How omicron could impact global progress to curb the pandemic

The pattern has become all too familiar: A new version of the SARS-CoV-2 virus emerges and begins to dominate new Covid-19 cases, until it’s replaced by an even more contagious version of the virus.

This year, subvariants of the omicron variant of the virus have ruled cases in the US. The BA.1 subvariant started the omicron wave. Then in April, BA.2 formed the majority of cases. By May, BA.2.12.1 took over. Now BA.5 is in the lead, triggering a rise in hospitalizations across the country. It may be the most contagious version of the virus to date.

After the month of May saw the United States cross the line of more than 1 million reported deaths from Covid-19, the SARS-CoV-2 virus that causes the disease is continuing to mutate. That means a growing number of new omicron subvariants are now fueling another rise in infections. The formula for containing the worst effects of the pandemic — namely vaccinations and treatments — still holds up. But progress has been slow, leaving the world vulnerable to more troubling changes to the virus.

The US is inching closer to authorizing Covid-19 vaccines for one of the last unprotected age groups, children under 5 years old. Pfizer and BioNTech reported preliminary data this week that a three-dose sequence of its Covid-19 vaccine yielded 80 percent efficacy in preventing disease in kids between six months and 5 years old. But the Food and Drug Administration will not meet until next month to consider granting emergency approval for these shots.

Shanghai, China’s bustling cosmopolis of 26 million, has been under lockdown since late March under the nation’s strict “dynamic zero-Covid” protocols. The system is so poorly managed that residents are frequently unable to access basic necessities like food, medications, and medical care, prompting fairly widespread, spontaneous protests online and in real life.

The government has touted the zero-Covid strategy, the government’s system of containment using intensive testing and tracing, combined with partial or complete lockdowns when a case is detected, has kept case counts and deaths low over the past two years. But the reports coming out of Shanghai suggest that the local government was unprepared for an outbreak in the country’s economic center and cast doubt on the feasibility of zero Covid at this point in the pandemic. That has translated into serious struggles for residents, including hourslong ambulance wait times, dwindling savings, and inadequate or rotten food supplies, among others. Although the central government is reportedly stepping up efforts to get supplies to the city, the overall policy is driving many residents to criticize the government’s policy — and Shanghai’s implementation of it — despite serious potential risks to their safety and freedom by doing so.

This month, Hong Kong saw its Covid-19 death rate become the highest in the world, topping 37 deaths per million people. The recent outbreak was a brutal shock to the 7.4 million residents of the bustling metropolis, which had until recently kept Covid-19 cases to admirably low levels. Hong Kong was once applauded for its response to Covid-19. Then it became the global epicenter of the pandemic.

Other cities in China like Shenzhen and Shanghai have also seen huge surges in infections, and countries in the Eastern Pacific like South Korea, Vietnam, Singapore, and Australia have seen a surge in cases this month as well. That’s largely due to the rise of BA.2, a highly infectious, hard to identify subvariant of omicron, itself a more transmissible version of the virus that causes Covid-19. Some of these countries also started to relax restrictions on travel and public gatherings just as the new subvariant took root.

Across the world, the omicron phase of the Covid-19 pandemic is now piling up towering case counts in places that have largely managed to keep the disease in check until this point. This troubling rise may signal that another wave of Covid-19 is rising in countries just coming out of their own omicron shadows, including the United States.

Hong Kong now reports the world’s highest death rate from the disease. Hospitals are overwhelmed and the surge is fueling a mental health crisis and leading to suicides, particularly among elderly residents.

There’s yet another twist in the pandemic: The omicron variant of SARS-CoV-2, the virus that causes Covid-19, now has a “subvariant” that seems to spread more quickly than any other version of the coronavirus to date.

The good news for now is that vaccines still appear to protect against it. But because it’s so transmissible, scientists are racing to figure out what harm it could cause.

Children under 5 years old, who make up one of the largest unvaccinated groups in the US, could soon become eligible to receive Covid-19 shots. The US Food and Drug Administration will consider whether to authorize two small doses of Pfizer/BioNTech vaccines for these children on an emergency basis, the companies announced this week.

Approval could come as soon as this month. But Pfizer and the FDA have a tricky needle to thread, moving quickly while trying to maintain public trust in the process.

Much like in the US, omicron has led a spike in caseloads and hospitalizations across Mexico. For thousands of migrants stranded in the country due to US border policy, that has meant exposure to the highly contagious variant. Worse, many of these migrants face the prospect of Covid-19 infection without widespread access to vaccines or health care.

Migrants are legally entitled to public health care in Mexico, but nonprofits serving migrants say hospitals are overwhelmed by Mexican Covid-19 patients, and as a result, migrants are the first to be turned away.

The Covid-19 vaccines available today are amazing feats of science. Researchers achieved in less than a year what can sometimes take decades: They targeted a new virus with multiple highly effective vaccines that have reached billions of people. They deployed new approaches like using messenger RNA and adenovirus vectors at large scales for the first time, making some of the biggest leaps in vaccine technology in hundreds of years.

Even as omicron is surging, the seasonal flu is back: More than 2,500 Americans were admitted to the hospital with influenza in the last week of December. The flu hospitalization rate is still about half of the pre-Covid normal, but it is eight times higher than it was last year when one side effect of pandemic restrictions was that flu cases fell off dramatically.

This is the first glimpse of a harsh new reality that will outlast this wave of the pandemic: Flu season has transformed into Covid-and-flu season — a “flu-rona” wave every winter.

Over the past two years, the United States has seen more than 63 million Covid-19 cases, with some people infected more than once. More than 240 million people in the US have received at least one dose of a Covid-19 vaccine. More than 60 million have received three.

While Covid-19 infections are never a good thing, these numbers still add up to a glimmer of good news: A large majority of Americans now have some immunity against SARS-CoV-2, the virus that causes Covid-19. That’s a big step toward defanging the disease.

Like many states across the country grappling with the onset of the omicron variant, Texas’s fight against Covid-19 took a turn for the worse in December. And due to the state’s relatively low vaccination rates, and a Republican state government that has fought public health officials’ recommendations on masking, vaccine mandates, and business restrictions, matters may not improve soon.

Although the symptoms of Covid-19 are typically milder for the vaccinated, omicron is more transmissible than previous variants, even among people who have had two shots. Together, the infectiousness of omicron and Texans’ resistance to getting the vaccine have created a crisis for hospitals and medical workers, one that disproportionately puts unvaccinated people in danger.

Should we be swabbing our noses or our throats for at-home tests? Do rapid tests even detect omicron at all? Are PCR tests the only results we can trust right now?

Guidance about how to approach testing in the omicron era seems to be evolving by the day. ​​A recent real-world study that followed 30 subjects likely exposed to omicron found that PCR saliva tests can catch Covid-19 cases three days before rapid antigen tests, which use nasal swabs. These findings, which have not been peer reviewed, follow the Food and Drug Administration’s announcement in late December that, while they do detect omicron, rapid antigen tests may now have “reduced sensitivity.” But that doesn’t mean rapid tests don’t play a key role in our pandemic response going forward.

In early December, after a two-year hiatus from the stage, Bad Bunny went home to Puerto Rico to give his most dedicated fanbase the concert of their lives. The reggaeton star may have delivered with his “P FKN R” show — a two-day, $10 million spectacle and tribute to Boricua culture at a massive 60,000-person stadium in San Juan. But it also turned out to be a superspreader event.

All concert-goers were required to show proof of Covid-19 vaccination and to wear masks or else risk a $100 fine and removal from the concert. Though their vaccination status was verified at the door, there wasn’t much enforcement of the mask mandate, and many attendees took them off once they got to their seats. As a result, an estimated 2,000 attendees tested positive for the virus afterward, contributing to a 4,600 percent jump in cases on the island last month. December 2021 accounted for a third of the total cases recorded in Puerto Rico, and now the island’s positivity rate is 36 percent.

Immigrants in detention have been at heightened risk throughout the pandemic. They have been confined to environments where social distancing is impossible, at times without adequate prevention and sanitation measures and with limited access to vaccines and information about them.

Now they’re even more vulnerable as the highly transmissible omicron has become the most common coronavirus variant in the US — and advocates say it’s another factor that adds to the already compelling case for releasing them from detention.

China’s zero-Covid policy of lockdowns and quarantines has been so strict that the country’s president, Xi Jinping, hasn’t left the country in about two years. Now that the highly transmissible omicron variant has been reported in China, what will it mean for the Olympics — and for us?

One thing is certain: With the Beijing Olympics a little more than a month away and the politically significant National Congress of the Chinese Communist Party to be held in the fall, the harsh localized lockdowns that have defined China’s response to the pandemic are likely to persist throughout 2022, maybe even longer.

The list of symptoms of Covid-19 has grown longer and stranger throughout the pandemic. With so many people now vaccinated, the warning signs of an infection have become more subtle and vague. That’s becoming especially evident as the omicron variant gallops around the world, squeezing through the nooks and crannies in the wall of immunity that’s been built over the past two years.

An international team of researchers has been tracking signs of infection throughout the pandemic with the Covid Symptom Study using a mobile app where users could self-report their symptoms. Data on the omicron variant is still preliminary, but a group of 171 app users in the United Kingdom, most of whom are vaccinated, recently reported that their top symptoms for omicron were a runny nose, headache, fatigue, sneezing, and a sore throat. These were also the top symptoms for people infected with the delta variant.

At the same time that omicron was quickly overtaking delta to be the dominant strain of Covid-19 in the US and many other countries, it’s also spread on social media.

People are posting about the omicron variant significantly more than they posted about the delta variant over a similar timeframe, according to an exclusive report for Recode gathered by media intelligence company Zignal Labs.

Less than a month ago, the omicron variant, first detected in South Africa, was labeled a “variant of concern.” Since then, the world has braced for another wave of coronavirus, as Covid-19 is spiking across Europe and, now, the United States.

A lot of these countries — particularly the United Kingdom and the United States — are pushing aggressive booster campaigns in response. Three shots, rather than two, is becoming the refrain of many public health experts.

The omicron variant of the SARS-CoV-2 virus, discovered just a few weeks ago, is poised to dominate Covid-19 cases around the world. It’s a stunning new twist to the pandemic saga that has countries scrambling to prepare.

In places like South Africa and the United Kingdom where omicron has been spreading fast, Covid-19 cases have doubled every three days or less. This includes people who were previously infected or vaccinated against Covid-19.

There’s still a lot we don’t know about the coming omicron wave, but there’s one thing we can be pretty sure about: A lot of people are going to get sick. Omicron is highly contagious, and people with previous immunity from a Covid-19 infection, or from vaccination, appear more vulnerable to omicron than to previous variants.

For vaccinated people, omicron cases are likely to be mild, but even a small fraction of cases resulting in hospitalization can overwhelm hospitals if enough people get sick at once — which looks likely to happen.

The coronavirus seems to really hate the holidays. Within the past week, the omicron variant, which accounted for less than 1 percent of new US cases in early December, has spread rapidly across the country to become the dominant Covid-19 strain. Schools and college campuses have suddenly shut down, and sports leagues, namely the NFL and the NBA, are delaying games as more and more players test positive. Omicron seems to be responsible for a record level of breakthrough cases among vaccinated people, and things are beginning to look a lot like the Covid-filled Christmas of yesteryear.

For many, 2021 was the promised year when we could safely attend in-person reunions with no masks and no fear of infecting our loved ones. Omicron has dashed the hopes of an entirely carefree holiday season. It will add further strain on already-struggling hospitals and could overwhelm the country’s finite supply of health care workers, who are already suffering from burnout.

A lot of Americans are going to get infected with the omicron variant of the novel coronavirus in the coming days and weeks. The United States is currently averaging more than 143,000 new cases every day, already nearly matching the peak of the delta wave over the summer and well on its way toward the record of 250,000 daily cases seen last winter.

Record case numbers seem likely in the near future. Hospitalizations and deaths will increase to some degree as well; they always do. But how much they increase remains to be seen, since more Americans are vaccinated now than were in previous waves.

A surge in cases driven by the highly transmissible omicron variant has stretched America’s Covid-19 testing capabilities to their limit. Rapid antigen tests are out of stock at many drug stores, and lines for PCR tests stretch around the block in cities across the United States. The problem will likely get worse as more people travel for the holidays and fuel new outbreaks, long before new supplies of tests from the federal government are scheduled to arrive.

Covid-19 is spreading so quickly that the US may need between 3 million and 5 million tests every day by early February, which is far more than the country currently conducts, according to internal modeling from the Health and Human Services Department. With test supplies dwindling, some local officials are urging the Biden administration to invoke the Defense Production Act, a Korean War-era law that allows the president to order private companies to manufacture certain products during emergencies. To help combat the shortage, the White House said early on Tuesday that it will ship up to 500 million free tests directly to US homes, beginning within the next few weeks.

With the omicron variant causing huge surges of Covid-19 infection, many of us are anxiously reconsidering our holiday plans. Is air travel safe? Can we still hug our parents? How should we think about testing? What about holiday parties?

I asked six epidemiologists how omicron is and isn’t changing their near-term plans. Most were already planning to keep things low-key, but they have added some modifications to make their gatherings safer in light of the variant. These include adding in buffer time between air travel and seeing relatives, testing multiple times, and taking into consideration whether contacts have been boosted as well as being vaccinated.