Omicron has completely changed the pandemic — it's time to change how we respond to it
Strict public health measures alone won’t stop variant, but could help slow its spread
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Omicron has completely changed what we thought we knew about COVID-19 — given how quickly it develops in the body, causes symptoms to emerge and infects others — meaning the tools we have to try to contain it are no longer as effective.
The highly contagious variant is now spreading at a rate unlike anything we've ever seen before, completely overwhelming our testing capacity and infecting more Canadians than at any other point in the pandemic as hospitalizations reach record highs.
"It's kind of the difference between a garden hose and a fire hose," said Michael Osterholm, an epidemiologist and director of the Center for Infectious Disease Research and Policy at the University of Minnesota.
"As bad as Delta was, that was more of a garden hose. This is a fire hose in terms of transmission."
Omicron has fundamentally changed the virus at almost every level — from the rate at which it spreads, to the time it takes to infect, to the severity of symptoms it causes.
"Thank God we're where we are," B.C. Provincial Health Officer Dr. Bonnie Henry said in a phone interview. "If this had been the initial virus that came ripping through before we had people vaccinated, especially older people, I mean it would have been the plague."
Henry said one of the biggest challenges with Omicron is that the incubation period has become so much shorter — meaning if it took five to seven days for symptoms to emerge with previous variants, it now takes just two or three days for people to get sick.
"So what that leads to is rapidly explosive outbreaks that are relatively less severe, but when you have that number of people infected, you're still going to have a strain on your health-care system," she said.
"It's not about stopping this, we cannot stop Omicron … but what we can do is slow it down and try and keep it away from those who are most at risk and try to mitigate the impact on hospitals."
WATCH | Hospital staff levels to drop as Omicron causes hospitalizations surge:
Will strict public health measures work against Omicron?
Canada is responding to the devastating Omicron-driven surge by reimposing strict public health measures — ranging from curfews to the closure of bars, restaurants and gyms, and even delaying the return to school.
But Osterholm, who is also a member of U.S. President Joe Biden's COVID-19 Advisory Board, co-authored a viewpoint in the journal JAMA this week that argued it's not possible to eliminate Omicron, saying we need to completely rethink our public health response to it.
"We're not going to contain it. That word shouldn't be used," he said. "But we sure can do a lot to slow it down."
Omicron has brought us "back to flattening the curve," said Bill Hanage, an epidemiologist at the Harvard T.H. Chan School of Public Health.
"Most people think previous measures would delay, but not stop, Omicron. This is still worth doing because you get to boost more vulnerable people," he said.
"There may be some interventions that are particularly effective, like closing large gatherings, restaurants and the like for a defined period when hospitals are under most strain."
WATCH | Canadian hospitals brace for rising COVID-19 admissions, staff shortages:
But Dr. Amesh Adalja, an infectious disease physician and senior scholar at the Johns Hopkins Center for Health Security in Baltimore, questions whether strict public health measures will have anywhere near the same level of impact on Omicron.
"They didn't make sense in the beginning of the pandemic and they don't make sense this late in the pandemic to me, because of all the negative cascading impacts that they have and the fact that they're very blunt," he said.
"I don't know how you can treat the vaccinated and unvaccinated the same with these types of policies when the virus doesn't treat them the same."
While COVID-19 is becoming a less serious respiratory virus for the vaccinated, Adalja said, it's still a major threat to the unvaccinated who continue to be at much higher risk of severe illness.
Steven Hoffman, director of the Global Strategy Lab and a global health law professor at York University in Toronto, believes the impact on hospitals could be devastating in the weeks ahead if public health measures fail to slow the spread of Omicron.
"The thing I'm really worried about is, what if someone gets hit by a car during the month of January when all the ICUs are filled with COVID-19 patients?" he said.
"Once you run out of ICU beds and once doctors and other health professionals have to start making decisions about who gets a bed and who doesn't — the whole system breaks down."
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Osterholm believes while many more people will become infected with Omicron in the coming weeks, strict public health measures and increased vaccinations will make an impact in its ability to spread and lead to hospitalizations.
"Besides helping to spare the immediate load on the health-care system, we can also make it so that we get more people vaccinated — particularly with that third dose," he said.
"It's becoming very clear that that can have a big impact on the severity of illness with Omicron. The more people who can get third-dose vaccinations, and at least 10 to 14 days under their belt before they encounter the virus, could be really very important."
The reason strict public health measures are being reinstated around the world is because attempting to spread out the sheer number of Omicron cases at a given time is an important step in trying to avoid overwhelming the health-care system, Osterholm said.
"Whether you have 1,000 people get infected and come to hospital today or 1,000 people get infected and come to the hospital in the next 10 to 15 weeks can make all the difference in the world," he said.
Will Omicron prolong the pandemic?
So if Omicron isn't possible to eliminate and is already spreading like wildfire, threatening to overwhelm our health-care system, what does that mean for the end of the pandemic? And how will the next few weeks and months play out?
"In North America, I think we'll probably have two to four weeks of major activity yet, and then I think it will start to decrease substantially," said Osterholm. "But the next few weeks should be very challenging."
Raywat Deonandan, a global health epidemiologist and associate professor at the University of Ottawa, expects COVID-19 levels to continue to increase dramatically before they peak in the coming weeks.
"A rapid high rise will be followed by a rapid decline. We saw that in South Africa. So while this will be a high peak, it will mercifully be a short wave," he said.
"So does that mean we should do nothing? No, of course, not. What we've got to do, of course, is slow down transmission to a.) preserve the health-care system, and b.) to protect the unvaccinated and to give them time to become vaccinated."
Henry thinks while we're on the path to COVID-19 becoming endemic, like other respiratory viruses, and the worst of the pandemic will end in the coming months, it will be a bumpy road to get there.
"I said this a couple of weeks ago, when I knew people were going to be really discouraged — I was really discouraged, I went home and cried for an hour — but we can't waste our energy wishing it was different. It is what it is, and we know what to do," she said.
"I really do believe that we're going to be in a much better environment and through the critical pandemic phase and into the, 'OK, how do we live with this virus going forward?' phase probably come the spring or summer."
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