Zeynep Tufekci one of the people whose reporting on Covid I most respect. Here's part 1 of a summary of how to think about Omicron or any new variant.
Immunity against breakthroughs/re-infections: Any day now, we’ll get lab reports about “neutralizing antibodies” against this variant from vaccinated or infected people. I’d expect a big drop—and it may sound very large because this is reported in multiples as in “20-fold drop” or “35-fold drop.” This can be a bit misleading: they can drop a lot but still be enough to neutralize or help hold off the infection.
It’s also important to remember that antibodies are the parts of the immune system that hold off the infection from taking root—the early shock troops. As I’ve written before, the immune system , by Dylan H. Morris), but everything else is not equal. This is a new variant, and the best data on this will be the epidemiology. (There is no way to look at just the sequence and assign a disease course). Still, it is not a brand new disease for the seropositives, people with prior infection and vaccination, and one expects disease course to be, on average, milder—subject to the usual conditions like immunocompetence, age and comorbidities.
Part two
Severity: This remains the third and big question, in multiple parts.
First: how severe will re-infections or vaccine breakthrough will be? Immunology suggests, everything else equal, they would be milder (
see this great post here, by Dylan H. Morris), but everything else is not equal. This is a new variant, and the best data on this will be the epidemiology. (There is no way to look at just the sequence and assign a disease course). Still, it is not a brand new disease for the seropositives, people with prior infection and vaccination, and one expects disease course to be, on average, milder—subject to the usual conditions like immunocompetence, age and comorbidities.
Second: what about the seronegatives? People with no vaccination, no prior infection? Well, they are already sitting ducks for Delta, which is highly transmissible and likely more severe than other strains, so the severity question may well play out differently for them. (Getting vaccinated would be the best idea, obviously).
It takes about two-three weeks from exposure and infection to hospitalization, and about four-six weeks to death, sadly. Plus, all early data is subject to selection effects: if the first superspreader events are in, say, college campuses, we get a young cohort who tend to have milder outcomes anyway, so we can’t really get a picture of severity from them easily—severe cases are already rare, so harder to tell the signal from the noise with smaller samples.
All this means it may take until the end of December or even early January to get clarity on the question of severity, likely from South Africa and United Kingdom and some European countries with good tracking.
I know this isn’t a good way to enter into the winter season, and I think even the best option will suck—many breakthroughs aren’t great to experience even if they turn out to be mild. Plus, the stress on the health system is real, plus it is winter in the Northern Hemisphere, so peak season anyway for respiratory illnesses.
By the way, getting vaccinated will certainly help even with a new variant, and so will the booster. Especially if Omicron turns out to be severe, we may be in for a variant-specific booster at some point, but the vaccines we have are still expected to provide substantial protection against severe progression, and good masks, ventilation, air-filtering etc. work against all variants.
So far, my understanding is that rapid tests will not have any issues working as before, but remember: they are good for when they are taken. Take one right before an event of consequence—not the day before.
And what if this does not turn into a crisis? That’s still possible. Still, it’s best to prepare while waiting. A few weeks of stress, and even overreaction, is better than finding out too late that it will cause us more problem than we anticipated, and also that it’s too late to do anything about it.