Before the Omicron variant took hold, travel was roaring back. The Delta wave of the virus delayed office re-openings but vaccines were holding well against infection, especially for those that were boosted. There was a broad sense that companies would return to the office – and to business travel – in the New Year.
However the fast-spreading Omicron has meant so much infection that behaviors are changing, and travel has fallen. TSA throughput numbers show it’s gone from within 10% of pre-pandemic levels on some days to much, much lower.
The view now is that we just need to get through Omicron. Indeed the industry is gearing up for a return to normal after the Omicron wave. There’s hope that more borders will re-open, more employees will return to office, and there’ll be a return to normal travel and then some given intertemporal substitution – that people refrained from travel for a long time, and will make up for it quickly.
Underlying this belief are several assumptions, which are very much the ‘base case’ but are far from assured.
- Omicron is spreading so quickly, enough people will have had it, that there’s such a big wall of immunity going forward that the virus spreads at much lower levels going forward.
- Plus we’re going to have variant-specific boosters that are more effective to prevent infection and symptomatic disease.
- And we’ll have treatments to keep people out of the hospital (Paxlovid) when they do get Covid.
In other words, once we “get through” Omicron “we’re done” and return to normal life, with the risk of Covid-19 just one of the many risks we deal with in daily life. That’s the optimism, but also seems entirely reasonable to believe, but it’s also far from certain. Here’s the story around which that does not happen.
- Omicron infection may not actually protect against Delta infection, so it doesn’t create the wall of immunity we’re hoping for – at least for those infected with Omicron who haven’t also been vaccinated.
Omicron infection enhances immunity against Delta for those who have been vaccinated, but hardly does so for people that are unvaccinated. So get vaccinated to reduce your chances to later catch a Delta infection! And prevent a resurgence of a 2nd Delta wave! https://t.co/dVhrKCYQRq
— Tom Wenseleers (@TWenseleers) January 17, 2022
"Omicron infection enhances preexisting immunity elicited by vaccines, but on its own may not induce broad, cross-neutralizing humoral immunity in unvaccinated individuals."https://t.co/WvMt69xN6e @GladstoneInst
Implications re: immunity wall built from Omicron infections alone pic.twitter.com/kmceu2lmWQ
— Eric Topol (@EricTopol) January 18, 2022
- Rather than the less virulent Omicron taking hold and becoming dominant, protection from Omicron due to so much prior infection means that Omicron recedes, and it’s the more dangerous Delta that is ultimately dominant. Or, since there’s not enough cross-immunity between the two, they effectively co-circulate and we’re faced with both going forward. Even if neither one can muster the infectiousness of past waves, the two together create enough background infection that the return to travel is slowed substantially.
- While it seems unlikely we’ll see more variants that spread faster than Omicron, or that evade the immune system in different ways than the variants we’ve seen (Omicron’s tricks aren’t entirely new, they just hadn’t been as fast-spreading in earlier incarnations) and those will continue to evade immunity from vaccination and from prior infection.
- We’re testing variant-specific boosters, but those boosters may not be as effective as hoped (we don’t know yet) or they may do well against the variant they’re targeted at but not as well across different strains as vaccines that have continued to target the ancestral Wuhan strain. Perhaps we’re able to roll out multivariant Covid vaccines (as we do with flu).
- Paxlovid has dangerous interactions with some drugs and isn’t indicated for everyone plus it’s only useful once someone already identifies infection to keep them out of the hospital, which requires a medical consult and testing and the sort of diligence that most people lack – so while it has the potential to allow us to ‘live with Covid’ human behavior may not adopt it well enough to do that.
For now the best that we have is boosters. A fourth dose doesn’t seem to return vaccines to the sterilizing effectiveness they had pre-Omicron but if you get boosted you’re probably highly protected against really bad things happening if you get it.
— Eric Topol (@EricTopol) January 18, 2022
Update: Switzerland now reports deaths by booster status.
Compared to unvaccinated people, the COVID mortality rate is:
• 9x lower after full vaccination
• 48x lower after a booster
— Edouard Mathieu (@redouad) January 17, 2022
Most frustrating for me is that my daughter isn’t 5 years old and can’t get vaccinated yet. Pfizer’s trial stalled because while its vaccine was safe (it’s just a 1/10th of an adult dose) it didn’t generate enough protectiveness in 2, 3 and 4 year olds and they’re testing a third dose. But Omicron seems less severe even in kids. There’s so much spread that there’s more hospitalization, but even those cases seem to be less serious, and indeed an unvaccinated child faces less risk than a vaccinated older American.
We’re going to get to the place where we can live with Covid-19. It seems more likely than not that the Omicron wave – which will infect perhaps 40% of the country in a matter of weeks – will be the virus’ last gasp of limiting travel. But it’s not a foregone conclusion. I’m optimistic but not nearly as optimistic as Delta CEO Ed Bastian was in his airline’s recent earnings call, nor as optimistic as I expect American and United to be in theirs this week.