COVID, Omicron, and Boosters in a Blind Spot

Here we are, a week later, and the critical deficit in what we know about the Omicron variant remains: does it make people sick?

Apparently, it can, with at least some of the cases detected among people with clinical illness. But what percentage of all the cases being discerned are associated with clinical illness, and what percentage with asymptomatic screening? Despite diligent searching, I cannot find that information.

To be clear, that information should be readily and immediately available. While I accept the official declarations that knowing the particulars of Omicron, including clinical severity, will require “several weeks” (that, or something like it, is the common refrain) – that should not extend to a basic cataloguing of who is testing positive in the first place. 

As we all know from a trying surfeit of pandemic experience, there are many reasons to get a COVID test. It can happen in the context of severe illness in the emergency room. It can happen with worrisome illness at the doctor’s office. It can happen with mild symptoms at a community test center. And finally, it can happen with no symptoms whatsoever due to required screening for work, travel, or some particular gathering.

That information- who is testing positive for Omicron, and where the testing is being done- is available at the time of testing. 

There is no valid rationale I can think of to hold these statistics hostage for several weeks. With the world’s health journalists all moths of the moment to Omicron’s flame, this information should be radiated out clearly and bright. All reporting on the topic should seek it, and include it.

Why does it matter? Because when a virus mutates enough, it is, in essence, a new virus. And what a new virus does cannot be assumed based on what some progenitor virus did. 

We did not undergo the sacrifices and upheaval of these last two years because a virus spread well; we have long been subject to common cold viruses that do so, and yielded none of our customs and conventions to them. We made painful adjustments because of a virus that not only spread well, but made significant segments of the population (although by no means all) dangerously ill.

Does Omicron do that? We didn’t know when I wrote last week, and we still don’t know this week.  While it will indeed take several weeks or more to observe the full clinical course of “Omicron-itis” and reach decisive conclusions, the statistical window I am referring to is already in front of us the moment we choose to draw the blinds.

Now, as a week ago, the only information on the topic I can find- very limited- hints at Omicron producing less severe disease. If those with symptomatic illness at all are a small fraction of those with no symptoms whatsoever, the news would be better still. Pandemics can end when mutation strips away virulence. We don’t know this is true, but we don’t know it isn’t.

We could know, now. In my view, we should know, now. If those with access to such data- the simple cataloguing of case ascertainment context for Omicron positives- are among the readership here, please help us all out and address this.

The rest of us, meanwhile, are being bombarded with advice about boosters in an Omicron blind spot. We are hearing that we should get boosters- even though the vaccines may or may not work reliably against Omicron. We are told to get boosters without regard for our first-hand experience with COVID to date.

I will say nothing here to oppose any official recommendations. At some point, even good advice does more harm than good if it propagates doubt, distrust, or discord. But there is, as ever, a middle path where a much-neglected opportunity resides to refine the prevailing guidance, without need to refute it.

I am in the camp that has both had COVID, and been fully vaccinated (Moderna, twice). As far as I am concerned, I have already been “boosted.” Since I had antibodies from my native infection, my first vaccine was a booster, and my second was an additional booster. I think the vaccines are safe and effective, but that does not mean I think they are completely innocuous. My calculus of the moment is: no additional booster for me without some reliable indication of likely personal benefit. 

For those who have not had COVID, and who have tolerated vaccination well- I support the guidance for a booster. Whether or not current vaccines reliably defend against Omicron, they do defend against the Delta variant, which still is, and for some time will be, the dominant strain circulating here in the U.S. and much of the world. Getting Delta now for want of a boost would be a real shame- almost like those tragic fatalities by gunshot right after an armistice has been declared.

Finally, your health status and personal vulnerability should figure in the mix, as ever with good medical guidance. Whatever the public health perspective on boosters, you want personalized health advice from a professional you trust. By all means seek that out before making your next move.

We are mired in the dark of an anxious pandemic blind spot just now.  But all pandemics end, and this one will, too. Perhaps it’s a good time to recall the particular darkness that precedes the dawn.