Greetings from an undisclosed location in my apartment. Welcome to COVID Transmissions.
It has been 826 days since the first documented human case of COVID-19. In 826, Cyril, a Byzantine Christian missionary who reached the Slavic peoples, was born. You may recognize Cyril from the name of the Cyrillic alphabet currently used for languages like Russian. Cyril was an impressive person, and I recommend reading up on him.
There is growing concern globally over the BA.2 Omicron subvariant. I have heard a bunch of extreme views on it, so I’d like to walk through a more subtle and expansive set of views—there are enough people variously saying it is a coming apocalypse or that it is nothing to worry about. Let’s chart a different course by acknowledging the waters are murkier than those views imply.
“Other Viruses” will appear later in the week this week; today’s content is all free.
Bolded terms are linked to the running newsletter glossary.
Keep COVID Transmissions growing by sharing it! Share the newsletter, not the virus. I rely on you to help spread good information, which you can do with this button:
Now, let’s talk COVID.
My thoughts on BA.2 and risk in various countries
I have been hearing a lot of talk lately that an apparent case surge in Europe, as well as indicators from wastewater surveillance in the US, are indicators that the Omicron wave is going to re-surge, dominated by the BA.2 subvariant of the SARS-CoV-2 Omicron variant.
I have shared some information about this in this newsletter before, and I think it’s important that we all keep open minds along with considering having masked faces, but I want to provide some perspective.
There is a tendency in online messaging to go for the shortest, most coherent message that does not leave much room for interpretation. Part of this is because if you leave a lot of room for interpretation, there is a good chance you’ll get dogpiled by people who have connected with the worst possible interpretation of what you’ve said, and that can get pretty unpleasant pretty quickly.
A side effect of this is that people tend to express very decided views that are often very polarized, with little room for subtlety, recognition of the vast differences between individuals, or acknowledgement of the wide range of options for what may be coming down the road. Unfortunately since everyone is expected to have one very clear opinion, we end up with a lot of arguments that have two distinct opinions in them and incorrectly portray a situation as a dichotomy when there’s a lot more to it.
The threat of BA.2 subvariant waves in various countries is no different. I have seen many people come out strongly with the view that, for example, the United States is at great risk, or at no risk at all, from this subvariant. Some very bitter arguments have ensued that I am glad to have had no part in.
I’d like to offer an alternative view to both of these positions, one based on my feeling that the world is a very big place with a great deal of human diversity.
Let’s begin with some facts that, at this point, I think have been demonstrated as true:
Immunity to BA.1, BA1.1, and BA.2 subvariants of the Omicron variant has a high level of cross-reactivity; someone who is protected from one of these subvariants will be well-protected from the others
High levels of vaccination are capable of reducing or eliminating the worst effects of Omicron variant infections within a population
Omicron variant infections remain very dangerous in unvaccinated people
If we use the US as an example, there are parts of the country where there have been a large number of Omicron variant disease cases, plus a large number of vaccinations. New York City, where I live, is a prime example of this. Around 75% of the population here has been vaccinated. A large portion have also been exposed to SARS-CoV-2 at some point during the pandemic, particularly recently with the Omicron variant wave that crested in January. We are entering a season in New York where people will also be more comfortable outdoors. So, looking at New York, I think we have the following scenario:
Indoor gatherings will be happening, but not with as much preference as they do in winter
A supermajority of people (maybe even more than 90%) have some sort of protective immunity against serious COVID-19 outcomes
Many of those people have Omicron-specific immune experience
Even at the peak of the Omicron wave in January, NYC deaths were around 20/day, far lower than the tens of thousands of cases being reported would have generated in prior pandemic waves
I look at this scenario and I am not concerned about BA.2 in New York specifically. But New York is one end of the spectrum.
Consider, instead, a place that we discussed recently that has a high vaccination rate, but with a vaccine that is poorly suited to defense against the Omicron variant. This place had limited experience with the Omicron variant until recently, and so has a large number of susceptible people. Population density is high. I am speaking of almost any major city in China here, where the risks from the BA.2 subvariant are high, and the situation continues to be very concerning.
The thing is, there are cities, counties, towns, and homesteads at different ends between these extremes all over the world. You may live in one right now, and I encourage you to become very familiar with the local history of the pandemic where you are. Ask yourself if your local patterns and history suggest that many people (at least 80% or more) are immune to the Omicron variant already, or whether it seems likely there are still a lot of vulnerable people.
The characteristics that worry me look like this:
Vaccination rate (for fully vaccinated) under 70% for total population
Cases during the Omicron surge in December-January (or similar, depending on the location) did not exceed case numbers seen during the Delta wave
Suburban or urban area
Places like that, I’d be concerned about BA.2 because I would be concerned about any Omicron subvariant. There are places that did not get hit as hard as where I live, and that means they are still vulnerable. If you live in one, I’d say it is essential to maintain a high level of vigilance—make sure you are boosted. Get and wear a good mask when you are indoors in public. Those who need it due to medical conditions should consider, in consultation with their physician, a prophylactic option like Evusheld.
In places that are more like where I live, I think you can be a bit more flexible, but it is still wise to do all of those things.
Still, the bottom line is that BA.2 is chiefly dangerous to those people who are not well-protected against the Omicron variant already. If you can’t be personally well-protected, then it is also important to be surrounded by large numbers of people who are. You need to evaluate local protective levels as well as personal immunity and decide on the precautions you want to be taking—I can’t make a sweeping proclamation. But hopefully I have given you some tools to make decisions for yourselves.
Part of science is identifying and correcting errors. If you find a mistake, please tell me about it.
Though I can’t correct the emailed version after it has been sent, I do update the online post of the newsletter every time a mistake is brought to my attention.
No corrections since last issue.
What am I doing to cope with the pandemic? This:
Playing: It Takes Two
I recently managed to secure a PlayStation 5, and since I’ve been a Mac user with no gaming consoles for over a decade, suddenly I find myself in a world of gaming possibilities that I’d never considered.
One game I’ve been playing (with my wife, for reasons you’ll see in a moment) that is worth mention here is the cooperative title It Takes Two, which I’m summarizing as a playable Pixar movie. It follows a couple who are planning to divorce, who are transformed into dolls by their daughter’s wish for them to stay together. They obviously want to turn back into people, and getting there involves solving all kinds of challenges together.
The puzzles are creative and the game is a lot of fun to play with the required two people. Here’s (one) trailer for it:1
You might have some questions or comments! Join the conversation, and what you say will impact what I talk about in the next issue. You can also email me if you have a comment that you don’t want to share with the whole group, or if you are unable to comment due to a paywall.
If you liked today’s issue, please consider becoming a paid subscriber and/or sharing this newsletter with everyone you know.
Please know that I deeply appreciate having you as readers, and I’m very glad that if we must be on this pandemic journey, at least we’re on it together.
Always,
JS
For the record—I don’t think I’ve every explicitly stated this before—I have never received any kind of incentive to recommend any form of media here. The things I mention in this section are all things I genuinely like. Sometimes, in part but never wholly because friends of mine have made them (but that’s not the case for today’s).
If people who are protected against one subvariant are also well-protected against others, why would there ever be a surge in a place that already had an Omicron surge (like Europe)? Is it just changes in behavior/regulations combined with immunity fading from vaccines & boosters, and nothing to do with the difference between subvariants at all?