Why Omicron is more likely to kill Americans
The new Omicron variant of the new coronavirus continues its march around the planet. It is now the dominant lineage in the United States, much of South America and Europe, and many Asian countries.
The new variant is mean. But some countries resisted Omicron without recording any significant increase in serious illness or death. Cases are skyrocketing. Serious cases no. Singapore and South Africa are good examples.
But other countries – the United States, for example – have not experienced the same high degree of “decoupling” between infections and deaths. Now epidemiologists are scrambling to figure out why. Differences in vaccination rates are an obvious explanation, but demographic factors also seem to play an important role.
“Countries that have younger average ages and generally healthier populations should do better in terms of hospitalizations and deaths,” said Irwin Redlener, founding director of the University’s National Disaster Preparedness Center. of Columbia, to the Daily Beast.
“The other big question,” he added, “is vaccination rates.” Highly vaxxed and younger countries mostly seem to ignore Omicron. But under-vaxxed countries, especially those with older populations, could have a tough few months as the new variant runs its course.
Omicron sounded the alarm to health agencies around the world in late November after South African officials reported the first cases. Compared to older lines, Omicron has around 50 key mutations, including around 30 on the spike protein that helps the virus latch onto our cells.
Some of the mutations are associated with a virus’s ability to evade antibodies and therefore reduce the effectiveness of COVID vaccines. Others are associated with higher transmissibility.
The genetic makeup of the lineage has resulted in a huge increase in infections in the unvaccinated as well as an increase in milder infections in the vaccinated. The World Health Organization reported a weekly record 15 million new COVID cases for the first week of January – a figure the WHO has warned is almost certainly an undercount due to incomplete data.
Many of these cases are mild or entirely asymptomatic. Virologists partly attribute Omicron’s relative mildness in many cases to its tendency to infect the throat rather than the lungs, where the pathogen can do much more damage.
But external factors also matter. Needless to say, countries that have vaccinated nearly their entire population fare better than countries where vaccination rates lag. Consider Singapore, one of the hottest countries in the world.
Singaporean authorities detected the first local case of Omicron in early December. A month later, the lineage accounts for most new infections in the Southeast Asian city-state, which has a population of 5.7 million.
Cases increased in Singapore after Omicron arrived. There were around 250 new infections per day in mid-December. Today, there are 800 a day and the escalation has tripled in just one month. But the death rate is stable. On average, one person a day died from COVID in Singapore in December. In January, the rate is still one death per day.
“We are still at the beginning of our Omicron epidemic,” Paul Ananth Tambyah, president of the Asia Pacific Society for Clinical Microbiology and Infection in Singapore, told The Daily Beast. “Still, there is no reason to believe that Singapore will not be like most other countries in the world, with a decoupling of cases and deaths.”
Experts have pointed to Singapore’s excellent vaccination coverage. About 90% of the population has been fully vaccinated, most with two doses of major messenger RNA vaccines. Half returned for a booster dose.
Yes, Omicron somewhat reduces the effectiveness of vaccines. But even with its ability to evade vaccine-induced antibodies, the lineage has come up against a wall of immunity in Singapore.
South Africa also managed to take on Omicron – and did so without widespread vaccination. Just over a quarter of South Africans are fully immunized with a one- or two-dose vaccine. Very few have been boosted.
Despite this, infections and deaths have decoupled, although not as dramatically as in Singapore. Between late November and late December, cases increased 40-fold, from 500 a day to more than 20,000. Deaths increased only eight-fold, from around 20 a day to around 170.
Many South Africans had natural immunity left over from the previous wave of infections over the summer. But these antibodies wear off quickly, so they alone cannot explain South Africa’s relative good fortune with Omicron.
Age is probably a factor. South Africa, which has 59 million inhabitants, is a young country. The median age is just 27, compared to a median age closer to 40 in Singapore. Young people tend to be less vulnerable to all variants of COVID than their parents and grandparents, and Omicron is no exception.
But there aren’t many countries that can rely on their very young populations to save them from the worst outcomes as Omicron circles the globe. The United States, whose median age is 39, certainly cannot. The United States falls into the unfortunate category of older countries with average vaccination rates.
This puts Americans at particular risk. “The concern is that once the spread occurs among older segments [of the population], hospitalizations and deaths could increase,” Edwin Michael, an epidemiologist at the Center for Global Health Infectious Disease Research at the University of South Florida, told The Daily Beast.
Only 63% of Americans are fully vaccinated, 37% are vaccinated. That leaves 122 million people with, at best, natural immunity to COVID. It’s no surprise that Omicron is tearing this large, mostly unprotected group apart.
The United States has recorded 760,000 new cases of COVID per day in recent days, a fivefold increase from the worst days of the Delta wave in the fall and triple the previous record of 230,000 new cases per day it a year ago.
There has been some decoupling in the United States, but nowhere near as significant as in Singapore and South Africa. About 1,700 Americans die each day, slightly fewer than died each day at the height of the Delta wave in the fall.
America is not alone. Brazil, a median age of 34, has fully vaccinated about two-thirds of its 212 million people and increased by 15%, making it roughly analogous to the United States in this respect.
Unsurprisingly, Omicron hits hard there. Cases have increased 10-fold this month to a record 44,000 a day. The death rate is rising rapidly, from a low of less than 50 a day in early January to 600 in a single day on January 9.
Experts warn that the figures from Brazil are likely underestimated. Under President Jair Bolsonaro, who denies COVID, the Brazilian Ministry of Health no longer reliably reports COVID data. “The Ministry of Health doesn’t want people to know the truth,” Pedro Hallal, an epidemiologist at the Federal University of Pelotas in Brazil, told The Daily Beast.
Inconsistent data forces epidemiologists to supplement official COVID numbers with educated guesses. Hallal for his part has seen the impact of Omicron firsthand. Only a few members of his immediate family caught Delta. More than a dozen caught Omicron. “It explodes,” he said of the new variant.
As uneven as Omicron’s impacts were on the planet, experts agreed it could have been worse. Imagine a line that has the vaccine evasion and extreme transmissibility of Omicron and also attacks the lungs like Delta does. “We can say we dodged a bullet,” Stephanie James, head of a COVID testing lab at Regis University in Colorado, told The Daily Beast.
The world is lucky that almost everywhere there has been a decoupling between Omicron cases and deaths. To a large extent, it is the people who decide the extent of this decoupling. You cannot choose the median age of your country, but you can choose to be vaccinated.
The more people vaccinated, the greater the gap between case rates and death rates. Vaccinate nearly everyone in your city, state, region, or country, and there’s a good chance you’ll ride out the Omicron wave with very few serious consequences.