The Daily - Why Omicron Is Counterintuitive

Episode Date: January 3, 2022

The Omicron variant is fueling record-breaking cases across the world and disrupting life. But it may not present as great a danger of hospitalization and severe illness as earlier variants. We explore why this is and what it means for the next stage of the pandemic.Guest: Carl Zimmer, a science writer and author of the “Matter” column for The New York Times.Sign up here to get The Daily in your inbox each morning. And for an exclusive look at how the biggest stories on our show come together, subscribe to our newsletter. Background reading: New studies are providing the first indication of why the Omicron variant causes milder disease than previous versions of the coronavirus: It spares the lungs.The decision by U.S. health officials to shorten isolation periods for many infected with the coronavirus has drawn both tempered support and intense opposition from scientists.The growing consensus in nations with Omicron that the virus is moving too fast to catch is tempered by early evidence that the variant causes milder symptoms.For more information on today’s episode, visit nytimes.com/thedaily. Transcripts of each episode will be made available by the next workday. 

From New York Times, I'm Michael Barbaro. This is The Daily. Today. Nearly half a million new COVID-19 cases were recorded in the U.S. The U.S. has averaged more than 300,000 new cases a day. Hospitalizations are also rising fast here. The highly contagious Omicron variant is fueling record-breaking infection rates across the world and the United States. There are three Americans are testing positive for COVID every second.

Yeah, I mean, these numbers are absolutely staggering. And disrupting basic services. Thousands of flights had to be canceled. From flights to subways in the process. And disrupting basic services. Thousands of flights had to be canceled. From flights to subways in the process. The fire department says 30% of its EMS personnel is out sick. Here in the U.S., new cases are higher, really, than they've ever been during the pandemic. But here's the thing. Deaths are down. But what it's not doing is killing or hospitalizing those it infects at the same rate as previous variants.

I spoke with my colleague, science writer Carl Zimmer, about why that is and what happens next. It's Monday, January 3rd. So, Carl, Happy New Year? Is it a Happy New Year? It is certainly a New year like no other. And yet, it kind of feels familiar, right? Yeah, there's a weird sense of deja vu. We're all hunkering down, hopefully, and just not seeing people as much as we might have before. We're giving up the things that we had thought we could have back in 2021. And yet, even though it feels familiar in a way, Omicron is actually kind of a new pandemic. What do you mean by that? Well, Omicron is really different than other variants in some

really important ways. On the one hand, it does seem to be milder, and it does seem like we get protection from vaccines in an important way. And yet, it's spreading like crazy and has this potential to really break a lot of our social systems in the next month. Right. as we start to understand what Omicron has done over the past 10 days or so since we last talked to you by talking through the biggest action that our government has taken, which I think will help put everything you just said into some context. And that's the CDC's decision to cut the length of time for self-quarantining after a COVID infection. And not just by a little, but by a lot. And I felt that was surprising, given that we are experiencing this record spike in infections that you just mentioned, but it also felt related to that fact. So can you

explain the CDC's decision? Sure. So until recently, the Center for Disease Control had recommended that infected patients isolate for 10 days after they tested positive for the virus. But then on the Monday after Christmas, the CDC slashed that period to just five days for those without symptoms or who didn't have fevers and there's other symptoms we're resolving. there's other symptoms we're resolving. The thing is that experts have been debating about whether maybe we should be cutting back on that 10-day rule for some time now. In fact, people were pointing out that actually some people, especially vaccinated people, they may not be infectious long before that 10-day point. And there were public health experts who were also saying, you know, 10 days is a long time. And so people may actually avoid testing because they don't want to be out of work for 10

days. So maybe there could be a sweet spot where you could really reduce a lot of transmission and not be so disruptive to people's own lives and to the economy. And in fact, in October, Cornell University, just on its own, had gone ahead and cut back their rules to five days. You could get out of isolation after five days only if you had two negative PCR tests. So Omicron shows up, and it, even more than previous variants, seems to be really arguing for a shorter isolation period. Why is that? Well, this variant moves fast. And this became really apparent once epidemiologists could start to look at some of the first outbreaks of Omicron. So for example, in Oslo, in Norway, there was a Christmas party,

they were all vaccinated. And roughly three days later, the majority of the people at that party were feeling sick. They had COVID. Right. You told us about this party. Yep. Yeah. And so this variant comes on fast. And for many people, especially people who are vaccinated, it clears out fast. And so this is days faster than other variants. So on top of that, you now have Omicron surging around and infecting people. They're testing positive. And so these companies are following CDC guidelines. They're telling their staff, well, don't come into work for 10 days. So it's incredibly disruptive. You don't have enough people to fly planes. You don't have enough people at clinics, you know, at stores and so on. I mean,

and so business people were telling the government, could you please change this policy? Is there any way that we can lessen this blow? And the CDC says yes. And so the CDC decides right after Christmas, we're going to cut that down to five days. What they say is that if you don't have symptoms or you don't have a fever and your other symptoms are clearing, that you can leave isolation but wear a mask, a really good mask, for the next five days. So that was the policy that they ended up with. So what began as a medically motivated decision, which had been under consideration for a while, it feels especially suited to the properties of Omicron, the speed of under consideration for a while. It feels especially suited to the

properties of Omicron, the speed of an Omicron infection. And this decision, you're saying, is nudged along pretty powerfully by the reality that the economy is starting to collapse because so many people are out of work for 10 days. That's basically how we get to this five instead of 10 day self-isolation. That's right. And we should be clear that this is a decision that is not uncontroversial. You know, there are a lot of experts who have been very critical of it because maybe five days is a good policy, but it has a central flaw, which is that there's no test involved. So remember, you know, when Cornell put their policy in place, they said, you can get out after five days with two negative tests. Because the fact is that just because people have different biology,

people get infected with a little virus or a lot of virus, some people will be totally clear at day five. And other people, they'll keep testing positive for a little while longer. And thus be contagious. Yeah. And so it could defeat the whole purpose to just let people go at five days instead of 10 if you're letting people go off and infect others. So why didn't the CDC issue any kind of requirement for a negative test to leave isolation after five days? Well, my sense would be that it's really hard to get a test right now. So if you're requiring people to go get some at-home antigen test and have it test negative before they come back to work, well, people aren't going to be able to go back to work because they're not going to be able to find these tests because we've run out of those tests. Right. So it would undermine what kind of central purpose of reducing this isolation by half.

It's just not practical right now to say that testing is going to be an integral part of some sort of five-day policy. Carl, you said at the start of this conversation that Omicron is milder, and I want to talk about that because that is something I know that public health officials and people like you, colleagues of ours, have been reluctant to say firmly for many weeks, but you said it pretty firmly. So why are we now able to say that an Omicron infection is milder? And I wonder if that fits into the CDC's decision at all. Well, it's actually hard to describe what it is about Omicron. And we use the word milder as sort of a shorthand, but it's tricky because Omicron is killing people right now. It's just not killing as many people as Delta.

The clearest evidence of this is now emerging from the United Kingdom, where they came out with a pretty clear conclusion that the risk of hospitalization from Omicron is cut in half compared to other variants. That's meaningful. Yeah, absolutely. Absolutely. That is a big deal. And that's for all populations, Carl? That's whether you're vaccinated or unvaccinated, boosted, unboosted? Well, that's where things get more complicated. The fact is that if you are vaccinated, you are well protected against hospitalization.

And here again, the United Kingdom has come out with lots of good numbers. And they have just reported that if you have two doses of the Pfizer vaccine, your risk of hospitalization is reduced by 65%. And if you have a booster, your risk of hospitalization is reduced by 81%. Huh. So that's interesting. A baseline of hospitalization rates for Omicron is 50% less than Delta. And if you're vaccinated and boosted, it's really, really good. So that's why we can use the word mild. That's right. The problem is that vaccines and boosters are not as effective at just preventing you from getting infected.

So you're getting infections in people who are either unvaccinated or vaccinated. But what then happens next is that the unvaccinated people are at much, much higher risk of ending up in the hospital. And even now, when you look at the numbers, the vast majority of people who are filling up our hospitals now are unvaccinated. Well, let's somewhat optimistically focus on the idea that Omicron for those vaccinated, boosted, and even unvaccinated is generally less likely to cause severe illness and hospitalization. And Carl, what is the science of that?

I mean, kind of chemically, biologically, why is this less likely to put you in the hospital than Delta? This has been amazing. I mean, scientists have been working like crazy to try to figure out what Omicron is doing on a cellular level. And so they all basically spent their holidays not opening presents so much as, you know, injecting viruses into hamsters or into dishes full of cells to try to figure out

what is going on with Omicron. How is Omicron different? And the results are really just coming out just now. And Twitter is where you go to get those hot new results. Okay. And what are those hot new results? The fact is that Omicron really does work in a fundamentally different way than other variants in the sense that when you get infected, say with the Delta variant, you know, it goes into your nose first, it sort of sets up shop there, and then it starts multiplying and spreading down your airway. And if you're unfortunate, it'll get into your lungs and into the deep recesses of your lungs. It can cause lung scarring, it can cause difficulty breathing, it can leak out from the lungs to elsewhere, cause really serious disease and potential death.

Right. Those are the people who end up on respirators. Yeah. However, Omicron does a really lousy job, it seems, of multiplying in the lungs. So, you know, when scientists look at these animal models for COVID, Omicron just really isn't there in the lungs. The lungs are usually undamaged. And so it's a really striking difference from other variants. On the other hand, if you look at cells taken from the lining of the nostrils, you will find that Omicron is really good at infecting those. So what we may be looking at is something that is specializing more in the upper airway, where it's generally causing milder disease and is also in a good place to go and spread to the next person because it's right there in your nose and ready to go. So we're basically getting pummeled by a gentler version

of COVID than we've seen before, which is a pretty weird concept. It is a very weird concept, very counterintuitive. But you just have to bear in mind that here we have this variant that is already producing twice as many cases a day on some days than our past peak. So even if it's half as likely to send people into the hospital, if you've got twice as many, you're still putting as many people into the hospital. And so scientists are now working on models, trying to look forward. And they actually see the number of cases from Omicron

going up even higher. So maybe we're looking at 600, 700,000 cases every day. Wow. And when you're talking those numbers in a very short period of time, you're going to have a whole bunch of people showing up at the hospital at once. You know, I've been trying to think of a good metaphor for this because this is so counterintuitive. How could something that's milder be as dangerous or more dangerous than what we've already been through. Right. And I think about hurricanes. Imagine that a Category 5 hurricane hits your house one day.

It slams your house and it does a lot of damage and you lose power and you're recovering for days. And then somebody comes by and says, hey, did you see the weather forecast? There's another hurricane coming. And you say, oh, great. And they say, no, no, no, did you see the weather forecast? There's another hurricane coming. And you say, oh, great. And they say, no, no, no, it's okay, it's okay. It's just a Category 3 hurricane. And you think, well, I guess Category 3 is better than Category 5.

And then they say, oh, and by the way, there are actually going to be four of them. Ombrakan is that string of Category 3 hurricanes. Milder, but potentially just as bad or worse. Right. In that case, mild isn't necessarily all that much better. If 700,000 people a day are getting an infection. That's right. It could be worse just because of the sheer number of cases that we're seeing. We'll be right back. Carl, as Omicron sweeps across the United States and hospitalizations are creeping up,

it feels like one area that has stood out is the hospitalization of children. So talk to us about that. It's a very scary issue, I think, for many of us. So the Center for Disease Control said at the very end of December that 378 children were being admitted to hospitals on average every day. And that is a jump of 66% from the week before. So, you know, that is a serious thing. But, you know, we do also need to put this in some perspective. If you look at people over 70 right now, almost 3,200 people a day in that age group are going into the hospital. So compared to other age groups, this is a very small risk that children are facing overall. But still, when

you're looking at a new record for hospitalization of children because of this variant, that's something to sit up and take notice of. Well, if Omicron is generally milder, why are children going to the hospital in larger numbers? They are just not as vaccinated as older people. If you look at kids between 5 and 11, about a quarter of children have had at least one dose of the vaccine. They're not even allowed to have boosters yet. Children under 5 are not to have boosters yet. Children under five are not eligible for any vaccine yet. Now, there's no evidence that Omicron is making kids sicker than other variants.

It's just a big pool of unvaccinated hosts that it can get into. And so they are just bearing the brunt of this new variant. Carl, when this episode airs, And so they are just bearing the brunt of this new variant. Carl, when this episode airs, it will be the Monday after, for many people, a long holiday break, which means that a lot of kids are going to be returning to school. And given what you just established about their vulnerability to Omicron, especially young kids, how should parents and schools be thinking about returning kids to the classroom this morning? Well, one thing we've learned from this pandemic is that kids really suffer when you keep them out of school.

And we have to do everything we can to keep them in school as much as possible without creating a massive public health crisis. And we are in a very special condition right now. The kids are going to be coming back into school after a holiday break, where maybe a lot of them have spent time with lots of other people. And so they may be showing up with Omicron. What's going to be the situation with the teachers?

If a teacher wakes up with a scratchy throat, tests positive, they can't come into school. And so you could have schools this month where teachers and administrators are just MIA. You actually are seeing some schools already acknowledging the gravity of this situation and saying like, okay, well, we will maybe spend the first week or two of school this month virtually, and we'll see how things go. But there are lots of other things that can be used as well. Masking, testing, ventilation. There are lots of ways of preventing schools from becoming incubators for Omicron. But yeah, this coming month is going to be a real rollercoaster ride for parents, for kids, and for teachers.

Carl, is there a world in which the Omicron variant, because it is mild and because it moves so fast, ends up infecting lots of people, creating antibodies against COVID and ultimately protecting lots of people from getting COVID and perhaps a more severe version of COVID in the future. looking at tens of thousands or hundreds of thousands of people dying through this Omicron wave. But at the same time, it is fascinating from a sort of scientific perspective to see Omicron showing up in the United States, a country that is dominated by another variant, Delta, and Delta causes very severe disease. And they're fighting it out like some sort of cage match between viruses. And scientists have been doing studies on how well you're protected from one variant if you got infected by the other. So if you got infected with Delta, let's say, in the spring, you don't have a whole lot of protection against infection from Omicron. What's interesting,

though, is that when scientists do experiments in labs using the blood of people who've gotten Omicron, it seems like Omicron infections actually really protect quite well against Delta. So as more people get infected with Omicron, it's going to get harder for Delta to find new hosts. And we're actually seeing this play out right now. As Omicron cases are shooting up, Delta is actually going down. So Omicron is beating Delta in this cage match of variants. Yeah. Omicron seems to be winning. It seems kind of weird. The milder virus seems to be winning, but that's what's happening. And so, you know, would you rather have a country with a huge massive rates of Delta or Omicron? Well,

Omicron, of course, because you're going to have fewer people in the hospital. And also, as people recover, mostly from mild Omicron infections, they will have this immunity. And if you add that immunity on to, say say, vaccination, you're going to be really strongly protected. So the long-term possibility is that we are looking at COVID-19 eventually kind of really going down to substantially lower levels. And as we get more people vaccinated, maybe we update vaccines, that'll help this even more. Of course, there could always be a new variant. But if you look out over the long term, there is some comfort to be had. Hmm. Omicron's potential silver lining is pushing Delta out, creating antibodies that protect

against Delta, and potentially giving lots of people protection against future COVID and therefore ushering us a little bit closer to the end of the pandemic. That's a possible outcome. That's the optimist take, Carl. No, no, that is a very plausible take. It's just that let's just not forget the death and the suffering that's going to have to come along until we get there. Well, as we conclude this conversation, Carl, I'm curious when Omicron is expected to reach its peak here in the U.S. I know that peak doesn't mean over. It just means the U.S. I know that peak doesn't mean over, it just means the height of infection. But when do we think, given the unique and rapid properties of Omicron, that that is

likely to happen? It could happen pretty soon. When you look at what happened in South Africa, which is where Omicron had its first big surge, it shot up at a really astonishing pace in just a few weeks and suddenly started falling back down. And so scientists are doing their best with very complex computer models to try to forecast or at least offer a projection of what's going to happen. And some of those are finding that, you know, maybe as soon as January 9th, next week, we might reach a peak. Wow. I mean, that will be a very high peak. And there will be a lot of shock to the system to deal with.

But if it then falls as quickly as what happened in South Africa, then we could be looking at a much better situation by the end of the month, by February. Hopefully, we can take that opportunity to get more people vaccinated, to set up systems to get more people, medicines that can treat infection in the hospitals. We can be overall in a much better place soon. But, you know, again, we'll have to see. But, you know, again, we'll have to see.

Well, Carl, thank you, as always, for your time. We appreciate it. Thank you. One of the things that we hope for is that this thing will peak after a period of a few weeks and turn around. We've seen that happen in South Africa where they had a major surge. On Sunday, in an interview with ABC News, the Biden administration's top advisor on the pandemic, Dr. Anthony Fauci, said he was optimistic that Omicron infections would quickly peak. Meanwhile, Fauci acknowledged growing criticism of the CDC's decision to shorten the recommended period of isolation after an infection from 10 to 5 days without requiring a negative test, and said that adding such a testing requirement was now under consideration.

The CDC is very well aware that there has been some pushback about that. Looking at it again, there may be an option in that that testing could be a part of that. And I think we're going to be hearing more about that in the next day or so from the CDC. We'll be right back. Here's what else you need to know today. President Biden has declared a suburb near Boulder, Colorado, a federal disaster area after a fast-moving wildfire destroyed nearly 1,000 homes there late last week. At least three people are feared dead from the fire, which was fueled by hurricane force winds. Soon after the fire, a winter storm dumped nearly a foot of snow on the same community, complicating recovery efforts.

Today's episode was produced by Munch Zadie and Lindsay Garrison. It was edited by Lisa Chow, contains original music from Marian Lozano and Dan Powell and was engineered by Corey Schreppel. Our theme music is by Jim Brunberg and Ben Landsberg of Wonderly. That's it for The Daily. I'm Michael Bilbaro. See you tomorrow.