID-19.

With the Omicron variant, COVID-19 offers an interesting combination. Evidence thus far suggests that the variant is highly transmissible and that progression from exposure to infection is faster than with other variants.^[4,5] These characteristics have driven the extraordinarily rapid increase in the number of new cases. At the same time, although infections among vaccinated people have been noted quite frequently, these tend to be asymptomatic or to produce largely mild symptoms.^[6] Consequently, a disconnect between the large number of COVID-19 cases and a disproportionately lower number of hospitalizations has become apparent. Even among those who are hospitalized, the severity of illness is notably less than what we saw in earlier surges, with less likelihood of requiring intensive care or ventilatory support. Most importantly, the data show that our vaccines continue to prevent severe illness and hospitalization during the Omicron variant surge (https://bit.ly/3K9GdJM). At the same time, it would help to better understand these issues if data on hospitalizations, intensive care unit admissions, and deaths were disaggregated by whether patients were admitted because of COVID-19–related signs and symptoms or because they had incidental COVID-19 identified through screening tests administered on admission.

Thus, despite the fear and turmoil caused by the Omicron variant, there may be a silver lining. For most of those who are fortunate enough to have access to vaccines, contracting the Omicron variant of COVID-19 may result in a mild illness. The availability of new antiviral treatments for COVID-19 that have been shown to prevent severe illness and death also offers a new reason for optimism.^[7,8] These facts point to a new reality and, potentially, a new understanding of what COVID-19 means for us. The Omicron variant may help us arrive at a level of comfort in living with the virus and an acceptance of the fact that there will not be a time anytime soon when COVID-19 is completely behind us. As we head into the third year of the pandemic, we may be ready to accept the fact that getting infected with the Omicron variant is highly likely but that in all likelihood this will not result in severe disease as long as we are vaccinated and have received a booster dose. Knowing this may mean that the fear that has paralyzed so many over the past two years will diminish sharply.

How will this new understanding affect our response to the pandemic? For one thing, case numbers will have less significance, even while infected individuals may need care and require medical attention from the health care system. The focus on counting cases should give way to giving more attention to monitoring COVID-19–related severe illness, hospitalizations, intensive care admissions, and deaths. The high transmissibility, the short incubation period, and the mild symptoms will make efforts to identify every case and all possible contacts unfeasible and of limited effectiveness.^[9,10] Contact-tracing programs, which have heroically sought to contact and support all persons with COVID-19 and their close contacts, will need to be transformed to deliver on a no less important effort—supporting those with substantial symptoms of COVID-19 or those at risk for complications by promptly guiding them to available treatment to prevent severe illness. With regards to testing efforts, we will need to shift our focus to prioritize pursuing a diagnosis among those who are ill and those who are most vulnerable to complications of COVID-19, particularly immunosuppressed individuals. Public health messaging will also need adjustment, focusing on a simple message for those who suspect infection or have tested positive, are vaccinated, and have no risk factors: mask up, avoid crowds, and suspend contact with vulnerable individuals.

But, before we can truly go down this road, we must acknowledge that vaccines are the game changers. This new reality motivated by the emergence of the Omicron variant is relevant only for those who are fortunate enough to have access to effective COVID-19 vaccines and booster doses. For much of the world, access to vaccines remains an elusive goal. Billions of people have yet to access a single dose of a COVID-19 vaccine.^[11] It is likely that, unfortunately, this disparity will extend to access to new antiviral drugs. This means that not only will tremendous swaths of humanity remain susceptible—needlessly so—to more severe disease, death, and all the social and economic hardships these cause, but also we will all remain vulnerable to new emerging variants. And that next variant may not be nearly as favorable as the Omicron variant.

The road map to a new COVID-19 reality is drawn. The critical question is, are we ready to follow it and embrace this new reality?