(disclaimer: I am not a epidimilogist or an expert in this field. My arguments are based on publicly available reports.)
The Omicron Variant of Covid-19 is now all over the world, and in a growing number of countries, it is already the dominant Covid variant.
Reports from South Africa, the United Kingdom and Denmark show that Omicron is more infectious than previous variants, but that at the same time it seems to make people less sick. It is still too recent for scientists to definitely say that less people will end up in hospitals, the ICUs (intensive care units) or die as a result of the Omicron variant. Another possible characteristic is that Omicron attacks more the upper respiratory tract (i.e. nose, throat) than the lower (i.e. lungs). This could mean that it could prove less deadly for older people; but at the same be more deadly to infants.
Omicron has exploded into the global scene, with cases growing exponentially (doubling weekly in many cases). It seems that it is on its way to becoming the predominant variant worldwide in weeks. If it does become so, there is the chance that infections will also quickly decline in country after country after reaching its peak.
What happens next? There are two possibilities. First, that Omicron could become so dominant that future variants will emerge from it. Or second, that a new variant could emerge from ‘nowhere’, just like Omicron did. (Experts think that the virus infected an animal, circulated among animals for a while, and eventually reinfected humans as Omicron.)
Let us look into both possibilities.
Mutations to the Omicron variant could be of 4 kinds:
1. those that increase the virus’ transmissibility.
2. those that decrease the virus’ transmissibility.
3. those that make people more sick.
4. those that make people less sick.
I think that all mutations will alter the virus to some extent, and thereby lower the chance of natural and vaccination-induced antibodies to detect previous versions.
#1 mutations will spread faster than the main Omicron variant, and will outcompete it.
#2 mutations will be lose out to the main Omicron variant, which will outcompete them.
#3 mutations will not result in faster hospitalizations, taking those infected with them out of circulation earlier than those without these mutations. As a result, they will have an evolutionary disadvantage when competing with the main Omicron variant.
#4 mutations would result in symptoms that are so mild that sick people will not know that they are sick, and potentially infect more people than the main Omicron variant.
Both #1 and #3 mutations will have a slight evolutionary advantage over the main Omicron variant, and will gradually replace it. This means that, over time, Omicron will become more transmitable and will get people less sick. We could call the result ‘Omicron+’.
And then, the second possibility is that there will be a surprise Covid-19 variant that emerges from pockets of people infected with other variants e.g. Alpha or Delta. For sure, the other variants of Covid-19 would be able to mutate as long as they are around. But they will need to be able to outcompete Omicron to become dominant; and this rather difficult and unlikely. Omicron emerged with more than 50 mutations; any new variants will need to have a combination of mutations with a stronger effect than that of Omicron. Also, the world population is becoming more and more immune against Covid-19; with time, this growth in immunity will make it more difficult for all Covid-19 variants to infect people.
No need to vaccinate?
In a relatively short time, the world will be faced with an increasingly dominant Omicron variant, and a smathering of other variants (which will be decreasing proportionately). And since Omicron tends to make less people very sick, some people (read: the anti-vaxxers) would say that there is no longer a need to get vaccinated for a sickness that is ‘mild’.
This is not true.
At this moment, Omicron is still quite dangerous – it still kills a lot of people. Its mildness is relative ( to Delta) and statistical. People still go to the hospital and ICUs, and even die, because of Omicron. But compared to the Delta variant, less people get very sick and die with Omicron. Vaccinated people could still be infected with Omicron, but they are much less likely to be infected or get very sick than unvaccinated people to do so.
Now is the most dangerous time to be unvaccinated. Omicron, Delta and other variants are spreading like wildfire among the unvaccinated. If they have not gained immunity from a previous Covid infection, they could become very sick or die from it. The overwhelming majority of those who die from Covid-19 will have been unvaccinated.
Delta vs Omicron
At this time, we should not forget that the Delta variant is still widespread. People who get infected with Delta will most likely be immune from getting very sick with Omicron, and vice versa. For the next months, governments will still need to consider both variants when they make policies to combat the pandemic.
Delta will have its own mutations. Similar to Omicron (see above), these mutations will tend to make Delta more transmissible and less harmful. If, by chance, Delta+ will overtake Omicron or Omicron+ in transmissibility, then the world will be faced with the spectre of both of them spreading.
I don’t think this will happen though, because Omicron is already near the maximum possible transmissibility for the virus, and because Omicron will also be mutating. Also, Omicron has a big headstart in spreading throughout the world.
Herd Immunity, sort of
Eventually, the overwhelming majority of people (say 97%) in the various countries will have developed some immunity for Covid-19, either through vaccinations or by having been infected. When this happens, people could still be infected by variants that differ from the one they got immune to; but only few of these would be hospitalized.
The large numbers of people in Africa and other Third World countries who remain unvaccinated could indeed cause mutations and variants. And these variants could in turn cause new Covid-19 waves in these countries. I am not too worried about this, though. Any such variants would be facing a wall of immunized populations in other countries and fizzle out.
Omicron has shown us that Covid-19 could also circulate for a long time among animals, before crossing over back to humans. This means that it could accumulate a lot of mutations before emerging. And the more mutations there are, the more likely the virus would have to infect people who were previously immunized against older variants. It takes time to develop this kind of variant though – perhaps two years or more. By that time, a lot more people would have been vaccinated, even in Africa. This means, a new variant of Covid-19 jumping over from an animal would be facing a more formidable wall of immunity in the human population.
Longer Term
In the longer term, there would be waves and peaks of Omicron infections especially in areas where many people are not vaccinated. Omicron would mutate to become Omicron+ or Omicron++ that would be even more transmissible and make people even less sick. Vaccinations will have then become more widespread – eventually reaching a minimum of 50% in Africa, and higher elsewhere. Countries may endure a few more waves of Covid-19, with each wave peak getting less each time as infections build more natural immunity with each round.
When this will happen, will depend to a large degree to how fast the Omicron variant spreads. The faster it spreads, the sooner it will be that Covid-19 will be less harmful.
I think that sometime in 2024, or earlier, the Covid-19 pandemic will be effectively over.
Carlo's Think Pieces 