How gentle is Omicron really?

For weeks, the buzzword on Omicron in much of America has been a form of phew. A flurry of reports encouraged a relatively rosy view of the variant, compared to some of its predecessors. Omicron seems to be somewhat lung-sparing. Infected laboratory mice and hamsters seem to fight it off easily. Proportionally fewer people who catch it end up in hospital or die. All of this allowed a deceptively reassuring narrative to take root and grow: Omicron is soft. The variant is docile, harmless, causes a #Omicold it’s no worse than a temporary flu. It’s so insignificant, some say, that the world should just “allow this mild infection to circulate”, and to avoid slow the spread. Omicron, as Senator Rand Paul of Kentucky would have you believe, is “basically nature’s vaccine.”

These rejections of the variant as insignificant — desirable, even — represent “a very dangerous attitude,” Akiko Iwasaki, an immunologist at Yale, told me. At the heart of the problem is the word Benign itself, a slippery, pernicious term that “doesn’t mean what people think it means,” Neil Lewis, a behavioral scientist at Cornell, told me. Less severe forms of COVID-19 can certainly be experienced by individuals, especially if they are vaccinated. And there’s real reason to think that Omicron, particle for particle, might be less tooth-rich than Delta. But the unfettered spread of Omicron has sown a situation that is not at all forgiving. And right now, the notion of candy makes the pandemic worse for everyone.

Much of our Omicron problem can be attributed to a false binary: that the variant is less danger is too often misinterpreted because the variant is not at all a danger. Severity works by degrees, that is indeed what we see. On a per capita basis, Omicron seems less likely than Delta to hospitalize or kill the people it infects. In South Africa, one of the first countries to be hit by the variant, cases have already reached a record high, but hospitalizations, intensive care unit admissions and deaths remain well below wave highs. previous; infections also appear to be dissociating from severe disease in parts of continental Europe. Even in the United States, where the pandemic is as severe as it has ever been, early data points to a weakening in the propensity for Omicron cases to become severe.

It is tempting to attribute all of this to the virus, but that would be too simplistic. Disease is always manifested by an interaction between the pathogen and the host, which means that there are two main reasons why Omicron cases may have milder symptoms: a more resilient human or a more docile microbe. In this current surge, we are likely seeing the two effects collide.

The first part of the equation concerns us entirely. Two years into a pandemic that has left hundreds of millions of people with known infections and prompted billions to sign up for vaccines, Omicron is coming up against populations that are better defended than ever. In the UK, where more than 80% of people over the age of 12 are at least doubly vaccinated, the injections clearly reduce the risk of hospitalization in people infected with Omicron, particularly in boosted people. A high number of previous infections from past COVID outbreaks may have had a similar calming effect in South Africa, where the average age of the population is also very young, and therefore better armed against severe COVID-19.

The second part of the equation – the inherent power of the virus itself – unfortunately becomes more difficult to analyze when the world is more immune, Roby Bhattacharyya, a microbiologist and infectious disease physician at Massachusetts General Hospital in Boston, told me. Yet even people not vaccinated with Omicron seem less likely to end up in hospital, intensive care or on ventilators. Laboratory rodents infected with Omicron do not appear to get sick either, possibly because the new variant is less able than Delta to colonize the lungs, where the wildfire-like inflammation of severe respiratory disease s often inflames. Similarly, researchers are finding that Omicron doesn’t like infecting human tissue extracted from the lung and may prefer to cloister itself in higher sites like the throat, Ravindra Gupta, a virologist at the University of Cambridge, told me. What happens in a rodent or a plastic dish cannot sum up what happens in a human body. But Iwasaki still thinks “there’s something inherently less virulent about Omicron.”

So it’s fair to say that the average case of Omicron is indeed “less severe”. And there are many people for whom the calculations will work well. They are young, healthy hosts up to date on their vaccines, taking on a pathogen that packs a bit weaker punch, at least compared to Delta. Keep in mind, though, that Delta is probably nastier than its already awful ancestors, so simply calling the virus “mild” massively understates the danger it still poses, especially when it ends up in people not vaccinated or vaccinated, but still. vulnerable hosts. Even people who have been vaccinated three times cannot escape the risk of Omicron, especially not when cases are increasing at such a high rate and exposures are so frequent and heavy.

The variant offers a harsh lesson in multiplication: so many people have been infected that a relatively small percentage of medically severe cases have yet erupted into absolutely staggering numbers. In the United States, where most of the population has at least one risk factor for severe COVID-19 and where a quarter of people have yet to receive a single dose of the vaccine, the detachment of severe illness from cases s announces like a noticeably muffled echo of what has been seen abroad. Hospitalizations have already reached a new pandemic peak. Among them are a large number of children, many of whom are still too young to be vaccinated. When Omicron finds vulnerable hosts, it can still demand the worst of SARS-CoV-2. And Omicron finds them.

COVID-19 doesn’t have to be medically serious to wreak havoc. Lekshmi Santhosh, a critical care physician at UCSF, has seen Omicron exacerbate chronic health conditions to the point where they become fatal. “You could say that they are not dead of COVID,” she told me. “But if they hadn’t had COVID, they wouldn’t have had this problem.” Yale’s Iwasaki is also concerned about the storm of long-lasting COVID cases, which may stem from initially nearly symptomless infections, which may soon be on the way. “Some of these people are bedridden, unable to return to work for months,” she told me. “There’s nothing sweet about it.”

In sufficiently large numbers, any Omicron infection can wreak havoc. Across the country, people are isolating en masse, closing schools and businesses and crippling hospitals that can already ill afford a staff shortage. In many parts of the country, hospital capacities are already reached and exceeded, making it difficult to seek care for any type of illness. An overloaded system could also, ironically, mask the extent of the Omicron tear: when hospitals are full, they cannot accept more patients, artificially deflating recorded rates of serious illness, even as the total number of cases continue to rise. “Omicron may be milder at the level of individual symptoms,” Duana Fullwiley, a medical anthropologist at Stanford who has studied how the term Benign affected people’s experience of sickle cell anemia in Senegal, I was told. “But we’re not talking about the gravity of Omicron because it impacts the system.”

Omicron also still harbors dangerous unknowns. The variant can snub the lungs, but it still accumulates quickly in the throat and mouth, which positions it to spread easily out of infected people. This, combined with Omicron’s ability to evade certain immune defenses, makes it a threat to many of us at once. Diminished symptoms can also have a catch if infected people ignore them and keep mingling. (And the variant appears to be harder to detect early in infection with some rapid antigen tests.) Researchers don’t yet have a good idea of ​​the immunity that Omicron infections, especially mild ones, can leave behind them.

Stephen Goldstein, an evolutionary virologist at the University of Utah, told me that Omicron could prove to be about as virulent as the original variant of SARS-CoV-2, the version of the virus that started all this misery. If so, that would be ironic. Two years ago is also when Benign and COVID-19[feminined’abord insidieusement entrelacés: environ 80% des cas pourraient être décrits comme tels, selon des rapports notés à l’époque, invitant à des comparaisons dédaigneuses et trompeuses avec la grippe et à des appels moqueurs pour repousser les Américains au travail et à l’école. Bénin est devenu un raccourci pour minable; ce cadre apaisant s’est installé, puis s’est attardé, “diminuant le sentiment d’urgence dans la prévention”, comme l’a écrit l’anthropologue médicale Martha Lincoln, même à travers les milliards d’infections et les nombreux millions d’hospitalisations et de décès qui ont suivi.

Aujourd’hui, les reportages utilisent Bénin et COVID-19 ensemble plus que jamais, m’a dit Elena Semino, linguiste à l’Université de Lancaster, au Royaume-Uni. Médicalement, le terme Bénin est à l’origine un fourre-tout académique pour toutes les infections par le SRAS-CoV-2 pas assez graves pour faire admettre quelqu’un à l’hôpital – tout, des cas asymptomatiques jusqu’aux personnes à peine atteintes d’insuffisance respiratoire. Mais la plupart de cette gamme correspond mal à Bénin’s connotations familières concernant la nourriture «tempérée, agréable, généralement bénigne», le temps, même les gens, a déclaré Semino. Bénin, pour la plupart d’entre nous, est peu importe, quelque chose qui souffle presque imperceptiblement par.

C’est le piège de la douceur : le sentiment sous-jacent de fatalisme qu’elle engendre. “Les gens disent, c’est inévitable; c’est doux; J’espère pouvoir l’attraper et passer à autre chose», m’a dit Santhosh, de l’UCSF. Appeler Omicron « doux » implique que le virus se domestique spontanément ; cela rejette la responsabilité de la réduction des dommages à l’agent pathogène, et loin de nous. Mais Omicron n’est pas notre dieu ex microbe. Comme le souligne Goldstein, de l’Université de l’Utah, l’impératif d’un virus est uniquement de se propager, pas nécessairement de traiter ses hôtes de manière plus cordiale. (Omicron ne descend même pas de Delta, nous ne pouvons donc pas définir leur sévérité comme une baisse évolutive par étapes.) L’attitude selon laquelle Omicron n’est pratiquement pas inquiétante aggrave le désastre dans lequel nous nous sommes trouvés : plus le virus a d’opportunités doit entrer de nouveaux hôtes, plus les variantes surgiront. Et on ne sait pas quel mal la prochaine itération du SRAS-CoV-2 apportera.

Il convient donc de se rappeler que la gravité, ou son absence, ne dépend pas uniquement du virus. Nous, en tant qu’hôtes, imposons ses dégâts au moins autant – et c’est le côté de l’équation que nous pouvons contrôler. On ne peut pas compter sur le SRAS-CoV-2 pour tirer ses coups, mais nous avons les vaccins pour le repousser immédiatement. Si la douceur est ce que nous recherchons, cet avenir dépend en grande partie de nous.


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