It’s No Longer the ‘Pandemic of the Unvaccinated’

Omicron is doubling so fast that it may soon be the pandemic of the unboosted — with holiday risks even for the boosted.

Two weeks ago, I was flippant about Omicron, calling it a variant “with a name like a villain from a Transformers movie.”

Now I’m feeling chastened — and nervous. Just in time for Christmas, data pouring in from South Africa, Britain, Germany, Scandinavia, Washington State and elsewhere shows Omicron cases doubling very rapidly.

It is pushing out Delta far faster than Delta replaced its predecessors.

And it is doing so in highly vaccinated networks: in countries like Norway (two doses in 88% of adults) and Denmark (81%), and at Cornell University (97%). (Yesterday, Cornell went to “red alert” and shut down its campus.)

Spread so rapid can only mean that the “fully vaccinated” (two doses) must be catching and passing on Omicron almost as fast as the unvaccinated spread Delta.

Studies back that up. They are showing that two doses of Pfizer vaccine are only 33 percent effective against infection. Meaning that, if this pandemic had begun with Omicron, none of the vaccines we now rely on would have been approved. The floor then was 50 percent.

To illustrate how vaccine evasion sustains rapid spread, Tomas Pueyo has just published an excellent article on his Substack feed: “The Omicron Question.”

(In March 2020, as a stunned country was creeping into lockdown, Mr. Pueyo published “The Hammer and the Dance,” the first article to explain — in layman’s language and with vivid epidemiological graphics — why the next year had to be horrible if we were to avoid a death count in the millions. Most of his predictions came true.)

We should stop calling this a “pandemic of the unvaccinated.”

It is becoming a pandemic of the unboosted.

But, in this environment, even us boosteds are not safe.

Only about 16 percent of the U.S. is boosted. That includes very few children, and they are back in schools, where any classroom can become a Superspreader Dome.

Plus, it’s winter here. Omicron emerged in South Africa during the southern hemisphere’s summer.

Also, flu levels are rising and they’re mostly the H3N2 strain, which is not good news. It’s too early to say how bad the flu season will be, but it’s on pace with previous medium-bad ones.

So the hospitals will fill up again with patients struggling to breathe. That is already happening in colder states, not just in sorta-vaccinated Colorado but in Vermont, the nation’s most-Covid-vaccinated state (75%).

New York City will not escape. Omicron rates in New York and New Jersey are four times the national average.

After I was fully vaccinated in February, and then again after I was boosted in October, I became pretty blasé about eating indoors, going to unmasked events and planning vacations.

But recently, I’ve had the same creepy feeling* I did in February 2020, when PCR tests were rolled out: “Wow, this is worse than I thought — there are a lot more cases around here than I expected.”

So I’m going to pull back. I’m not dropping Christmas gatherings with people I know and trust, but I’ll avoid, for example, crowded bars — even if they check vax status. Until we’re sure Omicron really is “milder,” I don’t think it’s smart to depend on the exhalations of strangers.

My risk of hospitalization is probably smallish, but when ICU’s get crowded, survival rates drop. And I’d still like to avoid Long Covid.

South Africa’s hospitalizations are up only modestly. But it’s still early days for them and even earlier for deaths. And South Africa is a poor model for the U.S. It has a younger population, much less obesity, diabetes and hypertension, much more under-treated H.I.V., much less routine access to doctors, much lower vaccination rates but probably quite high previous infection rates.

Protective pills are coming — Pfizer’s Paxlovid, which may be variant-agnostic, is nearly 90 percent effective at preventing hospitalization. But Omicron is moving a lot faster than the F.D.A. ever has.

And, since it only works if given early, we need ways to dispense it fast. We will need thousands of sites where one can get a rapid test and be handed a blister pack of pills on the spot.

For now, however, we can only protect ourselves. Six feet, please.

*I was just on the podcast “Keep Talking,” mostly reminiscing about the early days of covering Covid and about vaccine resistance. (It was taped when there was very little data on Omicron from outside South Africa.)

Disclosures: I own stock in Codexis, which makes an enzyme used in Paxlovid, and I am an occasional consultant to Kinsa Health, which tracks and predicts Covid and flu outbreaks.